Diagnosis and treatment of hypertensive disorders of pregnancy: a narrative review

The paper overviews classification, diagnosis and treatment of hypertensive disorders of pregnancy and early postpartum period (chronic hypertension (HTN), gestational HTN, pre-eclampsia) provided by different societies of cardiology and obstetrics and gynecology. The definition of pre-eclampsia offered by the International Society for the Study of Hypertension in Pregnancy ( ISSHP ) in 2018 and supported by the International Federation of Gynecology and Obstetrics ( FIGO ) in 2019, its screening and prevention are considered. All treatment options of moderate and severe HTN in pregnancy are reviewed. A new US Food and Drug Administration ( FDA ) classification system of drug therapy for pregnancy and lactation Pregnancy and Lactation Labelling Rule ( PLLR , 2015) is presented. Treatment goals of HTN and blood pressure (BP) thresholds in pregnancy as well as risk factors, causes, clinical presentation, diagnostic workup and management of hypertensive emergencies in pregnancy are provided. We discuss the evidence of BP ≥ 130/80 mmHg as a factor of high maternal and neonatal risks proposed by the American College of Cardiology/American Heart Association (2017) as the HTN criteria in pregnancy.