More care is needed for women with high blood pressure in pregnancy, researchers warn today.
About 5% of pregnancies cause the mother to develop chronic high blood pressure, and the problem appears to be on the rise due to increasing maternal age and obesity.
Dr Kate Bramham and her team at King’s College London, UK, set out to assess the complications caused by chronic hypertension in pregnancy.
They analysed 55 previous studies, covering 795,221 pregnancies based in 25 countries. Chronic hypertension was linked to nearly eight times the rate of pre-eclampsia – a condition that can develop into eclampsia, or life-threatening seizures during pregnancy.
It was also linked to a 30% rise in the risk of caesarean, and nearly three times the risk of preterm delivery (before 37 weeks’ gestation). Chronic hypertension was also linked to nearly three times the risk of a birth weight below 2,500g, and over three times the usual risk of admission to a neonatal unit.
But these rates varied widely between studies, say the researchers in the British Medical Journal.
They conclude: "This systematic review shows that adverse outcomes of pregnancy are common and emphasises a need for heightened antenatal surveillance. A consistent strategy to study women with chronic hypertension is needed, as previous study designs have been diverse.
"These findings should inform counselling and contribute to optimisation of maternal health, drug treatment, and pre-pregnancy management in women affected by chronic hypertension."
Commenting on the work, Dr Tine Clausen of the University of Copenhagen, Denmark, says: "An urgent need remains for research to establish best clinical practice for antenatal care, antihypertensive treatment, and timing of labour in women with uncomplicated chronic hypertension during pregnancy."
Mervi Jokinen, of the UK Royal College of Midwives, said: "Midwives are well aware of the risks of existing hypertension in pregnancy and the need for individualised care for each woman, supporting and advising women as well as providing clinical care."
Bramham, K. et al. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ 16 April 2014; doi: 10.1136/bmj.g2301 [abstract]
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