Document analysis reveals divergent pregnancy hypertension management guidelines across high-income countries, highlighting opportunities to improve maternal care in the United States.
Key Points
To compare American College of Obstetricians and Gynecologists (ACOG) guidelines on hypertensive disorders of pregnancy against national clinical recommendations from peer high-income countries.
Conducted a comparative document analysis of national guidelines from Australia and New Zealand, Canada, Japan, Trinidad and Tobago, and the United Kingdom versus ACOG guidance.
Systematically coded recommendations across five core domains: first-trimester risk assessment, preeclampsia prevention, antihypertensive initiation thresholds, postpartum monitoring, and patient education.
ACOG guidelines recommend initiating antihypertensive therapy at ≥ 160/110 mmHg for gestational hypertension, whereas international guidelines consistently recommend initiating pharmacotherapy at ≥ 140/90 mmHg with targeted control levels.
International guidelines recommend calcium supplementation for low dietary intake, structured postpartum monitoring beyond 8 weeks, home-based blood pressure monitoring, mental health screening, and long-term cardiovascular risk education, all of which are underspecified by ACOG.
ACOG uniquely includes Black race and low income as independent criteria for aspirin prophylaxis, while none of the reviewed international guidelines explicitly define the role of midwives in managing hypertensive disorders.