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Chronic Hypertension in Pregnancy Associated with 8-Fold Increase in Preeclampsia — Physician’s First Watch

Medical News |
April 16, 2014

Chronic Hypertension in Pregnancy Associated with 8-Fold Increase in Preeclampsia

By Amy Orciari Herman

Chronic hypertension is associated with elevated risk for a range of adverse pregnancy outcomes, including nearly an eightfold relative risk for preeclampsia, a BMJ meta-analysis finds.

The analysis included 55 observational cohort and randomized studies comprising nearly 800,000 pregnancies. Overall, women with chronic hypertension had a high incidence of adverse outcomes including preeclampsia (26%), delivery before 37 weeks' gestation (28%), and birth weight below 2500 g (17%). They had at least twice the risk for any adverse neonatal outcome as the general U.S. pregnancy population, and their risk for preeclampsia was increased 7.7-fold.

The authors acknowledge several limitations to their analysis. Nonetheless, editorialists say the study "adds important knowledge on a scale that has not previously been published, and its findings may prove to be extremely useful to healthcare professionals involved in pre-pregnancy counselling and antenatal management of women with chronic hypertension."

Reader Comments (2)

Jon Wilcox FRNZCGP Physician, Family Medicine/General Practice, Auckland

After 3 decades and being involved in 3000 births it did become apparent tome that asthma patients tended to deliver earlier and had premature labours far more often than anybody else. They also tended to get not just toxaemia more readily but also benign hypertension when they were not pregnant, observed by some researchers as 'pontine' hypertension. We still do not a reliable ability to differentiate benign and non-benign hypertension at an early stage apart from perhaps frequent and regular home monitoring as recommended in the 2013 Hypertension Guidelines. Urine ACR's can be useful as a monitoring tool. Interesting data.

Edward Grandi

A minimal invasive strategy for effectively addressing this situation in many of these pregnancies would be screening for sleep apnea and treating with positive airway pressure therapy if there is a high risk of the condition. Benefit the mother and the fetus.

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