Management of hypertension in pregnancy

Magee, Laura A.; Ornstein, M P; Dadelszen, Peter von

doi:10.1136/bmj.318.7194.1332

Cited by 273 publications

(148 citation statements)

References 36 publications

(23 reference statements)

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“…[169][170][171][172] Studies from different parts of the world, including the UK, show a higher risk of mortality among women who do not receive adequate antenatal care. 156,169,171,173 Although there is a debate about the role of antenatal care in preventing maternal deaths caused by acute conditions that emerge close to the time of delivery, its role in identifying pregnant women at high risk (such as women with hypertensive disorders, medical comorbidities, anaemia and infections) and lowering their risk of mortality is widely accepted.…”

Section: Conclusion and Implications For Policy And Practicementioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Conclusion and Implications For Policy And Practicementioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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“…Chronic hypertension has been estimated to complicate 1% to 5% of pregnancies. 48 Based on data from the National Health and Nutrition Examination Survey (1988 to 1991), prevalence among women between 18 and 29 years of age was estimated to be 0.6% to 2.0%, and it rises to 4.6% to 22.3% for women 30 to 39 years of age. 49 Approximately 77% of women in our sample were younger than 30 years old, and the prevalence in this group of age was 5%, compared with 9% for women older than 30 years of age.…”

Section: Lévesque Et Al Genetic Susceptibility To Pregnancy Hypertensionmentioning

confidence: 99%

Implication of an AGT Haplotype in a Multigene Association Study With Pregnancy Hypertension

et al. 2004

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Abstract-Several association studies of candidate genes for preeclampsia and essential hypertension have led to discordant results, partly because of small sample sizes. Using a large population-based sample of pregnant women, we conducted an association study of 10 polymorphisms in 9 genes and aimed (1) to validate 10 published associations with preeclampsia or essential hypertension, (2) to investigate candidate polymorphisms previously associated with preeclampsia for association with essential hypertension and similarly with polymorphisms previously associated with essential hypertension. From a prospective sample of 3391 nulliparous French Canadian pregnant women, we identified 180 cases of preeclampsia, 203 cases of essential hypertension that were matched with normotensive control subjects (nϭ310 and 357, respectively). Polymorphisms were genotyped by allele-specific PCR. Among our candidate polymorphisms, the Met allele of Thr174Met of AGT was associated with preeclampsia (Pϭ0.0033). Haplotype analysis revealed that the A-Met-Thr (G1035A-Thr174Met-Met235Thr) haplotype was associated with a 2.1-fold increased risk of preeclampsia (95% CI, 1.4 to 3.4; Pϭ0.0008). In conclusion, we observed a strong association between a specific AGT haplotype and preeclampsia in our population, without replicating previous published associations with either preeclampsia or essential hypertension. Our data support a role for AGT in genetic susceptibility to preeclampsia.

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“…4 In clinical trials, the benefits of antihypertensive treatment in PIH have been inconsistent. [5][6][7][8][9] The choice of antihypertensive drugs in pregnancy is often limited due to fetal safety concerns. Three antihypertensive drugsnifedipine, methyldopa and labetalol have been demonstrated to be safe for use in the pregnant women and are commonly used for the management of various hypertensive disorders during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension

Patel

Gadhavi

Gorasia

et al. 2012

Int J Basic Clin Pharmacol

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Background: Pregnancy-induced hypertension is associated with various adverse fetal and maternal outcomes. The use of anti-hypertensive drugs in pregnancy is controversial. We conducted a prospective study to evaluate the comparative effectiveness and safety of nifedipine, methyldopa and labetalol monotherapy in patients with pregnancy-induced hypertension. Methods: A total of 60 pregnant women with blood pressure of 140/90 mm Hg or more with ≥1+ proteinuria between 20 and 38 weeks of gestation were randomly allocated to receive nifedipine (n=20), methyldopa (n=20) or labetalol (n=20). Blood pressure was measured at 0, 6, 24, 48 and 72 h of initiation of antihypertensive drugs. Patients were also followed up for development of adverse drug effects during this period. Results: Antihypertensive treatment with methyldopa was associated with reduction in systolic blood pressure (SBP) by 50 mmHg and diastolic blood pressure (DBP) by 30 mmHg at 72 h. For the same period treatment with nifedipine was associated with reduction in SBP by 54 mmHg and DBP by 30 mmHg. Treatment with labetalol was associated with reduction in SBP by 70 mmHg and DBP by 36 mmHg at 72 h. Conclusions: Labetalol was more effective than methyldopa and nifedipine in controlling blood pressure in patients with pregnancy-induced hypertension while methyldopa and nifedipine are equally effective in controlling blood pressure. [Int J Basic Clin Pharmacol 2012; 1(3.000): 174-177

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Management of hypertension in pregnancy

Cited by 273 publications

References 36 publications

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Implication of an AGT Haplotype in a Multigene Association Study With Pregnancy Hypertension

Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension

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