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Pregnant women with hypertension at risk of adverse pregnancy outcome

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Pregnant women with chronic hypertension commonly have adverse outcomes of pregnancy and require heightened antenatal monitoring, shows a recent UK study.

The systematic review and meta-analysis selected 55 studies involving pregnant women with chronic hypertension, with a total of 795,221 pregnancies featured. Incidence for each pregnancy outcome was reported, and in the 22 US-based studies the women who were pregnant and had hypertension were compared against the general US population of pregnant women.

Women with chronic hypertension had high incidences of superimposed pre-eclampsia  (25.9%), caesarean section (41.4%), preterm delivery (before 37 weeks’ gestation, 28.1%), birth weight below 2,500 g (16.9%), neonatal unit admission (20.5%), and perinatal death (4.0%)

The incidences of adverse outcomes in women with chronic hypertension were compared with women from the US general population, and showed significantly higher risks in those with chronic hypertension. Women with hypertension had a seven-fold greater risk of superimposed pre-eclampsia, compared with the general population, and a more than four-fold greater risk of perinatal death. They also had a three-fold risk of admission to neonatal intensive care, and a more than two-fold risk of preterm delivery and a neonate birth weight below 2,500g.

The researchers note that their results ‘support the importance of increased antenatal surveillance for women with chronic hypertension to enable early identification of evolving complications’ and that the ‘women should receive pre-pregnancy counselling to optimise their health before pregnancy and to inform them of the increased maternal and foetal risks associated with their hypertension. ‘

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