ACOG Updates Guidelines for Gestational HTN, Preeclampsia

The American College of Obstetricians & Gynecologists (ACOG) has updated its guidance on the management of gestational hypertension and preeclampsia as well as chronic hypertension in pregnant women; the two practice bulletins were published in the January issue of Obstetrics & Gynecology.

Jimmy Espinoza, M.D., and colleagues from ACOG discuss the diagnosis and management of gestational hypertension and preeclampsia. The authors recommend that women with any high-risk factors for preeclampsia or those with more than one moderate risk factor receive low-dose aspirin for prophylaxis, initiated between 12 and 28 weeks of gestation and continuing until delivery. Delivery rather than expectant management is recommended for women with gestational hypertension or preeclampsia without severe features at or beyond 37 0/7 weeks of gestation. Nonsteroidal anti-inflammatory medications should be used preferentially over opioid analgesics.

Noting that from 2000 to 2009, the rate of maternal chronic hypertension increased and that the trend is expected to continue, Alex Vidaeff, M.D., M.P.H., and colleagues from ACOG address the management of chronic hypertension in pregnancy. The authors recommend initiating daily low-dose aspirin between 12 and 28 weeks of gestation for women with chronic hypertension; this aspirin dose should be continued until delivery. For persistent chronic hypertension when systolic and diastolic blood pressure are ≥160 and ≥110 mm Hg, respectively, initiation of antihypertensive therapy is recommended. Treatment should be initiated at lower thresholds in the setting of comorbidities or underlying impaired renal function. Labetalol or nifedipine is recommended for long-term treatment of pregnant women.

"The updated guidance provides clearer recommendations for the management of gestational hypertension with severe-range blood pressure," a coauthor said in a statement.

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