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Hypertension in pregnancy: diagnosis and management

Key priorities for implementation

Reducing the risk of hypertensive disorders in pregnancy

  • Advise women at high risk of pre-eclampsia to take 75 mg of aspirin* daily from 12 weeks until the birth of the baby. Women at high risk are those with any of the following:
    • hypertensive disease during a previous pregnancy
    • chronic kidney disease
    • autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome
    • type 1 or type 2 diabetes
    • chronic hypertension

Management of pregnancy with chronic hypertension

  • Tell women who take angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs):
    • that there is an increased risk of congenital abnormalities if these drugs are taken during pregnancy
    • to discuss other antihypertensive treatment with the healthcare professional responsible for managing their hypertension, if they are planning pregnancy
  • In pregnant women with uncomplicated chronic hypertension aim to keep blood pressure lower than 150/100 mmHg

Assessment of proteinuria in hypertensive disorders of pregnancy

  • Use an automated reagent-strip reading device or a spot urinary protein:creatinine ratio for estimating proteinuria in a secondary care setting

Management of pregnancy with gestational hypertension

  • Offer women with gestational hypertension an integrated package of care covering admission to hospital, treatment, measurement of blood pressure, testing for proteinuria and blood tests

Management of pregnancy with pre-eclampsia

  • Offer women with pre-eclampsia an integrated package of care covering admission to hospital, treatment, measurement of blood pressure, testing for proteinuria and blood tests
  • Consultant obstetric staff should document in the woman’s notes the maternal (biochemical, haematological and clinical) and fetal thresholds for elective birth before 34 weeks in women with pre-eclampsia
  • Offer all women who have had pre-eclampsia a medical review at the postnatal review (6–8 weeks after the birth)

Advice and follow-up care at transfer to community care

  • Tell women who had pre-eclampsia that their risk of developing:
    • gestational hypertension in a future pregnancy ranges from about
      1 in 8 (13%) pregnancies to about 1 in 2 (53%) pregnancies
    • pre-eclampsia in a future pregnancy is up to about 1 in 6 (16%) pregnancies
    • pre-eclampsia in a future pregnancy is about 1 in 4 (25%) pregnancies if their pre-eclampsia was complicated by severe pre-eclampsia, haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome or eclampsia and led to birth before 34 weeks, and about 1 in 2 (55%) pregnancies if it led to birth before 28 weeks

* Unlicensed indication–obtain and document informed consent

© NICE 2010. Hypertension in pregnancy: diagnosis and management. Available from: www.nice.org.uk/guidance/CG107. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication. 

First included: October 2010.