Guideline No. 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management

This guideline was developed by maternity care providers from obstetrics and internal medicine. It reviews the diagnosis, evaluation, and management of the hypertensive disorders of pregnancy (HDPs), the prediction and prevention of preeclampsia, and the postpartum care of women with a previous HDP. Pregnant women. Implementation of the recommendations in these guidelines may reduce the incidence of the HDPs, particularly preeclampsia, and associated adverse outcomes. A comprehensive literature review was updated to December 2020, following the same methods as for previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines, and references were restricted to English or French. To support recommendations for therapies, we prioritized randomized controlled trials and systematic reviews (if available), and evaluated substantive clinical outcomes for mothers and babies. The authors agreed on the content and recommendations through consensus and responded to peer review by the SOGC Maternal Fetal Medicine Committee. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, along with the option of designating a recommendation as a “good practice point.” See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).The Board of the SOGC approved the final draft for publication. All health care providers (obstetricians, family doctors, midwives, nurses, and anesthesiologists) who provide care to women before, during, or after pregnancy. 1.Pre-conception counselling is suggested for women with pre-pregnancy hypertension to advise on individualized management during pregnancy (conditional, low).2.Replacing angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) with other antihypertensives in women planning pregnancy is recommended unless there is a compelling clinical indication not to (strong, low).3.In early pregnancy, women should be screened, at a minimum, for clinical risk markers for preeclampsia (strong, moderate).4.If testing is available, women should be screened at 11–14 weeks gestation using a combination of clinical risk markers, uterine artery pulsatility index, and placental growth factor (PlGF) to individualize the risk of developing preeclampsia (strong, moderate).5.For women at increased risk of preeclampsia, low-dose acet