68
Blood Pressure Management
5.5. Hypertension and Pregnancy*
COR LOE
Recommendations
1 A
1. For individuals with hypertension who are planning a
pregnancy or who become pregnant, labetalol and extended-
release nifedipine are preferred agents to treat hypertension
and minimize fetal risk.
1 B-R
2. Individuals with hypertension who are planning a pregnancy
or who become pregnant should be counseled about the
benefits of low-dose (81 mg/day) aspirin to reduce the risk of
preeclampsia and its sequelae.
1 B-R
3. Pregnant individuals with SBP ≥160 mm Hg or DBP ≥110
mm Hg confirmed on repeat measurement within 15 minutes
should receive antihypertensive medication (Table 23) to
lower BP to <160/<110 mm Hg within 30 to 60 minutes to
prevent adverse events.
1 B-R
4. Pregnant individuals with chronic
†
hypertension (defined
as prepregnancy hypertension or SBP 140 to 159 mm
Hg and/or DBP 90 to 109 mm Hg prior to 20 weeks'
gestation) should receive antihypertensive therapy to achieve
BP <140/90 mm Hg to prevent maternal and perinatal
morbidity and mortality.
3: Harm C-LD
5. Individuals with hypertension who are planning a pregnancy
or who become pregnant should not be treated with atenolol,
ACEi, ARB, direct renin inhibitors, nitroprusside, or MRA
to avoid fetal harm.
* ACOG diagnostic criteria and classification of hypertensive disorders of pregnancy are found
in Tables 22 and 23.
†
Chronic hypertension in pregnancy is defined as a preexisting diagnosis of hypertension or
SBP ≥140 mm Hg and/or DBP ≥90 mm Hg on 2 occasions at least 4 hours apart before 20
weeks' gestation.
