This is an updated guideline from NICE on managing hypertension in pregnancy. It was first published in 2010 and has been updated in June 19.
I will do a summary of the bits of the guideline that are relevant to us, but the following are some of the key changes:
- Choice of medications. This has been tightened up. Now they advise labetolol first line, nifedipine second line and methyldopa third line.
- Target BP level. This has been lowered. For both chronic and gestational hypertension, the target BP is now 135/85.
- Risk of recurrence. There is a 1 in 5 chance of recurrence in future pregnancies.
- Future risks. There is a small increased risk of cardiovascular disease in later life in people who have had hypertensive problems in pregnancy.
- Aspirin should be used from 12/40 until birth at a dose of 75 – 150mg (there is no clear evidence about the best dose). This is unlicensed. This isn’t new advice, but I thought it worth highlighting as often we may need to initiate it. Women need it who have chronic hypertension or have risk factors for pre-eclampsia as advised below.
- Patients who had pre-eclampsia should have their urine dipped at 6-8/52. If they still have 1+ or more of protein, they need a further review at three months.
Chronic hypertension. This is pre-existing hypertension that was present at the time of booking, or where it presents before 20/40.