gestational hypertension

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Gestational hypertension is new hypertension presenting after 20 weeks without significant proteinuria.

women with gestational hypertension should be offered an integrated package of care covering admission to hospital, treatment, measurement of blood pressure, testing for proteinuria and blood tests as indicated
- in women with gestational hypertension, a full assessment should be carried out in a secondary care setting by a healthcare professional who is trained in the management of hypertensive disorders of pregnancy
- 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
  - multi-fetal 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
hypertension is a blood pressure >= 140/90; severe hypertension is a BP >=160/110
- offer pharmacological treatment if BP remains above 140/90 mmHg
- offer pharmacological treatment to all women with severe hypertension
oral labetalol is the first line treatment of choice
- only offer women with gestational hypertension antihypertensive treatment other than labetalol after considering side-effect profiles for the woman, fetus and newborn baby. Alternatives include methyldopa and nifedipine
when using medicines to treat hypertension in pregnancy, aim for a target blood pressure of 135/85mmHg

Offer 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

Last edited 08/2019 and last reviewed 08/2019

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