Abstract
Hypertensive disorders of pregnancy affect up to 10% of pregnancies worldwide, which includes the 3%–5% of all pregnancies complicated by preeclampsia. Preeclampsia is defined as new onset hypertension after 20 weeks’ gestation with evidence of maternal organ or uteroplacental dysfunction or proteinuria. Despite its prevalence, the risk factors that have been identified lack accuracy in predicting its onset and preventative therapies only moderately reduce a woman’s risk of preeclampsia. Preeclampsia is a major cause of maternal morbidity and is associated with adverse foetal outcomes including intra-uterine growth restriction, preterm birth, placental abruption, foetal distress, and foetal death in utero. At present, national guidelines for foetal surveillance in preeclamptic pregnancies are inconsistent, due to a lack of evidence detailing the most appropriate assessment modalities as well as the timing and frequency at which assessments should be conducted. Current management of the foetus in preeclampsia involves timely delivery and prevention of adverse effects of prematurity with antenatal corticosteroids and/or magnesium sulphate depending on gestation. Alongside the risks to the foetus during pregnancy, there is also growing evidence that preeclampsia has long-term adverse effects on the offspring. In particular, preeclampsia has been associated with cardiovascular sequelae in the offspring including hypertension and altered vascular function.
Highlights
Hypertensive disorders of pregnancy affect 10% of pregnancies [1] and are defined by the International Society for the Study of Hypertension in Pregnancy (ISSHP) as new onset hypertension (≥140 mmHg systolic or ≥90 mmHg diastolic) after 20 weeks’ gestation [2]
Other interventions including nutritional supplements, pharmacological agents, and dietary and lifestyle interventions have been investigated for protective effects against preeclampsia with varying efficacy
The ISSHP recommends that pregnant women with de novo hypertension are investigated with laboratory tests measuring haemoglobin, platelet count, serum creatinine, liver enzymes, and serum uric acid to determine the presence of maternal organ dysfunction and the diagnosis of preeclampsia [2]
Summary
Hypertensive disorders of pregnancy affect 10% of pregnancies [1] and are defined by the International Society for the Study of Hypertension in Pregnancy (ISSHP) as new onset hypertension (≥140 mmHg systolic or ≥90 mmHg diastolic) after 20 weeks’ gestation [2] This umbrella definition includes chronic hypertension, gestational hypertension and preeclampsia (de novo or superimposed on chronic hypertension). Both of these conditions can have significant impacts on maternal and foetal health in the immediate and long term For the mother, this includes a two- to four-fold increased risk of long-term hypertension, a doubling of the risk of cardiovascular mortality and major adverse cardiovascular events, and a 1.5-fold increased risk of stroke [3]. This article reviews the latest evidence base and guideline updates surrounding the diagnosis, management, and foetal surveillance in preeclampsia, as well as its increasingly recognised role as an independent cardiovascular risk factor for the offspring
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