Hypertension in Pregnancy: Natural History and Treatment Options

Abstract

Hypertensive disorders of pregnancy affect approximately 5-10% of all maternities and are major contributors of maternal and neonatal morbidity and mortality worldwide. This group of disorders encompasses chronic hypertension, as well as conditions that arise de novo in pregnancy: gestational hypertension and pre-eclampsia. The latter group is thought to be part of the same continuum but with arbitrary division. Research into the aetiology of hypertension in pregnancy have largely been focused on pre-eclampsia, with a majority of studies exploring either pregnancy-associated factors such as placental-derived or immunologic responses to pregnancy tissue, or maternal constitutional factors such as cardiovascular health and endothelial dysfunction. The evidence base for the pathophysiology and progression of hypertensive disorders in pregnancy, particularly pre-eclampsia, is reviewed. Clinical algorithms and pharmacological agents for the management of hypertension in pregnancy are summarised, with a brief focus on post-partum considerations and long-term health implications. Novel therapeutic options for the management of pre-eclampsia are also explored.

Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil

“…Regarding hemorrhage and high blood pressure, studies have reported an increased risk of perinatal death 25,26 , prematurity, low birth weight, and asphyxia at birth 15 among infants of mothers with hypertension in pregnancy, still a common condition during pregnancy 27,28 , and of mothers with vaginal hemorrhage prior to labor 17,29 .…”

Evaluation the anemia status among preeclamptic pregnants in hospital inpatients from Sanliurfa, Turkey

“…The diagnosis of Pre-Eclampsia was based on the American Congress of Obstetricians and Gynecologists (ACOG) and National High Blood Pressure Education Program (NHBPEP) criteria (5,13); patients with a sitting diastolic and systolic blood pressure of 90 and 140 mmHg, respectively, at least twice over a 6-hour interval and either proteinuria greater than 300 mg in 24-hour urine or a ≥ 1+ dipstick result were deemed as having mild Pre-Eclampsia. Patients with a systolic blood pressure of 160 and diastolic pressure of 110 mmHg or higher at the time of admission, with more than 5 g of protein in their 24-hour urine, and who had received magnesium sulfate (MgSO 4 ) treatment were considered to have severe Pre-Eclampsia.…”

“…The next report of the World Health Organization (WHO) indicated the condition as second most common cause of maternal death: 18% of deaths in mothers are linked to hypertension [3]. In Turkey, 13.7% of deaths during pregnancy are due to eclampsia, while 18.4% of maternal deaths are listed as being due to a combination including edema, proteinuria and hypertension; eclampsia is thus the second most common cause of maternal death in Turkey [4]. Pre-Eclampsia is defined as hypertension (BP >140/90 mmHg) associated with proteinuria past the 20th week of pregnancy and is classified as a pregnancy-induced hypertension [5].…”

Physical and Mental Health Consequences of Obesity in Women

“…Preconceptional obesity elevates the risk of gestational diabetes (GDM), gestational hypertension (GH), preeclampsia (PE) and deep venous thromboembolism (DVT), all of which are related to higher maternal morbidity rates postpartum [8,14,143,149]. A previous study assessed metabolic complications in relation to prepregnancy overweight and obesity (BMI ≥ 30 kg/m 2 ) 10 years postpartum in premenopausal Chilean women.…”

“…GH increases both maternal and foetal mortality with a 5-and 3-fold higher risk for PE and stillbirth, respectively [145]. PE, typically a late pregnancy or post-delivery syndrome characterised by new onset of hypertension and proteinuria, can often appear superimposed on established gestational or prior hypertension, and is frequently observed on a background of pre-existing maternal morbidities, including obesity [149]. Obese pregnant women are estimated to be at 3-10 times higher risk of PE [14].…”