CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Hypertension in pregnancy - Management
Basis for recommendation
Monitoring and review by a specialist
Monitoring and investigations postpartum
- These recommendations are expert opinion from NICE [National Collaborating Centre for Women's and Children's Health, 2010].
- NICE identified no evidence about investigations and treatment and, therefore, recommends that the investigations and observations relevant to the antenatal period also applied to the post-natal period, taking into account that blood pressure peaks between 3–5 days after birth.
- Women may develop pre-eclampsia after birth and NICE recommends that symptoms of pre-eclampsia be enquired about at each assessment.
Choice of antihypertensive drug
- NICE found a lack of good-quality evidence about choice of drug and whether antihypertensive treatment should be given routinely to women with pre-eclampsia. It therefore recommends that antihypertensive treatment used during the pregnancy should be continued, unless this was methyldopa.
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 postnatal period, as women are already at risk of depression, and if possible, it should be stopped.
Advice on review and referral
- These recommendations are based on expert opinion from NICE [National Collaborating Centre for Women's and Children's Health, 2010]. NICE also considers that all women with pre-eclampsia should have a review of their blood pressure at the postnatal 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 recommends specialist referral for women with persistent hypertension or proteinuria or both.
© NHS Institute for Innovation and Improvement