Helping Doctors Communicate with Patients About Preeclampsia

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Rates of preeclampsia are rising in the United States. Preeclampsia, a condition that some women develop during pregnancy, can cause serious complications for women and their babies — and may even be deadly. Women with preeclampsia develop high blood pressure after 20 weeks of pregnancy. Rarely, preeclampsia can lead to eclampsia, a more serious condition that can cause seizures and coma in women with preeclampsia.

Though preeclampsia is one of the most preventable causes of maternal deaths, little national population-based data has been released on the condition in recent years. To address this gap, the Healthcare Cost and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality (AHRQ), has published a new statistical brief. Delivery Hospitalizations Involving Preeclampsia and Eclampsia, 2005-2014 presents data and analyzes recent preeclampsia trends.

Rising Numbers, High Costs

In 2014, 5 percent of all inpatient deliveries involved preeclampsia or eclampsia — that’s a 21 percent increase in preeclampsia or eclampsia since 2005. “We don’t know for sure why it’s on the rise,” says Dr. Iris Mabry-Hernandez, one of the brief’s co-authors. “One reason could be rising rates of obesity and other conditions that we believe increase the risk of preeclampsia.”

Dr. Iris Mabry-Hernandez, co-author of Delivery Hospitalizations Involving Preeclampsia and Eclampsia, 2005-2014

The brief clearly illustrates the significant burden of rising rates of preeclampsia. And that burden extends beyond increasing maternal mortality rates. “Women with preeclampsia have longer hospital stays after delivery, and are more likely to have procedures like C-sections and blood transfusions,” Mabry-Hernandez explains. “Preeclampsia is also a leading cause of preterm delivery.”

Disparities in Preeclampsia Rates

Mabry-Hernandez emphasizes that there are clear disparities in preeclampsia rates. Black women, women in the youngest and oldest age groups at delivery, and women from the poorest areas of the South are all more likely than other populations to develop preeclampsia. Women in some of these groups may also be more likely to have risk factors for preeclampsia — like diabetes, hypertension, and obesity, explains Mabry-Hernandez.

“The preeclampsia rate is 60 percent higher in black women than in white women,” she says. “And black women are more likely to develop severe preeclampsia, possibly due to lack of access to health care. Black women may also have higher rates of chronic diseases that we believe are risk factors for preeclampsia.”

Improving Patient Understanding

Mabry-Hernandez believes part of the issue is that patients may not be getting enough information to recognize or effectively manage preeclampsia. “Health literacy is an important piece of the puzzle,” Mabry-Hernandez says. “Providers need to help women learn how to recognize symptoms of preeclampsia. Patients must clearly understand when to come back for care if they’re experiencing problems.”

Effective patient-provider communication is especially important because patients may confuse symptoms of preeclampsia with normal symptoms of pregnancy, Mabry-Hernandez explains. And delayed care for preeclampsia could contribute to more deaths in both mothers and their babies.

Dr. Quyen Ngo-Metzger, co-author of Delivery Hospitalizations Involving Preeclampsia and Eclampsia, 2005-2014

Dr. Quyen Ngo-Metzger, another co-author of the brief, adds: “Health care providers need to talk to patients about ways to lower their risk, like monitoring weight gain during pregnancy.” And there are resources providers can share with their patients to help them learn more — Ngo-Metzger points to a plain language FAQ from the American College of Obstetricians and Gynecologists (ACOG) as an example.

Finally, Ngo-Metzger stresses that providers can take steps to encourage women who may have limited access to care to be on the lookout for — or to better monitor — preeclampsia. “We know that high blood pressure is often the first sign,” she says, “so providers can help patients monitor their blood pressure during pregnancy.”

First Line of Defense

In spite of strategies that health care providers can use to empower women to recognize and manage preeclampsia, Mabry-Hernandez is careful to emphasize that professional diagnosis is still the most critical part of this conversation.

“Above all, providers need to be thinking about preeclampsia,” she says. “The presentation of the condition isn’t always clear. And it’s not something you want to miss.”

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