Treatment
Prevention of Preeclampsia
Î Women with chronic primary or secondary hypertension or previous
pregnancy-related hypertension should take low-dose aspirin from the
12
th
week of gestation until delivery (I-A).
Î Calcium supplementation (of ≥1 g/d, orally) should be considered
for women with low dietary intake of calcium (<600 mg/d) to prevent
preeclampsia (I-A).
Treatment of Hypertension in Pregnancy and Postpartum
Î Severe hypertension in pregnancy should be treated with safe and
effective antihypertensive medications, such as methyldopa, labetalol, and
nifedipine, with consideration of maternal and fetal side effects (I-A).
Î Consideration may be given to treatment of moderate hypertension in
pregnancy with safe and effective antihypertensive medications, given the
evidence for possibly increased stroke risk at currently defined systolic
and diastolic BP cutoffs, as well as evidence for decreased risk for the
development of severe hypertension with treatment (although maternal-
fetal risk-benefit ratios have not been established) (IIa-B).
Î Atenolol, angiotensin receptor blockers, and direct renin inhibitors are
contraindicated in pregnancy and should not be used (III-C).
Î After giving birth, women with chronic hypertension should be continued
on their antihypertensive regimen, with dosage adjustments to reflect
the decrease in volume of distribution and glomerular filtration rate that
occurs after delivery. They should also be monitored carefully for the
development of postpartum preeclampsia (IIa-C).
Prevention of Stroke in Women With a History of Preeclampsia
Î Because of the increased risk of future hypertension and stroke 1-30
years after delivery in women with a history of preeclampsia (B), it is
reasonable to (1) consider evaluating all women starting 6 months to
1 year postpartum, as well as those who are past childbearing age,
for a history of preeclampsia/eclampsia and document their history of
preeclampsia/eclampsia as a risk factor, and (2) evaluate and treat for
cardiovascular risk factors including hypertension, obesity, smoking,
and dyslipidemia (IIa-C).
