Hypertension in Pregnancy Change Package

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What Is the Hypertension in Pregnancy Change Package (HPCP)?

The HPCP was developed in partnership with the American Academy of Family Physicians (AAFP), American College of Nurse-Midwives (ACNM), American College of Obstetricians and Gynecologists (ACOG), American College of Osteopathic Obstetricians and Gynecologists (ACOOG), American Medical Association (AMA), National Association of Nurse Practitioners in Women’s Health (NPWH), and the Society for Maternal-Fetal Medicine (SMFM). It presents an evidence-informed listing of process improvements with accompanying tools and resources that outpatient clinicians and care team members can implement as they provide care to pregnant and postpartum women and women of reproductive age with a focus on early identification, optimal management, and prevention of complications of hypertension in pregnancy.

The HPCP is composed of change concepts, change ideas, and evidence- or practice-based tools and resources.

• Change concepts are general notions that are useful in the development of more specific ideas for changes that lead to improvement.
• Change ideas are specific, actionable ideas for changing a process. Change ideas can be rapidly tested on a small scale to determine whether they result in improvements in the local environment.
• Evidence- or practice-informed tools and resources listed with each change idea can be adapted or adopted in a clinical setting to improve identification and management of hypertension in pregnancy.

Join the Million Hearts® Action Forum

The Million Hearts® Hypertension in Pregnancy Action Forum provides an opportunity for clinical, public health, and community-based partners to exchange best and promising practices, identify solutions to common obstacles, and share resources related to improving hypertension management during and after pregnancy.

The purpose of the HPCP is to help outpatient clinicians put more efficient and effective systems in place to care for women with hypertension in pregnancy. It is meant to serve as a menu of options from which practices can select specific interventions to improve diagnosis and management of hypertension in pregnancy.

The HPCP is broken down into four focus areas:

How Should We Use the HPCP?

Start by bringing together a team of clinicians, administrators, and other interested parties to discuss the aspects of hypertension in pregnancy that are most in need of improvement. The team can then select corresponding interventions from the HPCP that best address those issues.

Each strategy you choose should first be tested on a small scale (i.e., conduct “small tests of change”) to assess feasibility and allow the team to evaluate and adjust before instituting the change on a broader, more permanent scale.

We do not recommend that any practice attempt to implement all of the interventions at once, nor is it likely that all interventions will be applicable to your clinical setting.

Learn More

Acknowledgments and ContributorsAuthors

The Million Hearts® Hypertension in Pregnancy Change Package was originally conceptualized and authored by Angela Ryan Lee, MD, FACC; Lisa Hollier, MD, MPH, FACOG1; Taylor E. Streeter, MPH (ASRT, Inc.)2; Rebecca Poni Lado (ORISE)2; Ashley N. Battarbee, MD, MSCR3; Christian A. Chisholm, MD4; Elizabeth A. Clark, MD, MPH1; Jacqueline Wallace, MD, MPH1; Scott Hartman, MD5; Michael Rakotz, MD, FAHA, FAAFP6; Nora Drummond, CNM, CNP7; Susan Kendig, JD, WHNP-BC, FAANP8; Shania J. Seibles, DO, JD, FACOOG9; Hilary K. Wall, MPH2

Contributors

The following individuals reviewed tools and resources: Neha Sachdev, MD5; Klodiana Myftari, PharmD5, BCACP; Susanna Lovik, RN5

Reviewers

We are grateful to the following individuals who provided external review and feedback on the document:

Kristi Anderson, MD, MPH (Healthcare Resources and Services Administration [HRSA]); Natalie Bello, MD, MPH, FACC (Cedars-Sinai Health System; American College of Cardiology); Rachel M Bond MD, FACC (Creighton University School of Medicine, Association of Black Cardiologists); Andre Chappel, PhD (HHS Assistant Secretary for Planning and Evaluation); Malamo Countouris, MD (University of Pittsburgh Medical Center; American College of Cardiology); Stacey Dawson, PhD, MSN, CNM (Indian Health Services); Jane Ellis, MD, PhD (Emory University School of Medicine); Carrie Hanlon, MPP (Centers for Medicare and Medicaid Services [CMS]); Heather M. Johnson, MD, MS, MMM, FAHA, FACC, FASPC (Boca Raton Regional Hospital/Baptist Health So FL, Association of Black Cardiologists); Emily J. Jones, PhD, RNC-OB, FAAN, FAHA, FPCNA (University of Oklahoma Health Sciences Center, Preventive Cardiology Nurses Association); Jessica Lee, MD, MSHP, MHS (CMS); Sarah Leetham (CMS); Debra McGrath, MSN, FNP (National Association of Community Health Centers [NACHC]); Wanda Montalvo, PhD, RN, FAAN (NACHC); Mabatemije Otubu, RN, MPH (HRSA); Tina Pattara-Lau, MD, FACOG (Indian Health Services); Eleni Tsigas (Preeclampsia Foundation); and Kristen Zycherman RN, BSN (CMS).

The following individuals from CDC provided review and feedback on the document:

Wanda Barfield, MD, MPH, FAAP; Fátima Coronado, MD, MPH; Shanna Cox, MSPH; Cynthia Ferré, PhD; Sarah L. Foster, MPH; Judy Hannan, RN, MPH; Tom Keane, JD, MPA; Charlan Kroelinger, PhD; Laurence S. Sperling, MD, FACC, FAHA, FACP, FASPC; Charlene A. Wong, MD, MSHP; and Janet S. Wright, MD, MACC, FPCNA.

Web Hosting Assistance

Website hosting support of tools and resources was provided by the Society for Maternal-Fetal Medicine.

Graphic Design and Editorial Assistance

Graphic and HTML design support was provided by Marilyn Werner, MPH, CHES2, Booker Daniels, MPH2; Susan Davis (Peraton)*; and Palladian Partners, Inc.

We would like to extend special thanks to the following organizations for developing the tools and resources that are showcased in the change package. Health care settings are in bold.

• Agency for Healthcare Research and Quality (AHRQ)
• Alliance for Innovation on Maternal Health (AIM)
• American Academy of Family Physicians (AAFP)
• American College of Cardiology (ACC)
• American College of Obstetricians and Gynecologists (ACOG)
• American College of Obstetricians and Gynecologists (ACOG) District II
• American College of Obstetricians and Gynecologists (ACOG) District XII
• American College of Preventive Medicine
• American Heart Association (AHA)
• American Medical Association (AMA)
• American Medical Group Foundation (AMGF)
• American Pregnancy Association (APA)
• Assistant Secretary for Planning and Evaluation (ASPE)
• Association of Black Cardiologists (ABC)
• Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
• Baptist Health College Little Rock
• Brigham and Women’s Hospital
• California Healthcare Foundation
• California Maternal Quality Care Collaborative (CMQCC)
• CardioSmart
• Center for Community Health Alignment
• Centers for Medicare & Medicaid Services (CMS)
• Cheshire Medical Center/Dartmouth-Hitchcock
• Community Preventive Services Task Force
• Consumer Reports
• Council on Patient Safety in Women’s Health Care
• Duke University School of Medicine
• Findhelp.org (formerly known as Aunt Bertha)
• Florida Perinatal Quality Collaborative (FPQC)
• Florida State University (FSU) Center for Prevention and Early Intervention Policy
• Fort Health Care
• Georgia Perinatal Quality Collaborative (GaPQC)
• Health Resources and Services Administration (HRSA)
• HealthyHearts NYC
• HIPxCHANGE
• Illinois Perinatal Quality Collaborative (ILPQC)
• Indiana Perinatal Quality Improvement Collaborative (IPQIC)
• Institute for Healthcare Improvement (IHI)
• Intermountain Healthcare
• Jupiter Medical Center
• Kaiser Family Foundation (KFF)
• Kaiser Permanente
• Maine Center for Disease Control and Prevention
• March of Dimes
• Marshfield Clinic Health System
• Mass General Brigham
• Minnesota Board of Nursing
• Minnesota Department of Health
• Minnesota Perinatal Quality Collaborative (MNPQC)
• Montana Cardiovascular Health Program
• The MotHERS Program
• MotherToBaby®
• National Alliance of State Pharmacy Associations
• National Association of Chronic Disease Directors (NACDD)
• National Association of Community Health Centers (NACHC)
• National Healthy Start Association
• National Heart, Lung, and Blood Institute (NHLBI)
• National Institute of Child Health and Human Development (NICHD)
• New York City Department of Health and Mental Hygiene (NYC DOHMH)
• North and South Dakota Perinatal Quality Collaborative (NSDPQC)
• Northern Health
• Office of the National Coordinator for Health Information (ONC)
• Oklahoma Perinatal Quality Improvement Collaborative (OPQIC)
• Open Door Family Medical Centers
• Oregon Primary Care Association (OPCA)
• Penn Medicine Department of OBGYN’s Heart Safe Motherhood Program
• Plymouth Family Physicians
• Preeclampsia Foundation
• Primary Maternity Care
• Project Implicit
• Public Health Informatics Institute
• Reproductive Health National Training Center (RHNTC)
• Script Your Future
• Sinai Urban Health Institute, Sinai Health System
• Society for Maternal–Fetal Medicine (SMFM)
• STRIDE BP
• Target: BP
• The Joint Commission
• United States Department of Agriculture (USDA)
• United States Preventive Services Task Force (USPSTF)
• University of California, San Francisco (UCSF)
• University of Chicago Medicine
• University of Connecticut (UConn) Health
• University of North Carolina (UNC) Collaborative for Maternal and Infant Health
• University of Texas Medical Branch
• Wake Forest Baptist Health (formerly Cornerstone Health Care)
• Washington State Department of Health
• Weill Cornell Medicine
• WellSpan Health
• Wisconsin Perinatal Quality Collaborative (WisPQC)
• Zufall Health

1 Centers for Disease Control and Prevention, Division of Reproductive Health
2 Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention
3 Society for Maternal-Fetal Medicine
4 American College of Obstetricians and Gynecologists
5 American Academy of Family Physicians
6 American Medical Association
7 American College of Nurse-Midwives
8 National Association of Nurse Practitioners in Women’s Health
9 American College of Osteopathic Obstetricians and Gynecologists

For More InformationHilary K. Wall, MPH
Division for Heart Disease and Stroke Prevention
Centers for Disease Control and Prevention
hwall@cdc.gov

Suggested CitationCenters for Disease Control and Prevention. Hypertension in Pregnancy Change Package. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2024.

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