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Management of gestational hypertension

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in women with gestational hypertension, take account of the following risk factors that require additional assessment and follow-up:
- nulliparity
- age 40 years or older
- pregnancy interval of more than 10 years
- family history of pre-eclampsia
- multiple pregnancy
- BMI of 35 kg/m2 or more
- gestational age at presentation
- previous history of pre-eclampsia or gestational hypertension
- pre-existing vascular disease
- pre-existing kidney disease

A summary of management of gestational hypertension guidance (1) is presented below:

Management of pregnancy with gestational hypertension

Classification of Hypertension	Hypertension: blood pressure of 140/90- 159/ 109mmHg	Severe hypertension: blood pressure of 160/110mmHg or more
Admission to hospital	Do not routinely admit to hospital	Admit, but if BP falls below 160/ 110 mmHg then manage as for hypertension
Antihypertensive pharmacological treatment	Offer pharmacological treatment if BP remains above 140/90 mmHg	Offer pharmacological treatment to all women
Target blood pressure once on antihypertensive treatment	Aim for BP of 135/85 mmHg or less	Aim for BP of 135/85 mmHg or less
Blood Pressure Measurement	Once or twice a week (depending on BP) until BP is 135/85 mmHg or less	Every 15-30 minutes until BP is less than 160/110 mmHg
Dipstick proteinuria testing (a)	Once or twice a week (with BP measurement)	Daily while admitted
Blood Tests	Measure full blood count, liver function and renal function at presentation and then weekly	Measure full blood count, liver function and renal function at presentation and then weekly
PlGF-based testing	Carry out PlGF-based testing on 1 occasion if there is suspicion of preeclampsia	Carry out PlGF-based testing on 1 occasion if there is suspicion of preeclampsia
Fetal assessment	Offer fetal heart auscultation at every antenatal appointment Carry out ultrasound assessment of the fetus at diagnosis and, if normal, repeat every 2 to 4 weeks, if clinically indicated Carry out a CTG only if clinically indicated	Offer fetal heart auscultation at every antenatal appointment Carry out ultrasound assessment of the fetus at diagnosis and, if normal, repeat every 2 weeks, if severe hypertension persists Carry out a CTG at diagnosis and then only if clinically indicated

(a) Use an automated reagent-strip reading device for dipstick screening for proteinuria in a secondary care setting.

Abbreviations: BP, blood pressure; CTG, cardiotography

Notes:

ofer placental growth factor (PlGF)-based testing to help rule out preeclampsia in women presenting with suspected pre-eclampsia (for example, with gestational hypertension) between 20 weeks and up to 35 weeks of pregnancy
do not offer bed rest in hospital as a treatment for gestational hypertension
Timing of birth
- do not offer planned early birth before 37 weeks to women with gestational hypertension whose blood pressure is lower than 160/110 mmHg, unless there are other medical indications
- for women with gestational hypertension whose blood pressure is lower than 160/110 mmHg after 37 weeks, timing of birth, and maternal and fetal indications for birth should be agreed between the woman and the senior obstetrician.
- if planned early birth is necessary, offer a course of antenatal corticosteroids and magnesium sulfate if indicated
Postnatal investigation, monitoring and treatment
- in women with gestational hypertension who have given birth, measure blood pressure:
  - daily for the first 2 days after birth
  - at least once between day 3 and day 5 after birth
  - as clinically indicated if antihypertensive treatment is changed after birth
- in women with gestational hypertension who have given birth:
  - continue antihypertensive treatment if required
  - advise women that the duration of their postnatal antihypertensive treatment will usually be similar to the duration of their antenatal treatment (but may be longer)
  - reduce antihypertensive treatment if their blood pressure falls below 130/80 mmHg
if a woman has taken methyldopa to treat gestational hypertension, stop within 2 days after the birth and change to an alternative treatment if necessary
for women with gestational hypertension who did not take antihypertensive treatment and have given birth, start antihypertensive treatment if their blood pressure is 150/100mmHg or higher
offer women who have had gestational hypertension and who remain on antihypertensive treatment, a medical review with their GP or specialist 2 weeks after transfer to community care
offer all women who have had gestational hypertension a medical review with their GP or specialist 6-8 weeks after the birth

Reference:

1) NICE (June 2019). Hypertension in pregnancy - the management of hypertensive disorders during pregnancy

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Management of gestational hypertension

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