Chronic hypertension is present in 0.9–1.5% of pregnant women (1) and may result in significant maternal, fetal, and neonatal morbidity and mortality. The rate of maternal chronic hypertension increased by 67% from 2000 to 2009, with the largest increase (87%) among African American women. This increase is largely secondary to the obesity epidemic and increasing maternal age (1, 2). The trend is expected to continue.
The purpose of this document is to clarify the criteria used to define and diagnose chronic hypertension before or during pregnancy, to review the effects of chronic hypertension on pregnancy and vice versa, and to appraise the available evidence for management options. The purpose of these revised best practice recommendations is to provide a rational approach to chronic hypertension in pregnancy based on new research data and relevant pathophysiologic and pharmacologic considerations.
This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center.
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For a comprehensive overview of these recommendations, the full-text version of this Practice Bulletin is available at http://dx.doi.org/10.1097/AOG.0000000000003020 .
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Committee on Practice Bulletins—Obstetrics. This Practice Bulletin was developed by the American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics in collaboration with Alex Vidaeff, MD, MPH; Jimmy Espinoza, MD, MSc; Hyagriv Simhan, MD; and Christian M. Pettker, MD.
Full-text document published online on December 20, 2018.
Copyright 2018 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
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Chronic hypertension in pregnancy. ACOG Practice Bulletin No. 203. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133:e26–50.