NICE clinical guidelines
Issued: August 2010 (last modified: January 2011)
CG107

Hypertension in pregnancy: The management of hypertensive disorders during pregnancy

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg107

Introduction

Hypertensive disorders during pregnancy occur in women with pre-existing primary or secondary chronic hypertension, and in women who develop new-onset hypertension in the second half of pregnancy.

Hypertensive disorders during pregnancy carry risks for the woman and the baby. Although the rate of eclampsia in the United Kingdom (UK) appears to have fallen, hypertension in pregnancy remains one of the leading causes of maternal death in the UK. Hypertensive disorders during pregnancy may also result in substantial maternal morbidity. A UK study reported that one-third of severe maternal morbidity was a consequence of hypertensive conditions. A study from one region of the UK reported that 1 in 20 (5%) women with severe pre-eclampsia or eclampsia were admitted to intensive care. More recently, the long-term consequences for women with a diagnosis of hypertension during pregnancy have become clear, in particular chronic hypertension and an increase in lifetime cardiovascular risk.

Hypertensive disorders also carry a risk for the baby. In the most recent UK perinatal mortality report, 1 in 20 (5%) stillbirths in infants without congenital abnormality occurred in women with pre-eclampsia. The contribution of pre-eclampsia to the overall preterm birth rate is substantial; 1 in 250 (0.4%) women in their first pregnancy will give birth before 34 weeks as a consequence of pre-eclampsia and 8–10% of all preterm births result from hypertensive disorders. Half of women with severe pre-eclampsia give birth preterm.

Small-for-gestational-age babies (mainly because of fetal growth restriction arising from placental disease) are common, with 20–25% of preterm births and 14–19% of term births in women with pre-eclampsia being less than the tenth centile of birth weight for gestation.

There is national guidance on the care of women with severe pre-eclampsia or eclampsia and on screening for hypertensive disorders during pregnancy[1]. However, there has been no guidance on the assessment and care of women and their babies after a diagnosis of hypertension (including the use of antihypertensive treatment) or on maternity care for women with chronic hypertension.

This clinical guideline contains recommendations for the diagnosis and management of hypertensive disorders during pregnancy in the antenatal, intrapartum and postnatal periods. It includes recommendations for women with chronic hypertension who wish to conceive and recommendations for advice to women after a pregnancy complicated by hypertension.

This clinical guideline contains recommendations for the diagnosis and management of hypertensive disorders during pregnancy in the antenatal, intrapartum and postnatal periods. It includes recommendations for women with chronic hypertension who wish to conceive and recommendations for advice to women after a pregnancy complicated by hypertension.

This guideline assumes that prescribers will use a drug's summary of product characteristics (SPC) to inform decisions made with individual patients. Drugs for which particular attention should be paid to the contraindications and special warnings during pregnancy and lactation are marked with and detailed in appendix D.

This guideline recommends some drugs for indications for which they do not have a UK marketing authorisation at the date of publication, if there is good evidence to support that use. Many drugs do not have a license for use specifically in pregnant women, reflecting the fact that this group is often excluded from studies. Unlicensed drugs are marked with an asterisk.

In this guideline, drug names are marked with an asterisk (*) if they do not have UK marketing authorisation for the indication in question at the time of publication (August 2010). Informed consent should be obtained and documented.



[1] Royal College of Obstetricians and Gynaecologists (2006) The management of severe
pre-eclampsia/eclampsia; National Institute for Health and Clinical Excellence (2008) Antenatal care. NICE clinical guideline 62. London: National Institute for Health and Clinical Excellence.