Management of hypertensive disorders during pregnancy: summary of NICE guidance

Reducing the risk of hypertensive disorders in pregnancy Advise pregnant women of their risk of developing hypertensive disorders during pregnancy (in particular pre-eclampsia; see box 2) and of the need to seek immediate advice from a healthcare professional if they experience symptoms of pre-eclampsia (severe headache; problems with vision, such as blurring or flashing before the eyes; severe pain just below the ribs; vomiting; sudden swelling of face, hands, or feet). Box 2 Risk factors for pre-eclampsia Moderate risk Age 40 years or more First pregnancy Multiple pregnancy Interval since last pregnancy of more than 10 years Body mass index of 35 or more at presentation Family history of pre-eclampsia High risk Chronic hypertension Chronic kidney disease Hypertensive disease during a previous pregnancy Diabetes Autoimmune disease Advise women with at least one high risk factor for pre-eclampsia or at least two moderate risk factors for pre-eclampsia (box 2) to take 75 mg of aspirin daily from 12 weeks until the birth of the baby. [Based on high quality evidence from meta-analyses of randomised controlled trials and a health economic model developed for the guideline] Although several drugs (nitric oxide donors, progesterone, diuretics, and low molecular weight heparin) and vitamin and nutrient supplements (such as vitamin C, vitamin E, folic acid, magnesium, fish oils, algal oils, and garlic) have been studied as preventive treatments for hypertensive disorders, these have not shown benefit and should not be given for this purpose. Aim to keep blood pressure lower than 150/100 mm Hg in...