Differential impacts of pregnancy-induced hypertension and chronic hypertension on maternal and foetal health outcomes: a systematic review of outcomes and risk factors

INTRODUCTION: Hypertensive disorders complicate approximately 5-10% of pregnancies globally, significantly impacting maternal and foetal health. To address the distinct impacts of chronic hypertension and pregnancy-induced hypertension (PIH) on foeto-maternal health, this review delineated their associated distinct risk factors and diagnostic markers, providing evidence-based insights to guide targeted, patient-centred management of hypertensive pregnancies. METHODS: A systematic search of Web of Science, PubMed, and SCOPUS was conducted using predefined criteria. Observational studies were rigorously screened and quality assessed. Data were extracted and narratively synthesised, with an emphasis on maternal and foetal outcomes, diagnostic modalities, and risk modifiers. RESULTS: The analysis confirmed that intrauterine foetal demise, intrauterine growth restriction, low birth weight, and neonatal as well as maternal mortality are major adverse outcomes of hypertensive pregnancies. The evidence demonstrates that whilst chronic hypertension and PIH confer considerable risk, PIH often results in more sudden and severe clinical deterioration, especially in the absence of vigilant prenatal monitoring and timely intervention. The findings underscored the value of targeted, patient-centred care: women with chronic hypertension benefit from early and sustained surveillance, whereas those with PIH require prompt escalation of monitoring following diagnosis, especially in the second trimester. Notably, comorbid systemic illnesses and advanced maternal age compound risks across hypertension categories, and diagnostic modalities, particularly ultrasound Doppler, are pivotal for early risk stratification and management. CONCLUSION: Effective management of hypertensive pregnancies requires early identification and individualised monitoring, recognising that chronic hypertension and pregnancy-induced hypertension differ in onset and progression, but both pose significant risks to maternal and foetal health.