1. Determining Risk Factors to Decrease Maternal Mortality Related to Chronic Hypertension
Chelsea Stellmach, MS with Alison DiValerio, MS, RN
DePaul University, Chicago, IL 60604
BACKGROUND
RESULTS
CONCLUSIONS
Maternal mortality ratio (MMR) in the U.S. in 2015 was 26.4, higher than many other developed countries.
Maternal deaths due to hypertensive disorders of pregnancy are on the rise, including chronic hypertension (CH).
CH is blood pressure greater than or equal to 140/90 mmHg before pregnancy or during the first 20 weeks of gestation.
CH occurs in up to 5% of pregnancies which are more likely to result in adverse maternal outcomes.
40% of maternal deaths are preventable, especially those related to chronic diseases.
The demographics of women are changing in the U.S.
Older women are more likely to have chronic illnesses and comorbidities due to lifestyle habits and obesity.
Unhealthy diet, physical inactivity, and overall lifestyle should be addressed by APNs.
Deficiencies in patient education, inadequate screening tools, and a lack of national legislation and action have major impacts on women’s health.
NURSING ROLES AND EDUCATION
Women with CH account for 26.2% of healthcare problems during pregnancy, which require more case-management by Advance Practice Nurses (APNs).
Many women with CH do not attribute their pregnancy complications to their hypertension.
Women with CH have little knowledge about how to manage their chronic condition before pregnancy, especially in regards to antihypertensive medication.
APNs can encourage behavior change, recommend interventions such as exercise, dietary advice, and prescribe medications.
Programs need to focus on improving mental health to be successful for women with anxiety or depression.
RISK FACTORS OF CHRONIC HYPERTENSION
Age
Race & ethnicity
Pre-pregnancy weight & BMI
Smoking
Anxiety & depression
Obstructive sleep apnea (OSA)
Education level
Occupation & insurance
Geographical location
DIRECTION FOR FUTURE RESEARCH
Future research may focus on racial and ethnic inequalities in healthcare for women and the impact of culturally competent care by APNs.
Studies may also want to focus on the impact of health insurance on access to care for preconception and interconception health.
PURPOSE
Evaluate gaps in knowledge of risk factors that precede CH in women of childbearing years.
Information will provide nursing actions to educate, empower, and support women at risk of developing CH to change health behaviors and prevent maternal mortality.
RESEARCH QUESTIONS
What are the current risk factors involved in the development of CH in females of childbearing age?
What are the possible nursing roles in detection and education of women at risk for developing CH to promote optimal preconception health and prevent adverse maternal outcomes and mortality?
NURSING IMPLICATIONS
MATERIALS AND METHODS
APNs’ specialty knowledge, advanced assessment skills, and targeted patient teaching are significant characteristics to reduce maternal morbidity, mortality, and healthcare costs.
Case management of high-risk pregnancies, especially those involving CH, can make regimens less difficult and can help identify women that may benefit from targeted surveillance prior to, during, and after pregnancy.
On a national level, nurses can be patient advocates by supporting organizations that will provide incentives to cover preventive care for women of all ages, in order to obtain better pre-pregnancy and interpregnancy care.
Databases searched include: MEDLINE (PubMed), Cumulative Index to Nursing and Health Literature (CINAHL) Complete, and Health Source: Nursing/Academic Edition.
Search terms include: chronic hypertension, risk factors, maternal mortality.
The conceptual framework used to demonstrate the possible lack of attention to the subject is best described through Tannahill’s model of health promotion.