Reprinted with permission from american college of obstetricians and gynecool gists hy. Women with gestational hypertension have high blood pressure that develops after 20 weeks of pregnancy. Jun 12, 2018 hypertension is the most common medical problem encountered during pregnancy, complicating 23% of pregnancies. High blood pressure in pregnancy preeclampsia medlineplus. The paper begins by defining and classifying hypertensive disorders in pregnancy. Intravenous labetalol and hydralazine have long been considered firstline medications for the management of acuteonset, severe hypertension in pregnant women and women in the postpartum period. There are different types of high blood pressure in pregnancy. Classification systems aim to separate hypertension similar to that seen outside pregnancy chronic and gestational hypertension from the potentially fatal pregnancyspecific conditions. Gestational hypertension or pregnancy induced hypertension pih is the development of new hypertension in a pregnant woman after 20 weeks gestation without the presence of protein in the urine or other signs of preeclampsia. Hypertension during pregnancy specific disorders cont. Most downloaded pregnancy hypertension articles the most downloaded articles from pregnancy hypertension in the last 90 days. Introduction hypertensive disorders of pregnancy hdp remains as one of common causes of maternal mortality in malaysia. Treatment and lifestyle changes can help control your high blood pressure to reduce your risk of lifethreatening complications. Hypertensive disorders of pregnancy american family.
The relative risk of serious renal damage in patients with uncomplicated essential hypertension is low as compared with other cardiovascular complications. Blood pressure is the force of blood pushing against artery walls through blood vessels. Who recommendation on antihypertensive drugs for women. Hypertensive disorders of pregnancy american family physician. Background hypertensive disorders of pregnancy are among the leading causes of maternal and erinatal deaths in develop ping countries, and many studies have been conducted in this field 1. Women might have preexisting hypertension when they become pregnant. The effect of hypertensive disorders in pregnancy on. Maternal mortality rate 10%, peripartum cardiomyopathy is the major cause of pregnancy related death in north america.
Dodampahala mbbs drh2 1,2 18920 sama mawatha, nawala road, nugegoda, sri lanka 2 1associate professor in obstetrics and gynaecology, department of obstetrics and gynaecology. Hypertension in pregnancy nice clinical guideline 107 this clinical guideline contains recommendations for the diagnosis and management of hypertensive disorders during pregnancy in the antenatal, intrapartum and postnatal periods. The blood pressure considered in pregnancy induced hypertension should be. Maternal hypertension during pregnancy and the risk of congenital heart defects in offspring. If a womans blood pressure is well controlled on an agent prepregnancy she may continue it during. List the risk factors for hypertension during pregnancy in particular, preeclampsia. Chronic hypertension in pregnancy is associated with increased rates of adverse maternal and fetal outcomes both acute and long term.
Emergent therapy for acuteonset, severe hypertension during acog. Did you have any of these problems during your most recent pregnancy. According to nhbpep methyldopa, labetalol, beta blockers other than atenolol, slow release nifedipine, and a diuretic in preexisting hypertension are considered as appropriate treatment. From 2004 2010, 11% of mothers in mar yland who had recently given birth had hypertension. Hypertension in pregnancy with onset beyond 20 weeks gestation and no proteinuria. Jan 15, 2016 hypertensive disorders affect up to 10% of pregnancies in the united states. Hypertension in pregnancy dr lim soon hock mrcog sarawak general hospital 2. This includes women with chronic hypertensionwhich may be diagnosed before pregnancy or in the early stages of pregnancy pregnancy gestational hypertension and preeclampsia see box 1. Hypertensive disorders are one of the major causes of pregnancy related maternal deaths in the united states. Ongoing monitoring for increased hypertension and proteinuria, consideration of expectant management or labor. Apec guidelines preeclampsia alabama perinatal excellence collaborative this document should not be construed as dictating an exclusive course of treatment or procedure to be followed.
Mildtomoderate systolic bp 140 159 mmhg andor diastolic bp 90 109 mmhg severe systolic bp 160 mmhg andor diastolic bp 110 mmhg. Report of the american college of obstetricians and gynecologists task force on hypertension in pregnancy. In other cases, high blood pressure develops during pregnancy. The study population was drawn from singleton, nonanomalous live births delivered between 20 and 44 weeks among africanamerican women from 20072011 in the birth cohort file maintained by the california office of statewide health. Hypertension, or high blood pressure, can have many damaging effects on the body. Citescore values are based on citation counts in a given year e. Although antihypertensive drugs, including ras blockers. Hypertension in pregnancy nice clinical guideline 107. Hypertension in pregnancy can occur for several reasons. The definition of hypertension in pregnancy has not always been. Hypertension in pregnancy 1993 current formerly known as. Hypertension in pregnancy is defined as blood pressure more than or equal to 14090mmhg in previously normotensive women that occur in 20th week of gestation without proteinuria until 6weeks postpartum.
Pregnancy induced hypertension pih is estimated to affect 7% to 10% of all pregnancies in the united states. This includes women with hypertension at the booking appointment or before 20 weeks of pregnancy. Hypertensive disorders of pregnancy refer to online version, destroy printed copies after use page 4 of 32 flowchart. Focus on hypertension during pregnancy among maryland women giving birth 20042010 the 2004 2010 maryland prams survey included the following question. Definitions and stratification of hypertension in pregnancy 7 a. Women with severe hypertension during pregnancy should receive treatment with antihyperten.
In the most serious cases, the mother develops preeclampsia also known as pregnancy induced hypertension, toxemia of pregnancy, or acute hypertensive disease of pregnancy, which can be life threatening for the mother and the fetus. Hypertension during pregnancy prevention and health promotion. Hypertension most often appears for the first time in women who have had normal blood pressure before pregnancy and may be associated with. Learn more about the causes, risk factors, symptoms, and treatment of this serious condition. Urgent confirmation of global ventricular systolic dysfunction by tte. Diagnosis and management of hypertension in pregnancy. Study of the prevalence of hypertension and complications.
The guidelines are general and intended to be adapted to many different situations. We will present a comprehensive update of the literature pertinent to hypertension in pregnancy. High blood pressure, or hypertension, during pregnancy can be lifethreatening to a woman in some cases. If a womans blood pressure is well controlled on an agent pre pregnancy she may continue it during. Hypertension in pregnancy is a common condition, affecting about 10% of pregnant women. Emergent therapy for acuteonset, severe hypertension. However, with good blood pressure control, you and your baby are more likely to stay healthy.
Hypertension in pregnancy definition hypertension in pregnancy is defined as bps 140 or bpd. Aug 25, 2010 this guideline has been updated and replaced by hypertension in pregnancy. Pathophysiology of hypertensive renal damage hypertension. Hypertensive disorders during pregnancy are classified into 4 categories, as recommended by the national high blood pressure education program working group on high blood pressure in pregnancy. Approximately 50% of women diagnosed with gestational hypertension between 24 and 35 weeks gestation ultimately develop preeclampsia. High blood pressure hypertension can quietly damage your body for years before symptoms develop. Obstetric guideline 11 hypertension in pregnancy 3 1. Sometimes high blood pressure is present before pregnancy. Classification of hypertensive disorders in pregnancy hdp 10 a. Evidence related to the differential effects of various antihypertensive drugs when used for.
Onset of hypertension before 20 weeks gestation or persisting beyond 12 weeks after delivery. If you continue browsing the site, you agree to the use of cookies on this website. Htn and antihypertensive drugs have adverse effects on both the mother and. A relative paucity of investigative data, as well as the frequent difficulty in making an etiological diagnosis by clinical criteria alone, may be among the reasons why there are many conflicts about the management of hypertension during pregnancy. The following forms are described in the recent european guidelines 1. Age 30 years at the time of the pregnancy, race black, african, haitian, and the presence of gestational hypertension. Despite being the leading cause of maternal death and a major contributor of maternal and perinatal morbidity, the mechanisms responsible for the pathogenesis of pih have not yet been fully elucidated. Hypertension in pregnancy is classified as chronic.
Six percent pregnant women had history of both pregnancy induced hypertension and gestational diabetes figure 5. Gestational hypertension pregnancyinduced hypertension. There is no excess protein in the urine or other signs of organ damage. Study of the prevalence of hypertension and complications of. The central issue in the management of hypertension in pregnancy is achieving a balance between the maternal benefits derived from improved bp control, and the fetal risks resulting from intrauterine medication toxicity and possible uteroplacental hypoperfusion. Chronic hypertension is blood pressure elevation either diagnosed before gestational week 20 or known to be present. Gestational hypertension also referred to as pregnancyinduced hypertension pih is a condition characterized by high blood pressure during pregnancy. Maternal hypertension, or high blood pressure in an expectant mother, has serious risks for her unborn baby.
The incidence of the hypertensive disorders of pregnancy can be expected to increase in settings where there is a trend towards an older and more. Drug treatment for severe hypertension in pregnancy world health. Women with pregnancy induced hypertension pih are at increased risk for preeclampsia, cesarean delivery, renal dysfunction, and placental abruption. Final report of study on hypertension during pregnancy. Management of htn during pregnancy is challenging and it requires. Please note there may be adverse effects and contraindications. Responsible for 16% of maternal deaths in developed countries hypertension during pregnancy is a marker for cardiovascular morbidity and mortality later in life. Hypertensive disorders during pregnancy carry risks for the woman and the baby.
Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy open access. Pregnancy induced hypertension and associated factors among. These adverse effects are common indications for preterm delivery. High blood pressure, hypertension including pregnancyinduced hypertension pih, preeclampsia, or. Who library cataloguinginpublication data who recommendations for prevention and treatment of preeclampsia and eclampsia. High blood pressure, hypertension including pregnancy induced hypertension pih, preeclampsia, or. Effect of pregnancy induced hypertension on mothers and their babies article pdf available in the indian journal of pediatrics 747. Hypertensive disorders complicate at least 7% of pregnancies and are expected to increase as obesity increases and older women conceive. Classification of the hypertensive disorders of pregnancy 35 are complicated by preexisting hypertension, 56% by gestational hypertension without proteinuria, and 12% by preeclampsia 4,5. Despite the differences in guidelines, there appears to be consensus that severe. Jan 30, 2014 hypertensive disorders of pregnancy represent the second commonest cause of direct maternal death and complicate an estimated 510 % of pregnancies. In these guidelines, severe preeclampsia is generally synonymous with the canadian. Progression from nonsevere previously referred to as mild to severe on the disease spectrum may be gradual or rapid. Chronic hypertension in pregnancy is defined by the american college of.
An international journal of womens cardiovascular health aims to stimulate research in the field of hypertension in. Background hypertension in pregnancy remains one of the leading causes of maternal deaths in the uk and is associated with an increased lifetime risk of cardiovascular disease. Gestational hypertension is high blood pressure that you develop while you are pregnant. Preeclampsia is a condition marked by high blood pressure in pregnant women.
Hypertension during pregnancy affects about 68% of pregnant women. Pdf effect of pregnancy induced hypertension on mothers and. Despite the scarcity of robust data to direct the drug treatment of hypertension during pregnancy and the puerperium 80, women in the index study were only treated with the commonly recommended. During pregnancy, hypertension can damage the mothers kidneys and other organs, and it may result in low birth weight and early delivery. Hypertension is the most common medical disorder encountered during pregnancy. Hypertension, pregnancy induced hypertension, preeclampsia, eclampsia, chronic hypertension 1. Hypertension canadas 2018 guidelines for the management of. Pregnancy induced hypertension and associated factors.
Chronic hypertension in pregnancy circulation aha journals. Usually it starts after youve been pregnant for about 20 weeks. Update on the use of antihypertensive drugs in pregnancy. Chronic hypertension 14090 mmhg that extends into pregnancy without preeclampsia. Pdf effect of pregnancy induced hypertension on mothers. Recent research breakthroughs relating to etiology are brie. Gestational hypertension can lead to a serious condition called preeclampsia, also referred to as toxemia. Similar fetal effects have been reported with exposure to angiotensin. The information in hypertension in pregnancy should not be viewed as a body of rigid rules. Hypertension refers to repeatedly elevated blood pressure measurements, which increase the risk for stroke, heart attack and other pregnancy complications.
Preeclampsia is a serious condition in which women. Nov 04, 2012 hypertension in pregnancy dapinderjit gill ross university ms3 s slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Gestational hypertension occurs when your blood pressure rises in the second half of your pregnancy. To investigate the role gestational and chronic hypertension htn play in rates of preterm birth ptb among africanamerican women. Although the rate of eclampsia in the united kingdom uk appears to have fallen, hypertension in pregnancy remains one of the leading causes of. Full length research maternal and fetal effects and outcome of pregnancy induced hypertension at a tertiary care setting in sri lanka prof s. An international journal of womens cardiovascular health aims to stimulate research in the field of hypertension in pregnancy, disseminate the useful results of such research. Most downloaded pregnancy hypertension articles elsevier.
Hypertension during pregnancy introduction leading cause of maternal morbidity and mortality worldwide complicates 510% of pregnancies. Hypertension in pregnancy was developed by the task force on hypertension in pregnancy. Pdf to study the hematological profile of mothers with pregnancy induced hypertension and their infants. Classification of the hypertensive disorders of pregnancy. Hypertensive disorders affect up to 10% of pregnancies in the united states. High blood pressure, or hypertension, is when this force against your artery walls is too high. Hypertension in pregnancy european society of cardiology. It also includes advice for women with hypertension who wish to conceive and women who have had a pregnancy complicated by hypertension. With the advent of pregnancy hypertension guidelines in the united kingdom, care of. Management of chronic hypertension in pregnancy patients should discuss antihypertensive treatment with the healthcare professional if they are planning pregnancy stop ace inhibitors, alpha and betablockers, thiazides if they become pregnant preferably within 2 working days of notification of pregnancy offer alternatives.
If you develop high blood pressure after 20 weeks of pregnancy but dont have protein in your urine or other key symptoms of preeclampsia, youll be diagnosed with gestational hypertension, sometimes called pregnancy induced hypertension pih. Or alternatively, a rise in systolic bp of more than 25mmhg or diastolic bp of more than 15mmhg compared with booking bp. Newonset hypertension presenting after 20 weeks of pregnancy is known as gestational hypertension. Protocol 15, version 3 page 2 of 9 6302015 pregnancy characterized by new onset hypertension and proteinuria or, in the absence of proteinuria. These adverse outcomes are particularly seen in women with. Its common to develop hypertension, or high blood pressure, during pregnancy. From 20042010, 11% of mothers in mar yland who had recently given birth had hypertension. This guideline covers diagnosing and managing hypertension high blood pressure, including preeclampsia, during pregnancy, labour and birth.
Healthcare professionals women who develop hypertension during pregnancy, who have hypertension and wish to conceive, and who have had a pregnancy complicated by hypertension, and their relatives and carers. Maternal and fetal effects and outcome of pregnancy. High blood pressure in pregnancy has become more common. Learn about these effects and why its important to manage hypertension. During pregnancy, chronic hypertension is categorized as. The national institute of health and clinical excellence nice clinical guideline on hypertension in pregnancy.
Learn the effects of hypertension on unborn babies. The incidence of pregnancy induced hypertension in india is about 710% of all antenatal admission shruti et al. Preeclampsia is a multisystem, progressive disorder characterized by the new onset of hypertension and proteinuria or hypertension and endorgan dysfunction with or without proteinuria in the last half of pregnancy. This doughnut shows 98% had no history of preeclampsia figure 6.
In the united states, high blood pressure happens in 1 in every 12 to 17 pregnancies among women ages 20 to 44. High blood pressure, also called hypertension, is very common. Statistics on and effects of hypertension in pregnancy. High blood pressure during pregnancy is defined as 140 mm hg or higher systolic, with diastolic 90 mm hg or higher. Uncontrolled high blood pressure can lead to disability, a poor quality of life, or even a fatal heart attack or stroke.
1459 875 819 1350 1640 1521 917 1245 46 1327 941 1300 833 1016 715 994 339 624 4 864 1635 1006 968 1065 227 97 13 1108 1409 109 298