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Hypertension in pregnancy - Management
Basis for recommendation
Monitoring and review by a specialist
Monitoring and control of blood pressure postpartum
- These recommendations are expert opinion from NICE [National Collaborating Centre for Women's and Children's Health, 2010].
- NICE identified no evidence about the frequency of postnatal observations or investigations.
- Its recommendations are therefore based on the knowledge that blood pressure peaks between 3–5 days after birth and that it is sensible to monitor blood pressure if changes are made to treatment.
Choice of antihypertensive drug
- NICE identified only one small randomized controlled trial that compared timolol with methyldopa, and therefore concluded that there is no evidence for any particular antihypertensive. NICE recommends that antenatal antihypertensive treatment should continue in the postnatal period unless methyldopa has been used.
Stopping methyldopa
- NICE is aware of a Medicines and Healthcare products Regulatory Agency (MHRA) report that considers methyldopa to be the drug of choice during pregnancy and breastfeeding [MHRA, 2009]. The MHRA states that methyldopa may not be suitable for some women. However NICE considers that this drug should not be used during the post-natal period, as women are already at risk of depression, and if possible, it should be stopped.
Advice on review and referral
- These recommendations are expert opinion from NICE [National Collaborating Centre for Women's and Children's Health, 2010]. NICE also considers that all women with gestational hypertension should have a review of their blood pressure at the post-natal review 6–8 weeks after the birth. Who carries out this review will depend on local circumstances and expertise, and NICE were not prescriptive about this. However NICE recommend that if the woman still requires antihypertensive treatment 6–8 weeks after the birth, then she should be offered a specialist assessment.
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