Gebeliğin Hipertansif Hastalıkları
Özet
Gebelikteki hipertansifbozukluklar ,dünya çapında anne ve perinatal ölümlerin önde gelen nedenlerinden birini oluşturmaktadır.Yüksek gelirli ülkelerde anne ölümleri,gelişmekte olan ülkelere göre çok daha düşük olsa da,yüksek gelirli ülkelerdeki anne ölümlerinin %16'sı hipertansif bozukluklardan kaynaklanır.
Amerikan Kadın Doğum Uzmanları ve Jinekologlar Koleji (ACOG), gebe kadınlardaki hipertansiyonu klinik olarak en az 4 saat arayla 2 veya daha fazla durumda annenin sistolik kan basıncının ≥ 140 mm Hg'ye ve/veya diyastolik kan basıncının ≥ 90 mm Hg olması şeklinde tanımlar. Ayrıca şiddetli hipertansiyonu ≥160 mm Hg sürekli sistolik kan basıncı ve/veya ≥ 110 mmHgdiyastolik kan basıncı olarak kategorize eder; bu değerlerde tedavide gecikmeleri önlemek için 15 dakika gibi kısa bir sürede doğrulama yapılmasını önerir.Gebelik sürecinde görülen hipertansiyon;kronik hipertansiyon, sekonderhipertansiyon,gestasyonel hipertansiyon, preeklampsi/eklampsi, kronik hipertansiyona superempozepreeklampsi olarak sınıflandırılır.Antihipertansif ilaç tedavisine başlama eşikleri,tanıya,hipertansiyonun şiddetine ve eşlik eden hastalıklara bağlı olarak değişir.Gebelikte akut şiddetli hipertansiyon,komplikasyonları önlemek için genellikle 30-60 dakika içinde tedavi edilmesi gerekir.Akut ve kronik hipertansiyonda tedavi eşiği ≥160 mmHg sürekli sistolik basıncı ve/veya ≥ 110 mmHgdiyastolik kan basıncı olup kronik hastalarda tedavi hedefi 159-120/109-80 mmHg’dır.Şiddetli olmayan kan basıncı aralıkları için tedavi eşikleri tartışılmaya devam etmektedir.
Hypertensivedisorders in pregnancy constituteone of the leading causes of maternal and perinatal deaths world wide.Even tough maternal mortality is much lower in high-income countries than in developing countries ,16 % of maternal deaths in high-in come countries are caused by hypertensive disorders.
American College of Obstetricians and Gynecologists (ACOG) defines hypertension in pregnant women as maternal systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg on 2 or more occasions at least 4 hours apart and categorizes severe hypertension as sustained systolic blood pressure ≥160 mmHgand/or diastolic blood pressure ≥110 mmHg; recommends verification in 15 minutes to prevent delays in treatment.
Hypertension during pregnancy is classified as chronic hypertension, secondary hypertension, gestational hypertension, preeclampsia/eclampsia, and preeclampsia superimposed on chronic hypertension (8). Thresholds for initiating antihypertensive drug therapy vary depending on diagnosis, severity of hypertension, andcomorbidities. Acute severe hypertension in pregnancy requires immediate treatment, usually within 30 to 60 minutes, to prevent complications.The treatment threshold in acute or chronic hypertension is ≥160 mmHg sustained systolic blood pressure and/or ≥ 110 mmHg diastolic blood pressure and the treatment targets in chronic patients are 159-120/109-80 mmHg.Non-severe blood pressure range for treatment thresholds continues to be debated.
Referanslar
Khedagi AM, Bello NA. HypertensiveDisorders of Pregnancy. CardiolClin. 2021;39(1):77-90. doi:10.1016/j.ccl.2020.09.005
Veland K,NovyM,PetersonEN,et al: Maternalcardiovasculsar Dynamics. Am J ObstetGynecol 104:856,1969
Staelens AS, Van Cauwelaert S, Tomsin K, Mesens T, Malbrain ML, Gyselaers W. Intra- abdominalpressuremeasurements in termpregnancyandpostpartum: an observationalstudy. PLoSOne 2014;9:e104782.
Malbrain ML, De Keulenaer BL, Oda J, et al. Intra-abdominalhypertensionandabdominalcompartmentsyndrome in burns, obesity, pregnancy, and general medicine. AnaesthesiolIntensiveTher2015;47:228–40.
Belloni FL. Teachingtheprinciples of he- modynamics. Am J Physiol 1999;277: S187–202.
Gyselaers W. Hemodynamicpathways of gestationalhypertensionandpreeclampsia. Am J ObstetGynecol. 2022;226(2S):S988-S1005. doi:10.1016/j.ajog.2021.11.022
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA guidelinefortheprevention, Detection, evaluation, andmanagement of highbloodpressure in adults: executivesummary: a report of theAmericanCollege of Cardiology/AmericanheartassociationTask Force on clinicalpracticeguidelines. Hypertension 2018;71(6): 1269–324. [PubMed: 29133354]
Roberts JM, August PA, Bakris G, Barton JR, Bernstein IM, DruzinML,Gaiser RR, Granger JP, Jeyabalan A, Johnson DD, et al. Hypertension in pregnancy: report of theAmericanCollege of ObstetriciansandGynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol.2013;122:1122–1131. doi: 10.1097/01.AOG.0000437382.03963.88
Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, SaitoS,Hall DR, Warren CE, Adoyi G, Ishaku S; International SocietyfortheStudy of Hypertension in Pregnancy (ISSHP). Hypertensivedisorders of pregnancy: ISSHP classification, diagnosis, andmanagementrecommendationsforinternationalpractice. Hypertension. 2018;72:24–43. doi:10.1161/HYPERTENSIONAHA.117.10803
American College of ObstetriciansandGynecologists’ Committee on PracticeBulletins—Obstetrics. Chronichypertension in pregnancy: ACOG PracticeBulletinNumber 203. ObstetGynecol 2019;133(1):e26–50.
Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlof B, Sever PS, Poulter NR. Prognosticsignificance of visit-to-visitvariability, maximumsystolicbloodpressure, andepisodichypertension. Lancet.2010;375:895–905. doi: 10.1016/S0140-6736(10)60308-X.
Ma Y, Song A, Viswanathan A, Blacker D, Vernooij MW, HofmanA,Papatheodorou S. Blood pressurevariabilityandcerebralsmallvesseldisease: a systematicreviewand meta-analysis of population-basedcohorts. Stroke.2020;51:82–89. doi: 10.1161/STROKEAHA.119.026739
Global, regional, andnationallevels of maternalmortality, 1990–2015: a systematicanalysisforthe Global Burden of DiseaseStudy 2015. TheLancet. 2016;388:1775–1812.
American College of ObstetriciansandGynecologists’ Committee on PracticeBulletins—Obstetrics. Gestationalhypertensionandpreeclampsia: ACOG Prac- tice Bulletin, Number 222. ObstetGynecol 2020;135(6):e237–60
Garovic VD, Dechend R, Easterling T, et al. Hypertension in Pregnancy: Diagnosis, Blood PressureGoals, andPharmacotherapy: A Scientific Statement FromtheAmericanHeartAssociation [publishedcorrectionappears in Hypertension. 2022 Mar;79(3):e70]. Hypertension. 2022;79(2):e21-e41. doi:10.1161/HYP.0000000000000208
Abel N,ContinoK,Jain N, et al.EighthJointNationalCommittee (JNC-8) guidelinesandtheoutpatientmanagement of hypertension in theAfrican_Americanpopulation.NAm J MedSci 2015; 7 (10): 438-45
Society forMaternal-Fetal M, Publications Committee. Electronic addresspso. SocietyforMaternal-FetalMedicine Statement: Antihypertensivetherapyformildchronichypertension in pregnancy-TheChronicHypertensionandPreg- nancytrial. Am J ObstetGynecol 2022;227(2):B24–7.
ACoOa Gynecologists. ClinicalGuidanceforthe Integration of theFindings of theChronicHypertensionandPregnancy (CHAP) Study. ACOG. Practiceadvisory Web site. Available at: https://www.acog.org/clinical/clinical-guidance/practice- advisory/articles/2022/04/clinical-guidance-for-the-integration-of-the-findings-of- the-chronic-hypertension-and-pregnancy-chap-study. .Published 2022. Updated April 2022. AccessedJuly 11, 2022.
Tita AT, Szychowski JM, Boggess K, et al. Treatmentformildchronichyperten- sionduringpregnancy. N Engl J Med 2022;386(19):1781–92 (1533-4406 (Electronic)).
Weinstein L:Syndrome of hemolysis,elevatedliverenzymesandlowplateletcount a severe consequence of hypertension in pregnancy. Am J ObstetGynecol 142:159,1982.
Seely EW, Ecker J. Chronichypertension in pregnancy. Circulation2014;129(11):1254–61. [PubMed: 24637432]
Lecarpentier E, Tsatsaris V, Goffinet F, et al. Risk factors of superimposedpreeclampsia in womenwithessentialchronichypertensiontreatedbeforepregnancy. PLoSOne 2013;8(5):e62140. [PubMed: 23671584]
Meyer NL,MercerBM,FriedmanSA,etal:Urinarydipstick protein: a poorpredictor of absentor severe proteinuria.Am J ObstetGynecol 170:137,1994
Hinchey J,ChavesC,AppignaniB,et al. A reversibleposteriorleukoencephalopathysyndrome.NEngl J Med1996;334 (8):494-500
Everitt RB,WorlyRJ,MacDonaldJ,etal:Effect of prostaglandinsyntheticinhibitors on pressorresponsetoangiotensin II in humanpregnancy.JClinEndocrinolMetab 46:1007,1978
Mastrogiannİs DS,O’BrienWF,KrammerK,etal:Potential role of endothelial in normal andhypertensivepregnancies.Am J ObstetGynecol 165:1771,1997
ACOG committeeopinion No. 743: low-dose aspirin useduringpregnancy. ObstetGynecol 2018;132(1): e44–52. [PubMed: 29939940]
LeFevre M Low-dose aspirin usefortheprevention of morbidityandmortalityfrompreeclampsia: U.S. Preventive Services Task Force recommendationstatement. AnnInternMed2014;161:819– 26. [PubMed: 25200125]
Meher S, Duley L, Hunter K, et al. Antiplatelettherapybeforeorafter 16 weeks’ gestationforpreventingpreeclampsia: an individualparticipantdata meta-analysis. Am J ObstetGynecol 2017;216(2): 121–8.e2. [PubMed: 27810551]
Roberge S, Nicolaides K, Demers S, et al. The role of aspirin dose on theprevention of preeclampsiaandfetalgrowthrestriction: systematicreviewand meta-analysis. Am J ObstetGynecol 2017;216(2): 110–20.e6. [PubMed: 27640943]
108. Romero R, Erez O, Hüttemann M, Maymon E, Panaitescu B, Conde-Agudelo A, Pacora P, Yoon BH andGrossman LI. Metformin, the aspirin of the 21st century: its role in gestationaldiabetesmellitus, prevention of preeclampsiaandcancer, andthepromotion of longevity. AmericanJournal of Obstetrics&Gynecology.2017;217:282–302. [PubMed: 28619690]
Lambert G,BrichantJF,HartsteinG,etal.Preeclampsia:anupdate.ActaAnaesthesiol 2011;21 (2):207-14.
Sibai B:Diagnosis,prevention, andmanagement of eclampsia.ObstetGynecol 105:402,2005
Crowther CA, Brown J, McKinlay CJ, et al. Magnesiumsulphateforpreventingpretermbirth in threatenedpretermlabour. Cochrane Database SystRev 2014; (8):Cd001060. [PubMed: 25126773]
Euser AG, Cipolla MJ. Magnesiumsulfateforthetreatment of eclampsia: a briefreview. Stroke2009;40(4):1169–75. [PubMed: 19211496]
Physical activityandexerciseduringpregnancyandthepostpartumperiod: ACOG committeeopinion, number 804. ObstetGynecol 2020;135(4):e178–88. [PubMed: 32217980]
Hypertension in pregnancy. Report of theAmericanCollege of ObstetriciansandGynecologists’ Task Force on hypertension in pregnancy. ObstetGynecol 2013;122(5):1122–31. [PubMed: 24150027]
Rezk M, Ellakwa H, Gamal A, et al. Maternalandfetalmorbidityfollowingdiscontinuation of antihypertensivedrugs in mildtomoderatechronichypertension: a 4-year observationalstudy. PregnancyHypertens 2016;6(4):291–4. [PubMed: 27939471]
Nakhai-Pour HR, Rey E, Berard A. Discontinuation of antihypertensivedruguseduringthefirsttrimester of pregnancyandthe risk of preeclampsiaandeclampsiaamongwomenwithchronichypertension. Am J ObstetGynecol 2009;201(2): 180.e1–8. [PubMed: 19646568]
Webster LM, Myers JE, Nelson-Piercy C, et al. Labetalolversusnifedipine as antihypertensivetreatmentforchronichypertension in pregnancy: a randomizedcontrolledtrial. Hypertension2017;70(5): 915–22. [PubMed: 28893900]
Ferrer RL, Sibai BM, Mulrow CD, et al. Management of mildchronichypertensionduringpregnancy: a review. ObstetGynecol 2000;96(5, Part 2):849–60. [PubMed: 11094241]
Easterling TR, Carr DB, Brateng D, et al. Treatment of hypertension in pregnancy: effect of atenolol on maternaldisease, pretermdelivery, andfetalgrowth. ObstetGynecol 2001;98(3):427– 33. [PubMed: 11530124]
Bellos I, Pergialiotis V, Papapanagiotou A, Loutradis D andDaskalakis G. Comparativeefficacyandsafety of oral antihypertensiveagents in pregnantwomenwithchronichypertension: a network metaanalysis. AmericanJournal of Obstetrics&Gynecology. 2020;223:525–537. [PubMed: 32199925]
Easterling T, Mundle S, Bracken H, Parvekar S, Mool S, Magee LA, vonDadelszen P, Shochet T andWinikoff B. Oral antihypertensiveregimens (nifedipineretard, labetalol, andmethyldopa) formanagement of severe hypertension in pregnancy: an open-label, randomisedcontrolledtrial. TheLancet.2019;394:1011–1021.
Collins R, Yusuf S, Peto R. Overview of randomisedtrials of diuretics in pregnancy. BrMed J (ClinResEd 1985;290(6461):17–23.
Lopes Perdigao J, Lewey J, Hirshberg A, Koelper N, Srinivas SK, Elovitz MA andLevine LD. Furosemideforacceleratedrecovery of bloodpressurepostpartum in womenwith a hypertensivedisorder of pregnancy: a randomizedcontrolledtrial. Hypertension.2021:Hypertensionaha12016133.
Nij Bijvank SW andDuvekot JJ. Nicardipineforthetreatment of severe hypertension in pregnancy: a review of theliterature. Obstetrical&GynecologicalSurvey. 2010;65:341–7. [PubMed: 20591204]
Tuimala R, Punnonen R andKauppila E. Clonidine in thetreatment of hypertensionduringpregnancy. AnnalesChirurgiae et GynaecologiaeSupplementum1985;197:47–50. [PubMed: 3863531]
Veena P, Perivela L andRaghavan SS. Furosemide in postpartummanagement of severe preeclampsia: A randomizedcontrolledtrial. Hypertension in Pregnancy. 2017;36:84–89. [PubMed: 27835048]
Duley L, Meher S, Jones L. Drugsfortreatment of veryhighbloodpressureduringpregnancy. Cochrane Database SystRev 2013;7:CD001449.
Mito A, Murashima A, Wada Y, Miyasato-Isoda M, Kamiya CA, Waguri M, Yoshimatsu J, Yakuwa N, Watanabe O, Suzuki T, Arata N, Mikami M andIto S. Safety of amlodipine in earlypregnancy. Journal of theAmericanHeartAssociation. 2019;8:e012093. [PubMed: 31345083]
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Referanslar
Khedagi AM, Bello NA. HypertensiveDisorders of Pregnancy. CardiolClin. 2021;39(1):77-90. doi:10.1016/j.ccl.2020.09.005
Veland K,NovyM,PetersonEN,et al: Maternalcardiovasculsar Dynamics. Am J ObstetGynecol 104:856,1969
Staelens AS, Van Cauwelaert S, Tomsin K, Mesens T, Malbrain ML, Gyselaers W. Intra- abdominalpressuremeasurements in termpregnancyandpostpartum: an observationalstudy. PLoSOne 2014;9:e104782.
Malbrain ML, De Keulenaer BL, Oda J, et al. Intra-abdominalhypertensionandabdominalcompartmentsyndrome in burns, obesity, pregnancy, and general medicine. AnaesthesiolIntensiveTher2015;47:228–40.
Belloni FL. Teachingtheprinciples of he- modynamics. Am J Physiol 1999;277: S187–202.
Gyselaers W. Hemodynamicpathways of gestationalhypertensionandpreeclampsia. Am J ObstetGynecol. 2022;226(2S):S988-S1005. doi:10.1016/j.ajog.2021.11.022
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA guidelinefortheprevention, Detection, evaluation, andmanagement of highbloodpressure in adults: executivesummary: a report of theAmericanCollege of Cardiology/AmericanheartassociationTask Force on clinicalpracticeguidelines. Hypertension 2018;71(6): 1269–324. [PubMed: 29133354]
Roberts JM, August PA, Bakris G, Barton JR, Bernstein IM, DruzinML,Gaiser RR, Granger JP, Jeyabalan A, Johnson DD, et al. Hypertension in pregnancy: report of theAmericanCollege of ObstetriciansandGynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol.2013;122:1122–1131. doi: 10.1097/01.AOG.0000437382.03963.88
Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, SaitoS,Hall DR, Warren CE, Adoyi G, Ishaku S; International SocietyfortheStudy of Hypertension in Pregnancy (ISSHP). Hypertensivedisorders of pregnancy: ISSHP classification, diagnosis, andmanagementrecommendationsforinternationalpractice. Hypertension. 2018;72:24–43. doi:10.1161/HYPERTENSIONAHA.117.10803
American College of ObstetriciansandGynecologists’ Committee on PracticeBulletins—Obstetrics. Chronichypertension in pregnancy: ACOG PracticeBulletinNumber 203. ObstetGynecol 2019;133(1):e26–50.
Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlof B, Sever PS, Poulter NR. Prognosticsignificance of visit-to-visitvariability, maximumsystolicbloodpressure, andepisodichypertension. Lancet.2010;375:895–905. doi: 10.1016/S0140-6736(10)60308-X.
Ma Y, Song A, Viswanathan A, Blacker D, Vernooij MW, HofmanA,Papatheodorou S. Blood pressurevariabilityandcerebralsmallvesseldisease: a systematicreviewand meta-analysis of population-basedcohorts. Stroke.2020;51:82–89. doi: 10.1161/STROKEAHA.119.026739
Global, regional, andnationallevels of maternalmortality, 1990–2015: a systematicanalysisforthe Global Burden of DiseaseStudy 2015. TheLancet. 2016;388:1775–1812.
American College of ObstetriciansandGynecologists’ Committee on PracticeBulletins—Obstetrics. Gestationalhypertensionandpreeclampsia: ACOG Prac- tice Bulletin, Number 222. ObstetGynecol 2020;135(6):e237–60
Garovic VD, Dechend R, Easterling T, et al. Hypertension in Pregnancy: Diagnosis, Blood PressureGoals, andPharmacotherapy: A Scientific Statement FromtheAmericanHeartAssociation [publishedcorrectionappears in Hypertension. 2022 Mar;79(3):e70]. Hypertension. 2022;79(2):e21-e41. doi:10.1161/HYP.0000000000000208
Abel N,ContinoK,Jain N, et al.EighthJointNationalCommittee (JNC-8) guidelinesandtheoutpatientmanagement of hypertension in theAfrican_Americanpopulation.NAm J MedSci 2015; 7 (10): 438-45
Society forMaternal-Fetal M, Publications Committee. Electronic addresspso. SocietyforMaternal-FetalMedicine Statement: Antihypertensivetherapyformildchronichypertension in pregnancy-TheChronicHypertensionandPreg- nancytrial. Am J ObstetGynecol 2022;227(2):B24–7.
ACoOa Gynecologists. ClinicalGuidanceforthe Integration of theFindings of theChronicHypertensionandPregnancy (CHAP) Study. ACOG. Practiceadvisory Web site. Available at: https://www.acog.org/clinical/clinical-guidance/practice- advisory/articles/2022/04/clinical-guidance-for-the-integration-of-the-findings-of- the-chronic-hypertension-and-pregnancy-chap-study. .Published 2022. Updated April 2022. AccessedJuly 11, 2022.
Tita AT, Szychowski JM, Boggess K, et al. Treatmentformildchronichyperten- sionduringpregnancy. N Engl J Med 2022;386(19):1781–92 (1533-4406 (Electronic)).
Weinstein L:Syndrome of hemolysis,elevatedliverenzymesandlowplateletcount a severe consequence of hypertension in pregnancy. Am J ObstetGynecol 142:159,1982.
Seely EW, Ecker J. Chronichypertension in pregnancy. Circulation2014;129(11):1254–61. [PubMed: 24637432]
Lecarpentier E, Tsatsaris V, Goffinet F, et al. Risk factors of superimposedpreeclampsia in womenwithessentialchronichypertensiontreatedbeforepregnancy. PLoSOne 2013;8(5):e62140. [PubMed: 23671584]
Meyer NL,MercerBM,FriedmanSA,etal:Urinarydipstick protein: a poorpredictor of absentor severe proteinuria.Am J ObstetGynecol 170:137,1994
Hinchey J,ChavesC,AppignaniB,et al. A reversibleposteriorleukoencephalopathysyndrome.NEngl J Med1996;334 (8):494-500
Everitt RB,WorlyRJ,MacDonaldJ,etal:Effect of prostaglandinsyntheticinhibitors on pressorresponsetoangiotensin II in humanpregnancy.JClinEndocrinolMetab 46:1007,1978
Mastrogiannİs DS,O’BrienWF,KrammerK,etal:Potential role of endothelial in normal andhypertensivepregnancies.Am J ObstetGynecol 165:1771,1997
ACOG committeeopinion No. 743: low-dose aspirin useduringpregnancy. ObstetGynecol 2018;132(1): e44–52. [PubMed: 29939940]
LeFevre M Low-dose aspirin usefortheprevention of morbidityandmortalityfrompreeclampsia: U.S. Preventive Services Task Force recommendationstatement. AnnInternMed2014;161:819– 26. [PubMed: 25200125]
Meher S, Duley L, Hunter K, et al. Antiplatelettherapybeforeorafter 16 weeks’ gestationforpreventingpreeclampsia: an individualparticipantdata meta-analysis. Am J ObstetGynecol 2017;216(2): 121–8.e2. [PubMed: 27810551]
Roberge S, Nicolaides K, Demers S, et al. The role of aspirin dose on theprevention of preeclampsiaandfetalgrowthrestriction: systematicreviewand meta-analysis. Am J ObstetGynecol 2017;216(2): 110–20.e6. [PubMed: 27640943]
108. Romero R, Erez O, Hüttemann M, Maymon E, Panaitescu B, Conde-Agudelo A, Pacora P, Yoon BH andGrossman LI. Metformin, the aspirin of the 21st century: its role in gestationaldiabetesmellitus, prevention of preeclampsiaandcancer, andthepromotion of longevity. AmericanJournal of Obstetrics&Gynecology.2017;217:282–302. [PubMed: 28619690]
Lambert G,BrichantJF,HartsteinG,etal.Preeclampsia:anupdate.ActaAnaesthesiol 2011;21 (2):207-14.
Sibai B:Diagnosis,prevention, andmanagement of eclampsia.ObstetGynecol 105:402,2005
Crowther CA, Brown J, McKinlay CJ, et al. Magnesiumsulphateforpreventingpretermbirth in threatenedpretermlabour. Cochrane Database SystRev 2014; (8):Cd001060. [PubMed: 25126773]
Euser AG, Cipolla MJ. Magnesiumsulfateforthetreatment of eclampsia: a briefreview. Stroke2009;40(4):1169–75. [PubMed: 19211496]
Physical activityandexerciseduringpregnancyandthepostpartumperiod: ACOG committeeopinion, number 804. ObstetGynecol 2020;135(4):e178–88. [PubMed: 32217980]
Hypertension in pregnancy. Report of theAmericanCollege of ObstetriciansandGynecologists’ Task Force on hypertension in pregnancy. ObstetGynecol 2013;122(5):1122–31. [PubMed: 24150027]
Rezk M, Ellakwa H, Gamal A, et al. Maternalandfetalmorbidityfollowingdiscontinuation of antihypertensivedrugs in mildtomoderatechronichypertension: a 4-year observationalstudy. PregnancyHypertens 2016;6(4):291–4. [PubMed: 27939471]
Nakhai-Pour HR, Rey E, Berard A. Discontinuation of antihypertensivedruguseduringthefirsttrimester of pregnancyandthe risk of preeclampsiaandeclampsiaamongwomenwithchronichypertension. Am J ObstetGynecol 2009;201(2): 180.e1–8. [PubMed: 19646568]
Webster LM, Myers JE, Nelson-Piercy C, et al. Labetalolversusnifedipine as antihypertensivetreatmentforchronichypertension in pregnancy: a randomizedcontrolledtrial. Hypertension2017;70(5): 915–22. [PubMed: 28893900]
Ferrer RL, Sibai BM, Mulrow CD, et al. Management of mildchronichypertensionduringpregnancy: a review. ObstetGynecol 2000;96(5, Part 2):849–60. [PubMed: 11094241]
Easterling TR, Carr DB, Brateng D, et al. Treatment of hypertension in pregnancy: effect of atenolol on maternaldisease, pretermdelivery, andfetalgrowth. ObstetGynecol 2001;98(3):427– 33. [PubMed: 11530124]
Bellos I, Pergialiotis V, Papapanagiotou A, Loutradis D andDaskalakis G. Comparativeefficacyandsafety of oral antihypertensiveagents in pregnantwomenwithchronichypertension: a network metaanalysis. AmericanJournal of Obstetrics&Gynecology. 2020;223:525–537. [PubMed: 32199925]
Easterling T, Mundle S, Bracken H, Parvekar S, Mool S, Magee LA, vonDadelszen P, Shochet T andWinikoff B. Oral antihypertensiveregimens (nifedipineretard, labetalol, andmethyldopa) formanagement of severe hypertension in pregnancy: an open-label, randomisedcontrolledtrial. TheLancet.2019;394:1011–1021.
Collins R, Yusuf S, Peto R. Overview of randomisedtrials of diuretics in pregnancy. BrMed J (ClinResEd 1985;290(6461):17–23.
Lopes Perdigao J, Lewey J, Hirshberg A, Koelper N, Srinivas SK, Elovitz MA andLevine LD. Furosemideforacceleratedrecovery of bloodpressurepostpartum in womenwith a hypertensivedisorder of pregnancy: a randomizedcontrolledtrial. Hypertension.2021:Hypertensionaha12016133.
Nij Bijvank SW andDuvekot JJ. Nicardipineforthetreatment of severe hypertension in pregnancy: a review of theliterature. Obstetrical&GynecologicalSurvey. 2010;65:341–7. [PubMed: 20591204]
Tuimala R, Punnonen R andKauppila E. Clonidine in thetreatment of hypertensionduringpregnancy. AnnalesChirurgiae et GynaecologiaeSupplementum1985;197:47–50. [PubMed: 3863531]
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