Hypertension During Pregnancy
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GUIDELINES/CLINICAL TRIALS/META-ANALYSIS (WJ KOSTIS, SECTION EDITOR)
Hypertension During Pregnancy Akanksha Agrawal 1 & Nanette K. Wenger 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Hypertensive disorders of pregnancy affect about 5–10% of pregnancies impacting maternal, fetal, and neonatal outcomes. We review the recent studies in this field and discuss the pathophysiology, diagnosis, and management of hypertension during pregnancy, as well as the short- and long-term consequences on the cardiovascular health of women. Recent Findings Although the American College of Cardiology/American Heart Association revised their guidelines for hypertension in the general population in 2017, hypertension during pregnancy continues to be defined as a systolic blood pressure (SBP) ≥ 140 mmHg and/or a diastolic blood pressure (DBP) ≥ 90 mmHg, measured on two separate occasions. The addition of stage 1 hypertension will increase the prevalence of hypertension during pregnancy, identifying more women at risk of preeclampsia; however, more research is needed before changing the BP goal because a lower target BP has a risk of poor placental perfusion. Women with chronic hypertension have a higher incidence of superimposed preeclampsia, cesarean section, preterm delivery before 37 weeks’ gestation, birth weight less than 2500 g, neonatal unit admission, and perinatal death. They also have a higher risk of developing cardiovascular disease later in life. The guidelines recommend low-dose aspirin for women with moderate and high risk of preeclampsia. While treating pregnant women with hypertension, the effectiveness of the antihypertensive agent must be balanced with risks to the fetus. Summary Hypertensive disorders of pregnancy should be appropriately and promptly recognized and treated during pregnancy. They should further be co-managed by the obstetrician and cardiologist to decrease the long-term negative impact on the cardiovascular health of women. Keywords Chronic hypertension . Pregnancy . Gestational hypertension . Women . Cardiovascular . Fetal
Introduction Hypertensive disorders of pregnancy complicate about 5– 10% of pregnancies causing maternal, fetal, and neonatal morbidity and mortality [1]. Hypertension during pregnancy is defined as a systolic blood pressure (SBP) ≥ 140 mmHg and/or a diastolic blood pressure (DBP) ≥ 90 mmHg, measured on two separate occasions. During the course of a
This article is part of the Topical Collection on Guidelines/Clinical Trials/ Meta-Analysis * Akanksha Agrawal [email protected]; [email protected] 1
Division of Cardiology, Emory University School of Medicine, 101 Woodruff Circle, Suite 319, Atlanta, GA 30322, USA
normal pregnancy, the BP decreases gradually in the first trimester due to a decrease in systemic vascular resistance. It reaches a nadir at about 22–24 weeks, rising again from 28 weeks to reach preconception levels by 36 weeks of gestation [2]. There are multiple hormonal, vascular, and metabolic factors postul
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