Evaluate blood pressure during pregnancy

Questions will come up about managing gestational hypertension. These women with normal blood pressure before pregnancy who develop blood pressures of 140/90 mmHg or higher AFTER 20 weeks' gestation are at increased risk of premature birth, low birth weight, and infant or maternal death. We know to monitor for progression to preeclampsia (hypertension over 140/90 with proteinuria) OR a severe feature (low platelets, renal impairment, pulmonary edema, etc). See these women at least weekly for blood pressure checks, labs, etc. It's okay to monitor blood pressure at home, but this doesn't replace office visits.

• Recommend pregnant women report any blood pressure over 140/90 or symptoms of preeclampsia (vision changes, severe headache or abdominal pain, worsening edema, etc).
• Don't expect to routinely prescribe antihypertensive medications, these can mask worsening blood pressure and progression to preeclampsia.
• But women with acute-onset blood pressure above 160/110 or severe features will need inpatient monitoring and may need IV medications or to deliver early.
• If women are managed at home after inpatient treatment, expect to use oral labetalol or nifedipine ER (Epilat Retard), the same medications used for chronic hypertension in pregnancy.
• Think of aspirin 81 mg/day to decrease risk of preeclampsia and low birth weight in women with prior preeclampsia or other risks (chronic hypertension, diabetes, etc). Start it between 12- and 28-weeks' gestation and continue until delivery in these women.
• Monitor blood pressure postpartum, women with gestational hypertension are at higher risk of chronic hypertension and cardiovascular disease.

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References

1. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019 Jan;133(1):1.
2. ACOG Practice Bulletin No. 203. (2019). Obstetrics & Gynecology, 133(1), pp.e26–e50.
3. ACOG Committee Opinion No. 743. (2018). Obstetrics & Gynecology, 132(1), pp.e44–e52.

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