Recent research published in the Canadian Medical Association Journal (CMAJ) reveals alarming trends in hypertensive disorders of pregnancy (HDP) across Canada. While some related health conditions have shown improvement, the incidence of HDP has significantly increased, attributed in part to rising rates of obesity among women of reproductive age.
HDP encompasses chronic hypertension, gestational hypertension, and more severe conditions like preeclampsia or eclampsia, affecting between 5% to 10% of pregnancies globally. The study, analyzing over 2.8 million hospital births in Canada (excluding Quebec) from 2012 to 2021, identified concerning trends: the overall rate of HDP rose from 6.1% to 8.5%, marking a relative increase of 40%. Specifically, pre-existing hypertension increased from 0.6% to 0.9%, gestational hypertension from 3.9% to 5.1%, and preeclampsia from 1.2% to 2.6%.
Notably, the study highlighted disparities across different demographics and regions. Rates of HDP were notably higher among women under 20 years old and those over 34 years old. Provincial variations were also evident, with the lowest rates in Northwest Territories (6.5%) and Ontario (6.9%), and the highest in Newfoundland and Labrador (10.7%).
The authors adjusted for various risk factors but emphasized that the surge in HDP may largely stem from factors like increased body mass index (BMI), a well-established risk factor for hypertension, especially during pregnancy. Over the study period, rates of overweight or obese BMI status among women aged 18-34 years rose from 41% to 48%, and from 56% to 64% among those aged 35-49 years.
The findings suggest a need for enhanced clinical management strategies for HDP, including consistent blood pressure monitoring during prenatal visits and evidence-based antihypertensive therapies. Dr. Susie Dzakpasu from the Public Health Agency of Canada underscored the necessity for addressing BMI-related risks in maternal health.
In response to these trends, Dr. Catherine Varner, in an accompanying editorial, stressed the urgent need for health policy-makers to prioritize accessible, specialized obstetrical care for high-risk patients. She highlighted the growing demand for obstetrical care providers equipped to handle complex cases, given the escalating number of women entering pregnancy with multiple comorbidities, including obesity-related risks.
The editorial concludes by advocating for scalable, team-based maternity care models to ensure timely and comprehensive care delivery, addressing the evolving healthcare needs of Canada’s reproductive population.
The study and editorial collectively call for proactive measures in obstetrical care to mitigate the impact of rising obesity rates on pregnancy outcomes, urging a collaborative approach among healthcare providers and policymakers to improve maternal health across the country.
