Home monitoring helps moms track blood pressure after birth, reducing risks
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A few days after her baby was born, Emily Elsner got a very bad headache.
Then her vision became blurry, and her legs were swollen. An after-hours nurse told her to seek emergency care immediately.
Four days after giving birth, Elsner was diagnosed with gestational hypertension, a form of high blood pressure that happens during pregnancy or postpartum.
High blood pressure disorders affect one in seven patients during pregnancy or after delivery, leading to an increased risk of dangerous complications that can include stroke, heart failure and seizures. They are also the leading cause of maternal mortality in industrialized countries, and their prevalence is increasing.
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When Elsner, 30, went into labor, her blood pressure readings were consistently high.
After a safe delivery, Elsner’s numbers returned to a more normal range. But before going home to St. Paul, she was told by her health care team to watch for headaches that did not go away with pain medication, changes in vision, cramping and swollen feet and legs, all signs of a troubling blood pressure level.
Following her emergency room visit, doctors gave Elsner medication to control her blood pressure, a home monitoring kit, and a plan to check her blood pressure twice a day. She was told to upload her results into a phone app that sends them to her healthcare team.
It is all part of a pilot program.
M Health Fairview launched the Home Observation of Postpartum Elevated Blood Pressure, or HOPE-BP program at the University of Minnesota Medical Center last year. New mothers diagnosed with high blood pressure disorders in pregnancy receive equipment to monitor and report their blood pressure from home for six weeks after delivery.
Dr. Bethany Sabol, maternal-fetal medicine physician at M Health Fairview, started the HOPE-BP program. She cares for individuals with high-risk pregnancies and manages hypertension and hypertensive disorders of pregnancy, an umbrella term that includes any blood pressure disorder-related issue in pregnancy, some of which can be life-threatening.
Her nursing team reviews the uploaded blood pressure results many times an hour, notifying patients immediately if the numbers concern them. Sometimes a medication adjustment is all that is needed to resolve the situation.
The six-week program has served about 460 individuals so far, with around 50 participating at any given time. It is only available for patients who deliver a baby at the University of Minnesota Medical Center and who have either chronic hypertension or high blood pressure disorder while pregnant or during postpartum.
The postpartum period is a high-risk time for patients with hypertensive disorders of pregnancy because they do not have as many interactions with their care providers. It is also the leading cause of readmission following delivery, and severe cases are associated with life-threatening complications.
Sabol said when people are pregnant the amount of blood volume in their bodies is substantially higher. Some of that volume shifts between cells or to places where fluid does not normally accumulate, making swelling a common symptom.
“In those first few days after delivery, the fluid gets remobilized and put back into the vascular system, which is normal if you look at blood pressure trends after delivery,” Sabol said. “That tips people into those more severe blood pressure ranges. Most patients are not seen in the clinic until three to five days after delivery and sometimes blood pressure becomes a problem before that visit can occur.”
It can also be challenging for postpartum people to come into the clinic for a blood pressure check, Sabol said. She added that not having to find child care or a ride to the clinic to get evaluated is one of the biggest ways HOPE-BP is improving access and reducing preventable readmissions while also identifying people who do need to come in.
Higher risk of hypertensive disorders for women of color
About one in five people who have a high blood pressure disorder of pregnancy will develop chronic hypertension, according to the Centers for Disease Control and Prevention.
Sabol said data suggests this can have ongoing implications and increases the risk for cardiovascular disease, stroke and heart failure later in life.
The HOPE-BP program is currently only offered in English. Sabol said her clinic sees a large Somali population whose primary language is not English, meaning they cannot be enrolled in the program. They are working on either translating HOPE-BP into multiple languages or offering a similar program in different languages to address this need and eliminate enrollment rate gaps between different races and ethnicities.
Significant racial disparities exist in postpartum complication and readmission rates. A 2021 study shows that Black women have the greatest risk of developing preeclampsia, a dangerously high blood pressure condition that can happen after the 20th week of pregnancy or after giving birth. But among women with preeclampsia, Asian/Pacific Islander women may be at the greatest risk of cardiovascular complications. Once women develop preeclampsia, regardless of race or ethnicity, the risk of cardiovascular complications is high.
Black women with cardiovascular risk factors are also more likely to be readmitted postpartum, to have severe morbidity and to have life-threatening complications, compared with white women.
Sabol said systemic racism plays a role in these health disparities and sometimes practitioners do not listen well to women of color.
“There’s no difference in the disorder itself,” Sabol said. “It is how we are approaching our diagnosis, treatment, and care and we need to do better.”
Women of color across all income and education levels experience higher levels of chronic stress during pregnancy, according to Dr. Courtney Jordan Baechler, a preventive cardiologist at Park Nicollet Heart and Vascular Center and serves on the state’s Maternal Mortality Review Committee.
“This results in greater rates of hypertensive disorders, preterm birth, low birth weight and perinatal mortality among Black women,” Jordan Baechler said.
Since 1999, Minnesota has had the lowest overall heart disease death rate in the country but results vary across race and ethnicity.
“Cardiovascular disease is the leading preventable cause of death for women during pregnancy in the postpartum period. So, lots and lots of work to be done there,” Jordan Baechler said.
Emily Elsner recently graduated from the HOPE-BP program and no longer takes her blood pressure every day. She feels great but is slightly anxious knowing there could be long-term health impacts after being diagnosed with gestational hypertension.
“It just felt surreal in the moment where you are adjusting to your new life and the thing you get scared of the most — something could be wrong with me or the baby — does happen,” Elsner said. “It is a relief to know that my body is regulating blood pressure on its own now.”