••• Chapter 13^ Hypertension and Pregnancy^127
❍ Describe some lifestyle modifications recommended for managing hypertension.
Weight reduction, physical activity, dietary sodium reduction, smoking cessation, and moderation of alcohol
consumption.
❍ What is the most common cause of chronic hypertension in pregnant women?
Essential or familial hypertension (>90%).
❍ Which pregnancy complications are associated with chronic hypertension?
Premature birth, IUGR, small for gestational age, fetal demise, placental abruption (1–2% and up to 8.4% with
severe chronic hypertension), cesarean delivery, superimposed preeclampsia, and perinatal mortality.
❍ What are the effects of preeclampsia on the fetus?
As a result of impaired uteroplacental blood flow or placental infarction, effects on the fetus may include IUGR,
oligohydramnios, placental abruption, and nonreassuring fetal status demonstrated on antepartum surveillance.
❍ Is a history of prior preeclampsia a risk factor for superimposed preeclampsia?
In women with chronic hypertension, a history of preeclampsia does not increase the rate of superimposed
preeclampsia, but is associated with an increased rate of delivery at <37 weeks.
❍ Name a few risk factors for the development of superimposed preeclampsia.
Severe hypertension in early pregnancy, hypertension for at least 4 years, and abnormal uterine artery Doppler
velocimetry (increased impedance at 16–20 weeks).
❍ When does the physiologic decrease in blood pressure reach its lowest level?
At 16 to 18 weeks of gestation.
❍ Which clinical tests are useful in the initial evaluation of a pregnant woman with chronic hypertension?
Recommendations include electrocardiography, echocardiography, ophthalmologic examination, and renal
ultrasonography. Baseline laboratory evaluations include serum creatinine, blood urea nitrogen, and 24-hour urine
evaluation of total protein and creatinine clearance. Uric acid of at least 5.5 mg/dL could indicate an increased
likelihood of having superimposed preeclampsia. Some would also recommend checking urinalysis, urine culture,
glucose, and electrolytes in an attempt to rule out etiologies such as renal disease or chronic pyelonephritis or to
identify comorbidities, such as diabetes.
❍ What are the guidelines for treatment of mild chronic hypertension during pregnancy?
Women with mild hypertension generally do not require antihypertensive medications. It is reasonable to either
stop or reduce medication in women who are already taking antihypertensive therapy, but therapy could be
increased or reinstituted for women with blood pressures exceeding 150–160 mmHg systolic or 100–110 mmHg
diastolic.
❍ What are the guidelines for treatment of severe chronic hypertension during pregnancy?
In women with severe hypertension (systolic of 180 mmHg or more or diastolic of 110 mmHg or more),
antihypertensive therapy should be initiated or continued for maternal indications. End-organ dysfunction
diastolic blood pressure of 90 mmHg or higher may be considered an indication for treatment.