Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines
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PREECLAMPSIA (VD GAROVIC, SECTION EDITOR)
Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines Rachel G. Sinkey 1,2 Alan T. N. Tita 1,2
&
Ashley N. Battarbee 1,2 & Natalie A. Bello 3 & Christopher W. Ives 4 & Suzanne Oparil 5 &
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Hypertensive disorders of pregnancy (HDP)—gestational hypertension, preeclampsia, and eclampsia—are a leading cause of adverse maternal and perinatal outcomes internationally. Prevention, timely diagnosis, and prompt management can reduce associated morbidity. The purpose of this review is to compare international guidelines pertaining to HDP. Recent Findings Fourteen HDP guidelines were compared relative to guidelines for the United States (US) where the authors practice. Aspirin is universally recommended for high-risk women to reduce preeclampsia risk. Recommended dose and gestational age at initiation vary. Diagnoses of chronic hypertension, gestational hypertension, and preeclampsia in pregnant women are similar, although blood pressure (BP) thresholds for antihypertensive medication initiation and treatment targets vary due to the limitations in high-quality evidence. Summary There are differences among international HDP guidelines related to dose and timing of aspirin initiation, thresholds for antihypertensive medication initiation, and BP targets. However, all guidelines acknowledge the significant morbidity associated with HDP and advocate for timely diagnosis and management to reduce associated morbidity and mortality. More research is needed to understand optimal BP thresholds at which to initiate antihypertensive medication regimens and BP targets in pregnancy. Keywords Chronic hypertension . Eclampsia . Gestational hypertension . Guidelines . Hypertensive disorders of pregnancy . Preeclampsia
Introduction This article is part of the Topical Collection on Preeclampsia * Rachel G. Sinkey [email protected] 1
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, 1700 6th Avenue South, 176F Suite 10270, Birmingham, AL 35249, USA
2
Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
3
Department of Medicine, Division of Cardiology, Columbia College of Physicians and Surgeons, New York, NY, USA
4
Tinsley Harrison Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
5
Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
Globally, hypertensive disorders of pregnancy (HDP) are a leading cause of morbidity, mortality, hospitalization, and resource utilization for both mothers and their neonates [1–5]. In developed countries, HDP are often diagnosed at routine prenatal care visits, as many women are asymptomatic at the time of diagnosis. Prenatal care affords the opportunity of preven
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