Women and Pregnancy
Because the use of oral contraceptives increases the risk of hypertension, women taking oral contraceptives should have regular BP checks. Hypertension in women who are pregnant may be classified as follows:
preeclampsia or eclampsia: preeclampsia—hypertension, proteinuria, generalized edema, and possibly coagulation and liver function abnormalities after 20 weeks’ gestation; eclampsia—those same abnormalities plus generalized seizures
chronic hypertension: BP greater than 140/90 mm Hg before 20 weeks’ gestation
chronic hypertension with superimposed preeclampsia or eclampsia
transient hypertension: hypertension without proteinuria or CNS manifestations during pregnancy; the return of normal BP within 10 days of delivery
Hypertension in women who are pregnant can potentially increase maternal and fetal morbidity and mortality. The possible adverse effects of antihypertensive drug therapy on fetal development must be considered, however, when pharmacologic treatment is planned. Methyldopa, β-blockers, and vasodilators are the recommended drugs for treatment of hypertension in pregnancy. ACE inhibitors and ARBs are contraindicated in pregnancy because of teratogenic effects; they should also be avoided in women who are likely to become pregnant.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.