Hypertension in pregnancy: the management of hypertensive disorders during pregnancy

National Institute for Health and Clinical Excellence

Key priorities for implementation

Reducing the risk of hypertensive disorders in pregnancy

• Advise women at high risk of pre-eclampsia to take 75 mg of aspirin* daily from 12 weeks until the birth of the baby. Women at high risk are those with any of the following:
  • hypertensive disease during a previous pregnancy
  • chronic kidney disease
  • autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome
  • type 1 or type 2 diabetes
  • chronic hypertension

Management of pregnancy with chronic hypertension

• Tell women who take angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs):
  • that there is an increased risk of congenital abnormalities if these drugs are taken during pregnancy
  • to discuss other antihypertensive treatment with the healthcare professional responsible for managing their hypertension, if they are planning pregnancy
• In pregnant women with uncomplicated chronic hypertension aim to keep blood pressure lower than 150/100 mmHg

Assessment of proteinuria in hypertensive disorders of pregnancy

• Use an automated reagent-strip reading device or a spot urinary protein:creatinine ratio for estimating proteinuria in a secondary care setting

Management of pregnancy with gestational hypertension

• Offer women with gestational hypertension an integrated package of care covering admission to hospital, treatment, measurement of blood pressure, testing for proteinuria and blood tests

Management of pregnancy with pre-eclampsia

• Offer women with pre-eclampsia an integrated package of care covering admission to hospital, treatment, measurement of blood pressure, testing for proteinuria and blood tests
• Consultant obstetric staff should document in the woman’s notes the maternal (biochemical, haematological and clinical) and fetal thresholds for elective birth before 34 weeks in women with pre-eclampsia
• Offer all women who have had pre-eclampsia a medical review at the postnatal review (6–8 weeks after the birth)

Advice and follow-up care at transfer to community care

• Tell women who had pre-eclampsia that their risk of developing:
  • gestational hypertension in a future pregnancy ranges from about
    1 in 8 (13%) pregnancies to about 1 in 2 (53%) pregnancies
  • pre-eclampsia in a future pregnancy is up to about 1 in 6 (16%) pregnancies
  • pre-eclampsia in a future pregnancy is about 1 in 4 (25%) pregnancies if their pre-eclampsia was complicated by severe pre-eclampsia, haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome or eclampsia and led to birth before 34 weeks, and about 1 in 2 (55%) pregnancies if it led to birth before 28 weeks

^* Unlicenced indecation–obtain and document informed consent

full guideline available from…
National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA
guidance.nice.org.uk/CG107

National Institute for Health and Clinical Excellence. Hypertension in pregnancy:the management of hypertensive disorders during pregnancy. August 2010