Key result
Elevated blood pressure and stage 1 hypertension in pregnancy are associated with an increased risk for hypertensive disorders of pregnancy and adverse perinatal and maternal outcomes.
Why the study?
The definition of hypertension changed to include elevated blood pressure and stage 1 hypertension, but whether these categories should be considered during pregnancy remained unclear.
Do elevated blood pressure and stage 1 hypertension increase the risk of adverse maternal and perinatal outcomes in pregnancy?
Do elevated blood pressure and stage 1 hypertension increase the risk of adverse maternal and perinatal outcomes in pregnancy?
Elevated BP and stage 1 hypertension in pregnancy are associated with increased risk for adverse perinatal and maternal outcomes, highlighting the need for management guidelines.
New BP categories may signal higher pregnancy risks; review leaves open treatment thresholds pending prospective data.
Importance Maternal and perinatal morbidity/mortality is significantly increased in pregnancies complicated by hypertension. The definition of hypertension has recently changed with the addition of 2 categories: elevated blood pressure (BP) and stage 1 hypertension. Should these categories be considered during pregnancy? Objective The aim of this study was to analyze the impact of the new hypertensive categories of elevated BP and stage 1 hypertension on maternal/perinatal outcomes. Methods Literature search of PubMed, Web of Science, and CINAHL search was undertaken. Citations were limited to the past 20 years. Results Of the 333 articles identified, 26 articles were the basis of this review. In 2017, new guidelines on the diagnosis and management of hypertension were published. Prepregnancy hypertension was replaced by elevated BP (systolic BP 120–129 mm Hg and diastolic BP <80 mm Hg) and stage 1 hypertension (systolic BP 130–139 mm Hg and diastolic BP 80–89 mm Hg). The risk factors for elevated BP and stage 1 hypertension are similar to chronic hypertension (CHTN) risk factors, diagnosed by BP readings before pregnancy or before 20 weeks' gestation. Patients with elevated BP and stage 1 hypertension are at increased risk for hypertensive disorders of pregnancies compared with normal patients. Treatment strategies for elevated BP and stage 1 hypertension are uncertain. Before 2017, these patients would not have been considered hypertensive and no guidelines existed. Conclusions Elevated BP and stage 1 hypertension increase the number of women labeled with hypertension in pregnancy. These women are at increased risk for adverse perinatal and maternal outcomes. There are currently no firm guidelines on management during pregnancy. Target Audience Obstetricians and gynecologists, family medicine physicians Learning Objectives After completion of this article, the reader should be better able to evaluate the published literature regarding elevated BP and stage 1 hypertension and associated outcomes; identify additional risks of pregnancy associated with these conditions; and analyze current recommendations regarding management during pregnancy.
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Wendel et al. (2022) conducted a review in Elevated blood pressure and stage 1 hypertension in pregnancy. Elevated blood pressure and stage 1 hypertension vs. Normal blood pressure was evaluated on Maternal and perinatal outcomes. Elevated blood pressure and stage 1 hypertension in pregnancy are associated with an increased risk for hypertensive disorders of pregnancy and adverse perinatal and maternal outcomes.
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