Review
Hypertension in Pregnancy and Women of Childbearing Age

https://doi.org/10.1016/j.amjmed.2009.03.036Get rights and content

Abstract

Hypertension in women of childbearing age is a challenging medical problem with increasing prevalence. Essential hypertension remains the most common diagnosis in young women. Reproductive goals and possible teratogenic effects must be considered when initiating therapy. Hypertensive disorders of pregnancy are frequent causes of maternal/fetal morbidity and mortality, the most common being preeclampsia/eclampsia. Pregnant patients should be screened routinely. Early recognition and prompt care from a multidisciplinary service, including obstetrics, cardiology, and intensive medicine, are required to prevent deleterious outcomes. Hypertensive disorders of pregnancy reflect endometrial endothelial dysfunction/abnormalities and systemic endothelial dysfunction, which might predict future cardiovascular disease in these young women, prompting early preventive measures.

Section snippets

Treatment of Essential Hypertension in Women of Childbearing Age

The Joint National Committee 7 definition of hypertension and the treatment goals do not vary by age or gender (Table 1). Medications should be considered carefully before prescribing in women who may be or who are planning to become pregnant. Many common antihypertensive medications have teratogenic potential. The Food and Drug Administration has developed guidelines and recommendations for use of these medications during pregnancy. Medications with significant risk for fetal effects are

Conclusions

Hypertension is a growing problem in women of childbearing age requiring attention to reproductive goals before therapy. Chronic hypertension during pregnancy requires reassessment of blood pressure therapy. Regular screening for hypertension during pregnancy is required because it is a harbinger of dangerous multiorgan syndromes. Therapy should be initiated for severe hypertension (>160/110 mm Hg) during pregnancy. Therapy is aimed at avoiding direct morbidity and mortality associated with

References (40)

  • F.G. Cunningham et al.

    Hypertension in pregnancy

    N Engl J Med

    (1992)
  • Sibai et al.

    Imitators of severe preeclampsia

    Obstet Gynecol

    (2007)
  • E. Abalos et al.

    Antihypertensive drug therapy for mild to moderate hypertension during pregnancy

    Cochrane Database Syst Rev

    (2007)
  • T. Podymow et al.

    Update on the use of antihypertensive drugs in pregnancy

    Hypertension

    (2008)
  • Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy

    Am J Obstet Gynecol

    (2000)
  • J.A. Gavard et al.

    Effect of exercise on pregnancy outcome

    Clin Obstet Gynecol

    (2008)
  • T.K. Sorensen et al.

    Recreational physical activity during pregnancy and risk of preeclampsia

    Hypertension

    (2003)
  • A.F. Saftlas et al.

    Work, leisure-time physical activity, and risk of preeclampsia and gestational hypertension

    Am J Epidemiol

    (2004)
  • C.B. Rudra et al.

    Perceived exertion during prepregnancy physical activity and preeclampsia risk

    Med Sci Sports Exerc

    (2005)
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    Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

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