Determining Risk Factors to Decrease Maternal Mortality Related to Chronic Hypertension: An Integrative Literature Review

Background: Maternal mortality ratio (MMR) in the United States 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. Chronic hypertension is defined as blood pressure greater than or equal to 140/90 mmHg before pregnancy or during the first 20 weeks of gestation. This condition occurs in up to 5% of pregnancies which are more likely to result in adverse maternal outcomes. Nearly 40% of maternal deaths are preventable, especially those related to chronic diseases. Objectives: The purpose of the integrative literature review was to identify risk factors that precede chronic hypertension in women of childbearing years, and to identify nursing roles related to patient education for this condition. Methods: An integrative literature review was conducted undergoing an extensive search to identify risk factors of chronic hypertension in women of childbearing years and nursing roles. A total of three databases were used to acquire relevant sources: MEDLINE (PubMed), Cumulative Index to Nursing and Health Literature (CINAHL) Complete, and Health Source: Nursing/Academic Edition. Results: Age, race and ethnicity, pre-pregnancy weight and body mass index (BMI), smoking, anxiety and depression, obstructive sleep apnea (OSA), education level, occupation and insurance, and geographical location are risk factors for the development of chronic hypertension in women of childbearing years. Advanced Practice Nurses (APNs) can identify those at risk for chronic hypertension and provide targeted patient teaching, involving both physical and mental health. Conclusion: This review found at least nine risk factors related to chronic hypertension in women of childbearing age. However, there is a need for effective patient education, screening tools, and national legislation and action. Key words: chronic hypertension, risk factors, and maternal mortality