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Hypertensive disorders of pregnancy are a leading cause of maternal death, and can put both mother and baby at risk during pregnancy and during and after delivery. They are also often preventable and treatable.
- In the United States, high blood pressure is found in 1 in every 12 to 17 pregnancies among women aged 20 to 44.
- These disorders are becoming more common, affecting about 15% of women in their reproductive years — partly because women are older at first pregnancy, and obesity and other cardiometabolic risk factors are rising.
- There are racial and ethnic disparities in both how often they occur and how they turn out.
The five disorders
| Disorder | What it is |
|---|---|
| Chronic hypertension | high blood pressure before pregnancy or diagnosed before 20 weeks. These women can also develop preeclampsia |
| Gestational hypertension | high blood pressure starting at or after 20 weeks, without protein in the urine or other heart or kidney problems. It usually improves after delivery, but some women face a higher risk of chronic hypertension later |
| Preeclampsia | a woman with previously normal blood pressure suddenly develops high blood pressure plus protein in the urine or other problems (such as a low platelet count or impaired liver function) after 20 weeks. It occurs in about 1 in 25 U.S. pregnancies |
| Eclampsia | seizures in a woman with preeclampsia — a medical emergency |
| HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count) | a life-threatening condition during pregnancy or soon after delivery; it can cause high blood pressure and seizures, and untreated can lead to a potentially fatal liver disorder or stroke |
Prevention
- Healthy weight gain and diet can improve pregnancy outcomes.
- Exercise may cut the risk of gestational hypertension and preeclampsia by 30% to 40%.
- Low-dose aspirin, started at 12 to 16 weeks, can reduce the risk of preeclampsia and related problems by 10% to 20% in women at increased risk.
- Accurate blood pressure readings matter for diagnosing, classifying and treating these disorders, and several home blood pressure devices are accurate in pregnancy, including with gestational hypertension and preeclampsia.
Seven simple tips for an accurate blood pressure reading. Million Hearts (text description)
Treatment
More evidence is needed on the best treatment targets and the point at which to start medicines. Treatment should use medicines that are safe and effective in pregnancy. For preeclampsia, the main approaches today are treating the high blood pressure, preventing seizures, and timing the delivery.
Care after birth
These disorders can bring complications during and after delivery, and a lifelong risk of cardiovascular disease starting earlier. So after birth, checking and controlling cardiovascular risk factors is essential, with team-based, multi-specialty care to hand patients on smoothly and keep up prevention across their lives.
A video, Hypertension in Pregnancy: Alicia's Story (transcript), gives a first-hand account.
For clinicians
- a table of oscillometric blood pressure devices validated in pregnancy, from a 2021 Current Atherosclerosis Reports article
- the U.S. Preventive Services Task Force's recommendation to screen for preeclampsia with blood pressure measurements throughout pregnancy
- the American College of Obstetricians and Gynecologists' task force report on hypertension in pregnancy
- a Cochrane review of antiplatelet agents, largely low-dose aspirin, which found moderate benefits for preventing preeclampsia and its complications
Sources
Based on "Hypertensive Disorders of Pregnancy," Million Hearts, content provided by the Centers for Disease Control and Prevention, citing Garovic and others (2022, 2020), CDC and Bello and others (2018); a work of the United States government in the public domain.
Licence : CC0 1.0 (domaine public) · Adapté de millionhearts.hhs.gov
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