Key result
A literature review found that pregnant women with blood pressure <140/90 mm Hg have a consistently increased risk of hypertensive disorders of pregnancy, gestational diabetes, and small-for-gestational-age neonates.
Why the study?
The ACC/AHA lowered the blood pressure cut-off for stage I hypertension to 130/80 mm Hg in 2017, prompting evaluation of delivery timing and outcomes in chronic hypertension during pregnancy.
Does elective induction of labor compared to expectant management improve outcomes in pregnant women with chronic hypertension?
Does elective induction of labor compared to expectant management improve outcomes in pregnant women with chronic hypertension?
There is conflicting evidence regarding the optimal timing of delivery for pregnant women with chronic hypertension, and lower BP cut-offs are associated with increased pregnancy complications, highlighting the need for further RCTs.
Conflicting evidence leaves optimal delivery timing unresolved in chronic hypertension; dedicated RCTs needed before practice change.
OBJECTIVE: weeks. The American College of Cardiology and American Heart Association in 2017 lowered the blood pressure cut-off for stage I hypertension to 130/80 mm Hg. METHODS: We performed a literature review on studies comparing elective induction of labor versus expectant management in pregnant women with chronic hypertension. In addition, we reviewed fetal and maternal outcomes in pregnant women with blood pressure of 120-139/80-89 or 130-139/80-89 mm Hg. RESULTS: We found two randomized clinical trials and one retrospective observational study comparing elective delivery of pregnant women with chronic hypertension versus expectant management. The randomized trials favored expectant management and the observational study favored induction of labor. We found 15 retrospective cohort studies analyzing maternal and fetal outcomes in pregnant women with blood pressure cut-off lower than 140/90 mm Hg. There was a consistent finding of increased risk of any hypertensive disorder of pregnancy, gestational diabetes mellitus, and small-for-gestational-age neonate. CONCLUSION: Randomized clinical trials are needed to assess the appropriate timing of delivery for women with stage I hypertension with a blood pressure cut-off of 130/80 mm Hg.
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Sisti et al. (2021) conducted a review in Chronic hypertension during pregnancy. Elective induction of labor and lower blood pressure cut-offs vs. Expectant management was evaluated on Fetal and maternal outcomes including hypertensive disorder of pregnancy, gestational diabetes mellitus, and small-for-gestational-age neonate. A literature review found that pregnant women with blood pressure <140/90 mm Hg have a consistently increased risk of hypertensive disorders of pregnancy, gestational diabetes, and small-for-gestational-age neonates.
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