management of gestational hypertension

Last edited 08/2019

• in women with gestational hypertension, take account of the following risk factors that require additional assessment and follow-up:
  • nulliparity
  • age 40 years or older
  • pregnancy interval of more than 10 years
  • family history of pre-eclampsia
  • multiple pregnancy
  • BMI of 35 kg/m2 or more
  • gestational age at presentation
  • previous history of pre-eclampsia or gestational hypertension
  • pre-existing vascular disease
  • pre-existing kidney disease

A summary of management of gestational hypertension guidance (1) is presented below:

Management of pregnancy with gestational hypertension

(a) Use an automated reagent-strip reading device for dipstick screening for proteinuria in a secondary care setting.

Abbreviations: BP, blood pressure; CTG, cardiotography

Notes:

• ofer placental growth factor (PlGF)-based testing to help rule out preeclampsia in women presenting with suspected pre-eclampsia (for example, with gestational hypertension) between 20 weeks and up to 35 weeks of pregnancy

• do not offer bed rest in hospital as a treatment for gestational hypertension
• Timing of birth
  • do not offer planned early birth before 37 weeks to women with gestational hypertension whose blood pressure is lower than 160/110 mmHg, unless there are other medical indications
  • for women with gestational hypertension whose blood pressure is lower than 160/110 mmHg after 37 weeks, timing of birth, and maternal and fetal indications for birth should be agreed between the woman and the senior obstetrician.
  • if planned early birth is necessary, offer a course of antenatal corticosteroids and magnesium sulfate if indicated
• Postnatal investigation, monitoring and treatment
  • in women with gestational hypertension who have given birth, measure blood pressure:
    • daily for the first 2 days after birth
    • at least once between day 3 and day 5 after birth
    • as clinically indicated if antihypertensive treatment is changed after birth
  • in women with gestational hypertension who have given birth:
    • continue antihypertensive treatment if required
    • advise women that the duration of their postnatal antihypertensive treatment will usually be similar to the duration of their antenatal treatment (but may be longer)
    • reduce antihypertensive treatment if their blood pressure falls below 130/80 mmHg
• if a woman has taken methyldopa to treat gestational hypertension, stop within 2 days after the birth and change to an alternative treatment if necessary
• for women with gestational hypertension who did not take antihypertensive treatment and have given birth, start antihypertensive treatment if their blood pressure is 150/100mmHg or higher
• offer women who have had gestational hypertension and who remain on antihypertensive treatment, a medical review with their GP or specialist 2 weeks after transfer to community care
• offer all women who have had gestational hypertension a medical review with their GP or specialist 6-8 weeks after the birth

Reference:

• 1) NICE (June 2019). Hypertension in pregnancy - the management of hypertensive disorders during pregnancy