New Intermountain Health Model Helps Pregnant and Postpartum Women with Hypertension

A new, innovative clinical care process model is being used by Intermountain Health caregivers for women at risk for complications of hypertension during and after pregnancy. The new model brings together providers in women’s health and primary care with pharmacists and experts in cardiovascular medicine and nephrology (kidney care) to proactively identify, manage, and monitor patients.

The Pregnancy and Hypertension Care Process Model aims to help patients modify their risk factors for hypertension and reduce its occurrence and progression to more serious hypertensive disorders of pregnancy including preeclampsia (toxemia), and eclampsia, and reduce their risk for serious heart conditions, such as heart attacks, strokes, and heart failure later in life.

“With this team-based approach of practicing care, we’re connecting the gap between caring for patients during and after pregnancy by guiding and ensuring continuity of care after delivery,” said Dr. Donna Dizon-Townson, a maternal-fetal medicine physician leading this work at Intermountain Health in Provo, Utah.

In the U.S., up to 4 in 10 women will have long-term high blood pressure after giving birth. Hypertension, or high blood pressure, is often called a silent killer because people usually do not have any symptoms until damage to organs has occurred.

Hypertensive disorders of pregnancy affect up to 20 percent of all pregnancies. Hypertension is also a disease marker for other potential health complications.

Hypertension during pregnancy and the related more serious disorders it can progress to if untreated, such as preeclampsia (toxemia) and eclampsia, are leading drivers of serious maternal health conditions, post-partum readmissions to the hospital, and long-term cardiovascular risk in women. Those cardiovascular risks can lead to serious conditions like heart attacks, strokes, and heart failure.

“Pregnant patients are often quite motivated to seek care and stay healthy during pregnancy to help their baby’s development. For many reasons after delivery, some patients are at risk of not receiving follow-up care. Optimal management of blood pressure after pregnancy is just as important as well-controlled blood pressure during pregnancy,” Dr. Dizon-Townson added.

Management of blood pressure during pregnancy can minimize the risk for adverse pregnancy outcomes including preterm birth, and optimal management of blood pressure after pregnancy can minimize maternal cardiovascular risks including heart attacks, heart failure, stroke, and even death.

Intermountain’s new and unique Pregnancy and Hypertension Care Process Model emphasizes whole-person continuous care. It gives women’s health and primary care providers and their prenatal and postpartum patients the tools and education they need to proactively manage hypertension conditions, including coordinating patient care and knowing when to refer to other medical specialists in cardiology and nephrology.

Cardiologists are specially trained to care for heart conditions. Having preeclampsia or eclampsia can also affect kidney health, which may require care from a nephrologist.

“Collaborating with so many providers across Intermountain with one specific goal in mind created an opportunity for us to have a real impact on women’s health,” said Kirstin Hesterberg, DO, an Intermountain Health physician in Denver who specializes in women’s cardiovascular disease and pregnancy and is closely involved in this work. “We’re excited to track this new care pathway and see the positive outcomes.”

“We hope that patients with hypertension during and after pregnancy are identified and get appropriate care, follow-up, and referrals, and receive specific education about their condition,” said Kismet Rasmusson, NP, cardiology program development director at Intermountain Health in Salt Lake City and an advance practice provider in heart failure and transplant.

“Ultimately, if we treat cardiovascular risks prior to pregnancy, we hope to see fewer cases of hypertensive conditions during pregnancy,” she added.

The goal of Intermountain’s Pregnancy and Hypertension Care Process Model is to reduce the occurrence and progression of hypertensive disorders of pregnancy. Key components include:

• Evidence-based pathways for the screening and management of chronic and gestational hypertension
• Guidance on postpartum follow-up and transition to primary care, cardiology, and/or nephrology
• Integrated strategies to educate and help patients modify their hypertension risk factors, live a healthy lifestyle, and if needed, use appropriate medication safely during pregnancy and breastfeeding
• Tools to facilitate collaborative care across multiple medical specialties and to screen for cardiovascular disease and related kidney conditions.

“In the past, there’s been a perception that if you have preeclampsia and deliver your baby, you’re cured. But in reality, the diagnosis of gestational hypertension or preeclampsia serves as a disease marker for other cardiovascular complications that can occur after delivery. Maintaining your blood pressure not only during pregnancy, but also after and in between pregnancies is important for women,” said Dr. Dizon-Townson.

The new care model is standardizing follow-up with postpartum patients with hypertension disorders before they leave the hospital following childbirth and outside of the hospital. Their blood pressure is checked within 72 hours after birth through remote monitoring, and again 7-10 days after they are discharged from the hospital to help identify early issues.

It will also be monitored again at their postpartum clinic visit, which is recommended at 4-6 weeks postpartum. Long-term follow-up visits for patients with hypertension are recommended at various intervals after that until one year postpartum to help identify and address cardiovascular risks such as diabetes, obesity, and high cholesterol.

Dr. Dizon-Townson also emphasized the importance of pre-pregnancy and prenatal visits so patients can have their blood pressure monitored and know if they need to make any lifestyle or medication changes before or during pregnancy.

“Research shows that after childbirth and during the postpartum period we need to continue blood pressure surveillance. Many insurance companies are now covering remote blood pressure monitoring equipment that can be used at home,” said Dr. Dizon-Townson.

“As we were creating our care process model, the American College of Cardiology published a Postpartum Hypertension Clinic Development Toolkit. We used this as a resource for best patient practice for follow up and management of women who had a pregnancy complicated by a hypertensive condition. When we took our care process model and compared it with their toolkit, we found a lot of similarities and overlap between the two publications. This was exciting and served as a validation of our care process model,” she added.

According to Dr. Dizon-Townson, it’s important for moms to have their blood pressure tracked and checked frequently during and after pregnancy to avoid serious health problems. Urine tests also help monitor for protein in the urine which can be associated with high blood pressure.

“We can teach patients how to safely monitor their blood pressure at home, and we can remotely monitor it. This results in fewer postpartum hospital visits, hospital readmissions and better adherence to blood pressure medications,” said Dr. Dizon-Townson.

About Intermountain Health

Headquartered in Utah with locations in six states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 33 hospitals, over 400 clinics, medical groups with some 4,600 employed physicians and advanced care providers, a health plans division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs. For up-to-date information and announcements, please see the Intermountain Health newsroom at https://news.intermountainhealth.org/.