From the Guidelines
Hypertension in pregnancy is a condition that requires immediate attention and treatment, as it can lead to severe maternal and fetal morbidity and mortality, with systolic blood pressure (SBP) > 160 mmHg being associated with adverse maternal outcomes. According to the most recent guidelines, blood pressure > 160/110 mmHg lasting >15 min warrants immediate drug treatment 1. The condition can be classified into different types, including chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension.
Key Considerations
- Hypertensive disorders in the peripartum period contribute substantially to maternal and fetal morbidity and mortality 1
- Early diagnosis and adequate treatment are essential to prevent complications such as stroke, pulmonary oedema, and eclampsia
- Labetalol i.v. and oral nifedipine are currently suggested as first-line treatment for hypertensive emergencies during pregnancy 1
- Magnesium sulfate is recommended for the prevention of eclampsia and treatment of seizures, but should not be given concomitantly with calcium channel blockers due to the risk of hypotension 1
Management and Treatment
- Blood pressure readings of > 160/110 mmHg require immediate treatment to prevent complications 1
- Target blood pressure should be below 140/90 mmHg
- Regular monitoring of maternal blood pressure, urine protein, and fetal growth is essential to prevent complications like placental abruption, preterm birth, intrauterine growth restriction, and maternal stroke or organ damage
- Women with hypertensive disorders need close postpartum follow-up as they have an increased risk of developing chronic hypertension and cardiovascular disease later in life 1
From the Research
Definition and Classification of Hypertension in Pregnancy
- Hypertensive disorders of pregnancy can be classified into four groups: chronic hypertension, preeclampsia, gestational hypertension, and superimposed preeclampsia on chronic hypertension 2
- Hypertension in pregnancy can be divided into three main groups: pre-eclampsia, gestational hypertension, and chronic hypertension 3
Risks and Complications of Hypertension in Pregnancy
- Hypertensive disorders of pregnancy complicate up to 10% of pregnancies and remain the major cause of maternal and neonatal morbidity and mortality 2
- Hypertension during pregnancy is associated with a higher risk of cardiovascular disease and kidney failure 2
- Severe pre-eclampsia is a life-threatening multisystem disease associated with eclampsia, HELLP syndrome, acute kidney injury, pulmonary oedema, placental abruption, and intrauterine fetal death 4
Management and Treatment of Hypertension in Pregnancy
- Early diagnosis and proper treatment for pregnant women with hypertension remain a priority since this leads to improved maternal and fetal outcomes 2
- Labetalol, nifedipine, methyldopa, and hydralazine are the preferred medications to treat hypertension during pregnancy 2, 5, 4
- Oral antihypertensive regimens, including nifedipine retard, labetalol, and methyldopa, can be effective in managing severe hypertension in pregnancy 5
- Delivery of the baby is the definitive management of severe pre-eclampsia 3, 4
Long-term Risks and Monitoring
- Hypertensive complications during pregnancy are potentially linked to cardiovascular, kidney, and metabolic diseases later in life 6
- Women with chronic hypertension should undergo a prepregnancy evaluation and close monitoring during and after pregnancy to ensure medication safety and to prevent end-organ damage 6