Practice Guidelines

Gestational Hypertension and Preeclampsia: A Practice Bulletin from ACOG

 

Am Fam Physician. 2019 Nov 15;100(10):649-650.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Low-dose aspirin therapy should be started between 12 and 28 weeks' gestation for patients with one high risk factor or two moderate risk factors for preeclampsia.

• Any patient with preeclampsia or gestational hypertension at 37 weeks' gestation or greater should proceed to delivery.

• Patients with preeclampsia or gestational hypertension with severe features at 34 weeks' gestation or greater should proceed to delivery, whereas expectant management can be considered at less than 34 weeks' gestation

From the AFP Editors

Preeclampsia, a disorder of pregnancy associated with new-onset hypertension, occurs in up to 8% of pregnancies globally, with an incidence that increased by 25% from 1987 to 2004 in the United States. Globally, hypertensive disorders of pregnancy are one of the main causes of maternal death. The American College of Obstetricians and Gynecologists (ACOG) has released a practice bulletin to outline diagnosis and treatment recommendations for these conditions.

Preeclampsia

Preeclampsia most commonly occurs in healthy women without risk factors or previous delivery; it typically presents after 20 weeks' gestation, usually near term. Risk is increased in patients with the factors noted in Table 1.

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TABLE 1.

Clinical Risk Factors for Preeclampsia

Risk levelRisk factors

High

Autoimmune disease (e.g., systemic lupus erythematosus, antiphospholipid syndrome) Chronic hypertension Diabetes mellitus – type 1 or type 2 History of preeclampsia Multifetal gestation Renal disease

Moderate

Age 35 years or older Black race or low socioeconomic status Family history of preeclampsia (mother or sister) History of low-birth-weight infant, adverse pregnancy outcome, or more than 10 years between pregnancies Obesity (body mass index > 30 kg per m2) Nulliparity

TABLE 1.

Clinical Risk Factors for Preeclampsia

Risk levelRisk factors

High

Autoimmune disease (e.g., systemic lupus erythematosus, antiphospholipid syndrome) Chronic hypertension Diabetes mellitus – type 1 or type 2 History of preeclampsia Multifetal gestation Renal disease

Moderate

Age 35 years or older Black race or low socioeconomic status Family history of preeclampsia (mother or sister) History of low-birth-weight infant, adverse pregnancy outcome, or more than 10 years between pregnancies Obesity (body mass index > 30 kg per m2) Nulliparity

The presence of hypertension and proteinuria is most commonly used to diagnose preeclampsia. In a woman at 20 weeks' gestation or more whose blood pressure was previously in the healthy range, hypertension is defined as at least 140 mm Hg systolic or at least 90 mm Hg diastolic twice on measurements taken four or more hours apart. Hypertension is considered severe when blood pressure is at least 160 mm Hg systolic or at least 110 mm Hg diastolic. Severe blood pressure values should be confirmed within a few minutes to facilitate timely intervention.

To diagnose preeclampsia, women with hypertension also will have proteinuria,

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

 

 

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