Hypertensive disorders of pregnancy: preventative-, immediate- and long-term management

The hypertensive disorders of pregnancy are common and continue to be significant contributors to maternal and perinatal mortality and morbidity, both globally and in the UK. This review aims to describe the recent developments in the understanding of the pathophysiology of the disease processes, potential strategies for identification of women at high risk, and current and future therapeutic strategies for the treatment and prevention of hypertension in pregnancy. Women who experience adverse pregnancy outcomes are also at increased risk of premature cardiovascular disease, and potential therapeutic strategies to minimize their risk profile are discussed.

[1]  A. Seidler,et al.  Antiplatelet agents for preventing pre-eclampsia and its complications. , 2007, The Cochrane database of systematic reviews.

[2]  K. Nicolaides,et al.  Prediction of pre‐eclampsia by uterine artery Doppler ultrasonography and maternal serum pregnancy‐associated plasma protein‐A, free β‐human chorionic gonadotropin, activin A and inhibin A at 22 + 0 to 24 + 6 weeks' gestation , 2006, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[3]  Caroline A Crowther,et al.  Spontaneous preterm delivery in primiparous women at low risk in Denmark: population based study , 2006, BMJ : British Medical Journal.

[4]  L. Poston,et al.  Vitamin C and vitamin E in pregnant women at risk for pre-eclampsia (VIP trial): randomised placebo-controlled trial , 2006, The Lancet.

[5]  M. Rönnback,et al.  Impaired vascular dilatation in women with a history of pre-eclampsia , 2006, Journal of hypertension.

[6]  A Metin Gülmezoglu,et al.  WHO analysis of causes of maternal death: a systematic review , 2006, The Lancet.

[7]  P. Ridker,et al.  Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER)--can C-reactive protein be used to target statin therapy in primary prevention? , 2006, The American journal of cardiology.

[8]  K. Nicolaides,et al.  A novel approach to first‐trimester screening for early pre‐eclampsia combining serum PP‐13 and Doppler ultrasound , 2005, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[9]  A. Koivisto,et al.  Bilateral notching of uterine arteries at 12–14 weeks of gestation for prediction of hypertensive disorders of pregnancy , 2005, Acta obstetricia et gynecologica Scandinavica.

[10]  K. Lim,et al.  Circulating Angiogenic Factors in the Pathogenesis and Prediction of Preeclampsia , 2005, Hypertension.

[11]  D. Henderson-smart,et al.  Altered dietary salt for preventing pre-eclampsia, and its complications. , 2005, The Cochrane database of systematic reviews.

[12]  A. Ebrashy,et al.  Usefulness of aspirin therapy in high-risk pregnant women with abnormal uterine artery Doppler ultrasound at 14-16 weeks pregnancy: randomized controlled clinical trial. , 2005, Croatian medical journal.

[13]  K. Nicolaides,et al.  Prediction of pregnancy complications by first‐trimester maternal serum PAPP‐A and free β‐hCG and with second‐trimester uterine artery Doppler , 2005, Prenatal diagnosis.

[14]  Kypros H Nicolaides,et al.  An integrated model for the prediction of preeclampsia using maternal factors and uterine artery Doppler velocimetry in unselected low-risk women. , 2005, American journal of obstetrics and gynecology.

[15]  I. Greer,et al.  Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. , 2005, Blood.

[16]  I. Sargent,et al.  Latest Advances in Understanding Preeclampsia , 2005, Science.

[17]  K. Nicolaides,et al.  Assessment of risk for the development of pre‐eclampsia by maternal characteristics and uterine artery Doppler , 2005, BJOG : an international journal of obstetrics and gynaecology.

[18]  P. Baker,et al.  Sildenafil citrate (Viagra) enhances vasodilatation in fetal growth restriction. , 2005, The Journal of clinical endocrinology and metabolism.

[19]  J. Craig,et al.  Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. , 2005, The Cochrane database of systematic reviews.

[20]  Kirsten Duckitt,et al.  Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies , 2005, BMJ : British Medical Journal.

[21]  B. Sibai,et al.  Vitamin C and E supplementation in women at high risk for preeclampsia: a double-blind, placebo-controlled trial. , 2005, American journal of obstetrics and gynecology.

[22]  J. Martin,et al.  Stroke and Severe Preeclampsia and Eclampsia: A Paradigm Shift Focusing on Systolic Blood Pressure , 2005, Obstetrics and gynecology.

[23]  Roberto Pastor-Barriuso,et al.  Meta-Analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality , 2005, Annals of Internal Medicine.

[24]  P. Bossuyt,et al.  World Health Organization systematic review of screening tests for preeclampsia. , 2005, Obstetrics and gynecology.

[25]  M. Muenke,et al.  Mechanistic and epidemiologic considerations in the evaluation of adverse birth outcomes following gestational exposure to statins , 2004, American journal of medical genetics. Part A.

[26]  W. Ferrell,et al.  Divergent metabolic and vascular phenotypes in pre-eclampsia and intrauterine growth restriction: relevance of adiposity , 2004, Journal of hypertension.

[27]  L. Cherry,et al.  Short- and Long-Term Changes in Plasma Inflammatory Markers Associated With Preeclampsia , 2004, Hypertension.

[28]  B. Howard,et al.  Antioxidant Vitamin Supplements and Cardiovascular Disease , 2004, Circulation.

[29]  P. Ridker,et al.  High-sensitivity C-reactive protein: clinical importance. , 2004, Current problems in cardiology.

[30]  M. Wolf,et al.  Insulin Resistance and Alterations in Angiogenesis: Additive Insults That May Lead to Preeclampsia , 2004, Hypertension.

[31]  M. Muenke,et al.  Central nervous system and limb anomalies in case reports of first-trimester statin exposure. , 2004, The New England journal of medicine.

[32]  D. Rader,et al.  Effects of an inhibitor of cholesteryl ester transfer protein on HDL cholesterol. , 2004, The New England journal of medicine.

[33]  Paul Schoenhagen,et al.  Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. , 2004, JAMA.

[34]  Luquan Wang,et al.  Materials and Methods Figs. S1 to S4 Tables S1 and S2 References Niemann-pick C1 like 1 Protein Is Critical for Intestinal Cholesterol Absorption , 2022 .

[35]  K. Lim,et al.  Circulating angiogenic factors and the risk of preeclampsia. , 2004, The New England journal of medicine.

[36]  F. Parazzini,et al.  A small randomised trial of low-dose aspirin in women at high risk of pre-eclampsia. , 2004, European journal of obstetrics, gynecology, and reproductive biology.

[37]  M. Blankenstein,et al.  Markers for Presymptomatic Prediction of Preeclampsia and Intrauterine Growth Restriction , 2004, Hypertension in pregnancy.

[38]  M. Lassere,et al.  Treatment of antiphospholipid syndrome in pregnancy--a systematic review of randomized therapeutic trials. , 2004, Thrombosis research.

[39]  R. E. Hoekstra,et al.  Survival and long-term neurodevelopmental outcome of extremely premature infants born at 23-26 weeks' gestational age at a tertiary center. , 2004, Pediatrics.

[40]  K. Nicolaides,et al.  Randomized controlled trial using low-dose aspirin in the prevention of pre-eclampsia in women with abnormal uterine artery Doppler at 23 weeks' gestation. , 2004, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[41]  N. Sattar,et al.  Microvascular dysfunction: a link between pre‐eclampsia and maternal coronary heart disease , 2003, BJOG : an international journal of obstetrics and gynaecology.

[42]  L. Magee,et al.  Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis , 2003, BMJ : British Medical Journal.

[43]  T. Libermann,et al.  Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. , 2003, The Journal of clinical investigation.

[44]  F. Chevy,et al.  Molecular mechanisms underlying limb anomalies associated with cholesterol deficiency during gestation: implications of Hedgehog signaling. , 2003, Human molecular genetics.

[45]  M. Merialdi,et al.  Nutritional interventions during pregnancy for the prevention or treatment of maternal morbidity and preterm delivery: an overview of randomized controlled trials. , 2003, The Journal of nutrition.

[46]  G. Prescott,et al.  Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study , 2003, BMJ : British Medical Journal.

[47]  C. van Walraven,et al.  Risk of subsequent thromboembolism for patients with pre-eclampsia , 2003, BMJ : British Medical Journal.

[48]  M. Muenke,et al.  How a Hedgehog might see holoprosencephaly. , 2003, Human molecular genetics.

[49]  D. Lawlor,et al.  Is the Association Between Parity and Coronary Heart Disease Due to Biological Effects of Pregnancy or Adverse Lifestyle Risk Factors Associated With Child-Rearing?: Findings From the British Women’s Heart and Health Study and the British Regional Heart Study , 2003, Circulation.

[50]  Mary C. Brucker Cnm DNSc.  Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk, 6th edition. , 2003 .

[51]  Andrew P McMahon,et al.  Developmental roles and clinical significance of hedgehog signaling. , 2003, Current topics in developmental biology.

[52]  J. Taipale,et al.  A defective response to Hedgehog signaling in disorders of cholesterol biosynthesis , 2003, Nature Genetics.

[53]  D. Henderson-smart,et al.  Drugs for treatment of very high blood pressure during pregnancy. , 2013, The Cochrane database of systematic reviews.

[54]  K. Nicolaides,et al.  Screening for pre‐eclampsia and fetal growth restriction in twin pregnancies at 23 weeks of gestation by transvaginal uterine artery Doppler , 2002, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[55]  N. Sattar,et al.  Pregnancy complications and maternal cardiovascular risk: opportunities for intervention and screening? , 2002, BMJ : British Medical Journal.

[56]  E. Kujansuu,et al.  Low dose acetylsalicylic acid in prevention of pregnancy‐induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches , 2002, BJOG : an international journal of obstetrics and gynaecology.

[57]  D. Henderson-smart,et al.  Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. , 2014, The Cochrane database of systematic reviews.

[58]  M. Khamashta,et al.  Management of pregnancy in antiphospholipid syndrome. , 2001, Rheumatic diseases clinics of North America.

[59]  L. Green,et al.  NHBPEP report on high blood pressure in pregnancy: a summary for family physicians. , 2001, American family physician.

[60]  N Rifai,et al.  Effect of statin therapy on C-reactive protein levels: the pravastatin inflammation/CRP evaluation (PRINCE): a randomized trial and cohort study. , 2001, JAMA.

[61]  J. Pell,et al.  Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129 290 births , 2001, The Lancet.

[62]  Shah Ebrahim,et al.  Dietary fat intake and prevention of cardiovascular disease: systematic review , 2001, BMJ : British Medical Journal.

[63]  A. Hagiwara,et al.  Losartan and fetal toxic effects , 2001, The Lancet.

[64]  L. Poston,et al.  Placentation, antiphospholipid syndrome and pregnancy outcome , 2001, Lupus.

[65]  James J. Walker,et al.  Pre-eclampsia , 2000, The Lancet.

[66]  J. Higgins,et al.  The detection, investigation and management of hypertension in pregnancy: full consensus statement , 2000, The Australian & New Zealand journal of obstetrics & gynaecology.

[67]  K. Khan,et al.  How useful is uterine artery Doppler flow velocimetry in the prediction of pre‐eclampsia, intrauterine growth retardation and perinatal death? An overview , 2000, BJOG : an international journal of obstetrics and gynaecology.

[68]  G Koren,et al.  Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis , 2000, The Lancet.

[69]  Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. , 2000, American journal of obstetrics and gynecology.

[70]  A W Halligan,et al.  Comparison of auscultatory and oscillometric automated blood pressure monitors in the setting of preeclampsia. , 1999, American journal of obstetrics and gynecology.

[71]  R. Mann,et al.  Losartan: a study of pharmacovigilance data on 14 522 patients , 1999, Journal of Human Hypertension.

[72]  M. Pfeffer,et al.  Long-Term Effects of Pravastatin on Plasma Concentration of C-reactive Protein , 1999 .

[73]  L. Magee,et al.  Fortnightly review: management of hypertension in pregnancy. , 1999, BMJ.

[74]  I. Sargent,et al.  Preeclampsia: an excessive maternal inflammatory response to pregnancy. , 1999, American journal of obstetrics and gynecology.

[75]  R. Burrows,et al.  Assessing the Teratogenic Potential of Angiotensin‐Converting Enzyme Inhibitors in Pregnancy , 1998, The Australian & New Zealand journal of obstetrics & gynaecology.

[76]  S. Rabkin,et al.  Report of the Canadian Hypertension Society Consensus Conference: 2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy. , 1997, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[77]  J. Cutler,et al.  Trial of calcium to prevent preeclampsia. , 1997, The New England journal of medicine.

[78]  J. Penny,et al.  Blood pressure measurement in severe pre-eclampsia , 1997, The Lancet.

[79]  S. Ferry,et al.  Cardiovascular sequelae of toxaemia of pregnancy. , 1997, Heart.

[80]  Y. Horsmans,et al.  Clinical Pharmacokinetics of 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Inhibitors , 1996, Clinical pharmacokinetics.

[81]  M. Marmot,et al.  Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study , 1996, The Lancet.

[82]  B. Sibai.  Treatment of hypertension in pregnant women. , 1996, The New England journal of medicine.

[83]  R. North,et al.  Perinatal morbidity in chronic hypertension , 1996, British journal of obstetrics and gynaecology.

[84]  A. Halligan,et al.  Lack of reproducibility in pregnancy of Korotkoff phase IV as measured by mercury sphygmomanometry , 1996, The Lancet.

[85]  R. Arngrímsson,et al.  Death rates from ischemic heart disease in women with a history of hypertension in pregnancy. , 1996, Acta obstetricia et gynecologica Scandinavica.

[86]  G. Boysen,et al.  Influence of systolic and diastolic blood pressure on stroke risk: a prospective observational study. , 1995, American journal of epidemiology.

[87]  R. Arngrímsson,et al.  Death rates from ischemic heart disease in women with a history of hypertension in pregnancy , 1995 .

[88]  M. Barr,et al.  Teratogen update: angiotensin-converting enzyme inhibitors. , 1994, Teratology.

[89]  J. Whitworth,et al.  Measuring blood pressure in pregnant women: a comparison of direct and indirect methods. , 1994, American journal of obstetrics and gynecology.

[90]  J. Dekker,et al.  Number of pregnancies and risk of cardiovascular disease. , 1993, The New England journal of medicine.

[91]  J. Mckenney,et al.  Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) , 1993, JAMA.

[92]  R. D'Agostino,et al.  Number of pregnancies and the subsequent risk of cardiovascular disease. , 1993, The New England journal of medicine.

[93]  D. Wlody,et al.  Hypertension in pregnancy. , 1992, The New England journal of medicine.

[94]  B. Sibai.  Diagnosis and management of chronic hypertension in pregnancy. , 1991, Obstetrics and gynecology.

[95]  S. Kennedy,et al.  Atenolol in essential hypertension during pregnancy. , 1990, BMJ.

[96]  B. Sibai,et al.  A protocol for managing severe preeclampsia in the second trimester. , 1990, American journal of obstetrics and gynecology.

[97]  E. M. Symonds,et al.  The fetal outcome in a randomized double-blind controlled trial of labetalol versus placebo in pregnancy-induced hypertension. , 1989, British journal of obstetrics and gynaecology.

[98]  F. Pipkin,et al.  The fetal outcome in a randomized double‐blind controlled trial of labetalol versus placebo in pregnancy‐induced hypertension , 1989 .

[99]  V. Beral,et al.  Mortality in women in relation to their childbearing history. , 1988, BMJ.

[100]  H. Iinuma.  [Follow-up study on women suffered from severe toxemia of pregnancy]. , 1988, Nihon Sanka Fujinka Gakkai zasshi.

[101]  I. Macgillivray,et al.  The classification and definition of the hypertensive disorders of pregnancy. , 1988, American journal of obstetrics and gynecology.

[102]  F. Broughton Pipkin,et al.  The effect of nitrendipine (NIT) on maternal and fetal blood pressure, uterine blood flow, and blood gas status in pregnant sheep. , 1988, Journal of cardiovascular pharmacology.

[103]  D. Beevers,et al.  Nifedipine as a second line antihypertensive drug in pregnancy , 1988, British journal of obstetrics and gynaecology.

[104]  E. Amon,et al.  A comparative trial of labetalol and hydralazine in the acute management of severe hypertension complicating pregnancy , 1987, Obstetrics and gynecology.

[105]  B. Sibai,et al.  A comparison of labetalol plus hospitalization versus hospitalization alone in the management of preeclampsia remote from term , 1987, Obstetrics and gynecology.

[106]  C. Fish.  Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk , 1986 .

[107]  M. Thompson,et al.  Blood pressure in the puerperium. , 1986, Clinical science.

[108]  E. Gallery,et al.  Antihypertensive treatment in pregnancy: analysis of different responses to oxprenolol and methyldopa. , 1985, British medical journal.

[109]  B. Sibai,et al.  Effects of diuretics on plasma volume in pregnancies with long-term hypertension. , 1984, American journal of obstetrics and gynecology.

[110]  L. Butters,et al.  First year of life after the use of atenolol in pregnancy associated hypertension. , 1984, Archives of disease in childhood.

[111]  J. Reid,et al.  Obstetric aspects of the use in pregnancy-associated hypertension of the beta-adrenoceptor antagonist atenolol. , 1984, American journal of obstetrics and gynecology.

[112]  D. Clark,et al.  PLACEBO-CONTROLLED TRIAL OF ATENOLOL IN TREATMENT OF PREGNANCY-ASSOCIATED HYPERTENSION , 1983, The Lancet.

[113]  C. Redman,et al.  FINAL REPORT OF STUDY ON HYPERTENSION DURING PREGNANCY: THE EFFECTS OF SPECIFIC TREATMENT ON THE GROWTH AND DEVELOPMENT OF THE CHILDREN , 1982, The Lancet.

[114]  S. Hunyor,et al.  Plasma volume contraction: a significant factor in both pregnancy-associated hypertension (pre-eclampsia) and chronic hypertension in pregnancy. , 1979, The Quarterly journal of medicine.

[115]  L. Beilin,et al.  TREATMENT OF HYPERTENSION IN PREGNANCY WITH METHYLDOPA: BLOOD PRESSURE CONTROL AND SIDE EFFECTS , 1977, British journal of obstetrics and gynaecology.

[116]  C. Redman,et al.  The role of coagulation and fibrinolysis in preeclampsia. , 1976, Perspectives in nephrology and hypertension.

[117]  A. S. Douglas,et al.  Coagulation and fibrinolytic systems in pre-eclampsia and eclampsia. , 1971, British medical journal.