From the Guidelines
For patients with chronic hypertension, delivery is generally recommended at 37-39 weeks of gestation, with the exact timing individualized based on maternal and fetal status, as indicated by the most recent guidelines 1. When considering the timing of delivery for patients with chronic hypertension, it's essential to balance the risks of continuing pregnancy against the potential complications of early delivery.
- The American Journal of Obstetrics and Gynecology study from 2022 1 provides the most recent and highest quality evidence, suggesting that half of the clinical practice guidelines recommend delivery by 37-39 weeks for women with chronic hypertension.
- The study also highlights the importance of individualizing the timing of delivery based on the patient's specific condition, such as the presence of antihypertensive agents or the severity of hypertension.
- For patients with well-controlled chronic hypertension without evidence of end-organ damage or superimposed preeclampsia, waiting until 39 weeks may be reasonable, as long as blood pressure is closely monitored and kept below 160/110 mmHg to prevent cerebrovascular complications.
- Common medications used during pregnancy, such as labetalol, nifedipine, or methyldopa, should be continued as needed to control blood pressure, and earlier delivery (before 37 weeks) may be necessary if complications develop, such as superimposed preeclampsia, fetal growth restriction, or worsening maternal hypertension despite maximal medical therapy, as supported by the 2018 ISSHP classification, diagnosis, and management recommendations for international practice 1.
From the Research
Gestational Age for Delivery in Chronic Hypertension
- The optimal gestational age for delivery in patients with chronic hypertension is a topic of ongoing research and debate 2, 3, 4.
- A study published in 2023 found that planned delivery at 37 or 38 weeks' gestation did not appear to be associated with a higher risk of adverse perinatal outcomes compared to expectant management in patients with chronic hypertension on antihypertensive medication 2.
- Another study published in 2022 recommended delivery at 36-39 weeks' gestation for pregnant women with chronic hypertension 3.
- A Cochrane review published in 2017 found that planned early delivery was associated with less composite maternal morbidity and mortality, but there was no clear difference in composite infant mortality and severe morbidity 4.
Key Findings
- There is no clear consensus on the optimal gestational age for delivery in patients with chronic hypertension, but most studies suggest delivery between 36-39 weeks' gestation 2, 3, 4.
- The decision to deliver should be individualized based on the patient's specific clinical circumstances and risk factors 2, 3, 4.
- Further research is needed to determine the optimal timing of delivery for patients with chronic hypertension and to minimize the risk of adverse maternal and perinatal outcomes 2, 3, 4.