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Am J Perinatol
DOI: 10.1055/a-2051-2127
Review Article

Hypertensive Disorders of Pregnancy and the Cardiovascular System: Causes, Consequences, Therapy, and Prevention

Ahmet A. Baschat 
1   Johns Hopkins Center for Fetal Therapy, Baltimore, Maryland
,
Kristin Darwin 
2   Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
,
Arthur J. Vaught
2   Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
› Author Affiliations
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Abstract

Hypertensive disorders of pregnancy continue to be significant contributors to adverse perinatal outcome and maternal mortality, as well as inducing life-long cardiovascular health impacts that are proportional to the severity and frequency of pregnancy complications. The placenta is the interface between the mother and fetus and its failure to undergo vascular maturation in tandem with maternal cardiovascular adaptation by the end of the first trimester predisposes to hypertensive disorders and fetal growth restriction. While primary failure of trophoblastic invasion with incomplete maternal spiral artery remodeling has been considered central to the pathogenesis of preeclampsia, cardiovascular risk factors associated with abnormal first trimester maternal blood pressure and cardiovascular adaptation produce identical placental pathology leading to hypertensive pregnancy disorders. Outside pregnancy blood pressure treatment thresholds are identified with the goal to prevent immediate risks from severe hypertension >160/100 mm Hg and long-term health impacts that arise from elevated blood pressures as low as 120/80 mm Hg. Until recently, the trend for less aggressive blood pressure management during pregnancy was driven by fear of inducing placental malperfusion without a clear clinical benefit. However, placental perfusion is not dependent on maternal perfusion pressure during the first trimester and risk-appropriate blood pressure normalization may provide the opportunity to protect from the placental maldevelopment that predisposes to hypertensive disorders of pregnancy. Recent randomized trials set the stage for more aggressive risk-appropriate blood pressure management that may offer a greater potential for prevention for hypertensive disorders of pregnancy.

Key Points

  • Optimal management of maternal blood pressure to prevent preeclampsia and its risks is undefined.

  • Early gestational rheological damage to the intervillous space predisposes to preeclampsia and FGR.

  • First trimester blood pressure management may need to aim for normotension to prevent preeclampsia.

Keywords

blood pressure - preeclampsia - prevention - first trimester - cardiovascular disease - hypertension


Publication History

Received: 20 May 2022

Accepted: 06 March 2023

Accepted Manuscript online:
09 March 2023

Article published online:
10 April 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol 2000; 183 (01) S1-S22
    CrossrefPubMedGoogle Scholar
  • 2 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep 2021; 70 (02) 1-51
    PubMedGoogle Scholar
  • 3 Dolea C, AbouZahr C. Global burden of hypertensive disorders of pregnancy in the year 2000. In: Evidence and Information for Policy (EIP). World Health Organization; . accessed February 2022 at: http://www.who.int/healthinfo/statistics/bod_hypertensivedisordersofpregnancy.pdf
    Google Scholar
  • 4 Wallis AB, Saftlas AF, Hsia J, Atrash HK. Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, United States, 1987-2004. Am J Hypertens 2008; 21 (05) 521-526
    CrossrefPubMedGoogle Scholar
  • 5 Panaitescu AM, Syngelaki A, Prodan N, Akolekar R, Nicolaides KH. Chronic hypertension and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol 2017; 50 (02) 228-235
    CrossrefPubMedGoogle Scholar
  • 6 Rezk M, Gamal A, Emara M. Maternal and fetal outcome in de novo preeclampsia in comparison to superimposed preeclampsia: a two-year observational study. Hypertens Pregnancy 2015; 34 (02) 137-144
    CrossrefPubMedGoogle Scholar
  • 7 Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367 (9516): 1066-1074
    CrossrefPubMedGoogle Scholar
  • 8 Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol 2010; 116 (06) 1302-1309
    CrossrefPubMedGoogle Scholar
  • 9 Arabin B, Baschat AA. Pregnancy: an underutilized window of opportunity to improve long-term maternal and infant health-an appeal for continuous family care and interdisciplinary communication. Front Pediatr 2017; 5: 69
    CrossrefPubMedGoogle Scholar
  • 10 Baschat AA. First-trimester screening for pre-eclampsia: moving from personalized risk prediction to prevention. Ultrasound Obstet Gynecol 2015; 45 (02) 119-129
    CrossrefPubMedGoogle Scholar
  • 11 Sonek JD, Kagan KO, Nicolaides KH. Inverted pyramid of care. Clin Lab Med 2016; 36 (02) 305-317
    CrossrefPubMedGoogle Scholar
  • 12 Tsigas EZ. The Preeclampsia Foundation: the voice and views of the patient and her family. Am J Obstet Gynecol 2022; 226 (2S): S1254, 1264.e1
    CrossrefPubMedGoogle Scholar
  • 13 Roberts VHJ, Morgan TK, Bednarek P. et al. Early first trimester uteroplacental flow and the progressive disintegration of spiral artery plugs: new insights from contrast-enhanced ultrasound and tissue histopathology. Hum Reprod 2017; 32 (12) 2382-2393
    CrossrefPubMedGoogle Scholar
  • 14 Allerkamp HH, Clark AR, Lee TC, Morgan TK, Burton GJ, James JL. Something old, something new: digital quantification of uterine vascular remodelling and trophoblast plugging in historical collections provides new insight into adaptation of the utero-placental circulation. Hum Reprod 2021; 36 (03) 571-586
    CrossrefPubMedGoogle Scholar
  • 15 Kaufmann P, Scheffen I. Placental development. In: Polin RA, Fox WW. eds. Fetal and Neonatal Physiology. Philadelphia: WB Saunders; 1998: 59-70
    Google Scholar
  • 16 Foidart JM, Hustin J, Dubois M, Schaaps JP. The human placenta becomes haemochorial at the 13th week of pregnancy. Int J Dev Biol 1992; 36 (03) 451-453
    PubMedGoogle Scholar
  • 17 Hustin J, Schaaps JP. Echographic [corrected] and anatomic studies of the maternotrophoblastic border during the first trimester of pregnancy. Am J Obstet Gynecol 1987; 157 (01) 162-168
    CrossrefPubMedGoogle Scholar
  • 18 Burton GJ, Woods AW, Jauniaux E, Kingdom JC. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy. Placenta 2009; 30 (06) 473-482
    CrossrefPubMedGoogle Scholar
  • 19 Pritchard JA. Changes in the blood volume during pregnancy and delivery. Anesthesiology 1965; 26: 393-399
    CrossrefPubMedGoogle Scholar
  • 20 Robson SC, Hunter S, Boys RJ, Dunlop W. Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol 1989; 256 (4 pt 2): H1060-H1065
    PubMedGoogle Scholar
  • 21 Metcalfe J, Ueland K. Maternal cardiovascular adjustments to pregnancy. Prog Cardiovasc Dis 1974; 16 (04) 363-374
    CrossrefPubMedGoogle Scholar
  • 22 Curran-Everett D, Morris Jr KG, Moore LG. Regional circulatory contributions to increased systemic vascular conductance of pregnancy. Am J Physiol 1991; 261 (6 pt 2): H1842-H1847
    PubMedGoogle Scholar
  • 23 Ouzounian JG, Elkayam U. Physiologic changes during normal pregnancy and delivery. Cardiol Clin 2012; 30 (03) 317-329
    CrossrefPubMedGoogle Scholar
  • 24 Chapman AB, Abraham WT, Zamudio S. et al. Temporal relationships between hormonal and hemodynamic changes in early human pregnancy. Kidney Int 1998; 54 (06) 2056-2063
    CrossrefPubMedGoogle Scholar
  • 25 Thomsen JK, Fogh-Andersen N, Jaszczak P, Giese J. Atrial natriuretic peptide (ANP) decrease during normal pregnancy as related to hemodynamic changes and volume regulation. Acta Obstet Gynecol Scand 1993; 72 (02) 103-110
    CrossrefPubMedGoogle Scholar
  • 26 Fournier A, Gregoire I, el Esper N. et al. Atrial natriuretic factor in pregnancy and pregnancy-induced hypertension. Can J Physiol Pharmacol 1991; 69 (10) 1601-1608
    CrossrefPubMedGoogle Scholar
  • 27 Sala C, Campise M, Ambroso G, Motta T, Zanchetti A, Morganti A. Atrial natriuretic peptide and hemodynamic changes during normal human pregnancy. Hypertension 1995; 25 (4 Pt 1): 631-636
    CrossrefPubMedGoogle Scholar
  • 28 Baschat AA. Fetal responses to placental insufficiency: an update. BJOG 2004; 111 (10) 1031-1041
    CrossrefPubMedGoogle Scholar
  • 29 Block-Abraham DM, Turan OM, Doyle LE. et al. First-trimester risk factors for preeclampsia development in women initiating aspirin by 16 weeks of gestation. Obstet Gynecol 2014; 123 (03) 611-617
    CrossrefPubMedGoogle Scholar
  • 30 Melchiorre K, Giorgione V, Thilaganathan B. The placenta and preeclampsia: villain or victim?. Am J Obstet Gynecol 2022; 226 (2S): S954-S962
    Google Scholar
  • 31 Allotey J, Snell KI, Smuk M. et al. Validation and development of models using clinical, biochemical and ultrasound markers for predicting pre-eclampsia: an individual participant data meta-analysis. Health Technol Assess 2020; 24 (72) 1-252
    CrossrefPubMedGoogle Scholar
  • 32 Scholten RR, Hopman MT, Sweep FC. et al. Co-occurrence of cardiovascular and prothrombotic risk factors in women with a history of preeclampsia. Obstet Gynecol 2013; 121 (01) 97-105
    CrossrefPubMedGoogle Scholar
  • 33 Meekins JW, Pijnenborg R, Hanssens M, McFadyen IR, van Asshe A. A study of placental bed spiral arteries and trophoblast invasion in normal and severe pre-eclamptic pregnancies. Br J Obstet Gynaecol 1994; 101 (08) 669-674
    CrossrefPubMedGoogle Scholar
  • 34 Ridder A, Giorgione V, Khalil A, Thilaganathan B. Preeclampsia: the relationship between uterine artery blood flow and trophoblast function. Int J Mol Sci 2019; 20 (13) 3263
    CrossrefPubMedGoogle Scholar
  • 35 Khong TY, De Wolf F, Robertson WB, Brosens I. Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants. Br J Obstet Gynaecol 1986; 93 (10) 1049-1059
    CrossrefPubMedGoogle Scholar
  • 36 Brosens I, Pijnenborg R, Vercruysse L, Romero R. The “Great Obstetrical Syndromes” are associated with disorders of deep placentation. Am J Obstet Gynecol 2011; 204 (03) 193-201
    CrossrefPubMedGoogle Scholar
  • 37 Granger JP, Alexander BT, Llinas MT, Bennett WA, Khalil RA. Pathophysiology of hypertension during preeclampsia linking placental ischemia with endothelial dysfunction. Hypertension 2001; 38 (3 Pt 2): 718-722
    CrossrefPubMedGoogle Scholar
  • 38 Powe CE, Levine RJ, Karumanchi SA. Preeclampsia, a disease of the maternal endothelium: the role of antiangiogenic factors and implications for later cardiovascular disease. Circulation 2011; 123 (24) 2856-2869
    CrossrefPubMedGoogle Scholar
  • 39 Redman CW, Sargent IL. Immunology of pre-eclampsia. Am J Reprod Immunol 2010; 63 (06) 534-543
    CrossrefPubMedGoogle Scholar
  • 40 Roberts JM, Bell MJ. If we know so much about preeclampsia, why haven't we cured the disease?. J Reprod Immunol 2013; 99 (1-2): 1-9
    CrossrefPubMedGoogle Scholar
  • 41 Pijnenborg R, Vercruysse L, Hanssens M. The uterine spiral arteries in human pregnancy: facts and controversies. Placenta 2006; 27 (9-10): 939-958
    CrossrefPubMedGoogle Scholar
  • 42 Scholten RR, Lotgering FK, Hopman MT. et al. Low plasma volume in normotensive formerly preeclamptic women predisposes to hypertension. Hypertension 2015; 66 (05) 1066-1072
    CrossrefPubMedGoogle Scholar
  • 43 Gabbay-Benziv R, Oliveira N, Baschat AA. Optimal first trimester preeclampsia prediction: a comparison of multimarker algorithm, risk profiles and their sequential application. Prenat Diagn 2016; 36 (01) 34-39
    CrossrefPubMedGoogle Scholar
  • 44 Karimu AL, Burton GJ. The effects of maternal vascular pressure on the dimensions of the placental capillaries. Br J Obstet Gynaecol 1994; 101 (01) 57-63
    CrossrefPubMedGoogle Scholar
  • 45 Burton GJ, Jauniaux E. Pathophysiology of placental-derived fetal growth restriction. Am J Obstet Gynecol 2018; 218 (2S): S745-S761
    CrossrefPubMedGoogle Scholar
  • 46 Jauniaux E, Nicolaides KH. Placental lakes, absent umbilical artery diastolic flow and poor fetal growth in early pregnancy. Ultrasound Obstet Gynecol 1996; 7 (02) 141-144
    CrossrefPubMedGoogle Scholar
  • 47 Hutchinson ES, Brownbill P, Jones NW. et al. Utero-placental haemodynamics in the pathogenesis of pre-eclampsia. Placenta 2009; 30 (07) 634-641
    CrossrefPubMedGoogle Scholar
  • 48 Salafia CM, Pezzullo JC, López-Zeno JA, Simmens S, Minior VK, Vintzileos AM. Placental pathologic features of preterm preeclampsia. Am J Obstet Gynecol 1995; 173 (04) 1097-1105
    CrossrefPubMedGoogle Scholar
  • 49 Falco ML, Sivanathan J, Laoreti A, Thilaganathan B, Khalil A. Placental histopathology associated with pre-eclampsia: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2017; 50 (03) 295-301
    CrossrefPubMedGoogle Scholar
  • 50 Hayward RM, Foster E, Tseng ZH. Maternal and fetal outcomes of admission for delivery in women with congenital heart disease. JAMA Cardiol 2017; 2 (06) 664-671
    CrossrefPubMedGoogle Scholar
  • 51 Drenthen W, Boersma E, Balci A. et al; ZAHARA Investigators. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J 2010; 31 (17) 2124-2132
    CrossrefPubMedGoogle Scholar
  • 52 Bartl W, Müller-Tyl E. Placental morphology and clinical correlations in pregnancies complicated by hypertension. Biol Res Pregnancy Perinatol 1985; 6 (04) 173-176
    PubMedGoogle Scholar
  • 53 Ducas R, Saini BS, Yamamura K. et al. Maternal and fetal hemodynamic adaptations to pregnancy and clinical outcomes in maternal cardiac disease. Can J Cardiol 2021; 37 (12) 1942-1950
    CrossrefPubMedGoogle Scholar
  • 54 Brown MA, Gallery ED. Volume homeostasis in normal pregnancy and pre-eclampsia: physiology and clinical implications. Baillieres Clin Obstet Gynaecol 1994; 8 (02) 287-310
    CrossrefPubMedGoogle Scholar
  • 55 Salas SP, Rosso P, Espinoza R, Robert JA, Valdés G, Donoso E. Maternal plasma volume expansion and hormonal changes in women with idiopathic fetal growth retardation. Obstet Gynecol 1993; 81 (06) 1029-1033
    PubMedGoogle Scholar
  • 56 Nagaya N, Nishikimi T, Uematsu M. et al. Secretion patterns of brain natriuretic peptide and atrial natriuretic peptide in patients with or without pulmonary hypertension complicating atrial septal defect. Am Heart J 1998; 136 (02) 297-301
    CrossrefPubMedGoogle Scholar
  • 57 Westerlind A, Wåhlander H, Lindstedt G, Lundberg PA, Holmgren D. Clinical signs of heart failure are associated with increased levels of natriuretic peptide types B and A in children with congenital heart defects or cardiomyopathy. Acta Paediatr 2004; 93 (03) 340-345
    CrossrefPubMedGoogle Scholar
  • 58 Furuhashi N, Kimura H, Nagae H, Yajima A, Kimura C, Saito T. Brain natriuretic peptide and atrial natriuretic peptide levels in normal pregnancy and preeclampsia. Gynecol Obstet Invest 1994; 38 (02) 73-77
    CrossrefPubMedGoogle Scholar
  • 59 Adam B, Malatyalioğlu E, Alvur M, Kökçü A, Bedir A. Plasma atrial natriuretic peptide levels in preeclampsia and eclampsia. J Matern Fetal Investig 1998; 8: 85-88
    PubMedGoogle Scholar
  • 60 Tihtonen KM, Kööbi T, Vuolteenaho O, Huhtala HS, Uotila JT. Natriuretic peptides and hemodynamics in preeclampsia. Am J Obstet Gynecol 2007; 196 (04) 328.e1-328.e7
    CrossrefPubMedGoogle Scholar
  • 61 Yap SC, Drenthen W, Meijboom FJ. et al; ZAHARA investigators. Comparison of pregnancy outcomes in women with repaired versus unrepaired atrial septal defect. BJOG 2009; 116 (12) 1593-1601
    CrossrefPubMedGoogle Scholar
  • 62 Yap SC, Drenthen W, Pieper PG. et al; ZAHARA investigators. Pregnancy outcome in women with repaired versus unrepaired isolated ventricular septal defect. BJOG 2010; 117 (06) 683-689
    CrossrefPubMedGoogle Scholar
  • 63 Kolovetsiou-Kreiner V, Moertl MG, Papousek I. et al. Maternal cardiovascular and endothelial function from first trimester to postpartum. PLoS One 2018; 13 (05) e0197748
    CrossrefPubMedGoogle Scholar
  • 64 Hermida RC, Fernández JR, Mojón A. High sensitivity test for the early diagnosis of gestational hypertension and preeclampsia. III. Computation of time-specified tolerance intervals as reference for blood pressure excess in the diagnosis of gestational hypertension. J Perinat Med 1997; 25 (03) 237-253
    PubMedGoogle Scholar
  • 65 Ayala DE, Hermida RC, Mojón A. et al. Blood pressure variability during gestation in healthy and complicated pregnancies. Hypertension 1997; 30 (3 pt 2): 611-618
    CrossrefPubMedGoogle Scholar
  • 66 Ayala DE, Hermida RC, Mojón A, Fernández JR, Iglesias M. Circadian blood pressure variability in healthy and complicated pregnancies. Hypertension 1997; 30 (3 pt 2): 603-610
    CrossrefPubMedGoogle Scholar
  • 67 Thadhani R, Ecker JL, Kettyle E, Sandler L, Frigoletto FD. Pulse pressure and risk of preeclampsia: a prospective study. Obstet Gynecol 2001; 97 (04) 515-520
    PubMedGoogle Scholar
  • 68 Rurangirwa AA, Gaillard R, Steegers EA, Hofman A, Jaddoe VW. Hemodynamic adaptations in different trimesters among nulliparous and multiparous pregnant women; the Generation R study. Am J Hypertens 2012; 25 (08) 892-899
    CrossrefPubMedGoogle Scholar
  • 69 Bartsch E, Medcalf KE, Park AL, Ray JG. High Risk of Pre-eclampsia Identification Group. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ 2016; 353: i1753
    CrossrefPubMedGoogle Scholar
  • 70 Gestational Hypertension and Preeclampsia. Gestational hypertension and preeclampsia: ACOG Practice Bulletin Summary, Number 222. Obstet Gynecol 2020; 135 (06) 1492-1495
    CrossrefPubMedGoogle Scholar
  • 71 Poon LC, Wright D, Rolnik DL. et al. Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history. Am J Obstet Gynecol 2017; 217 (05) 585.e1-585.e5
    CrossrefPubMedGoogle Scholar
  • 72 Baschat AA, Dewberry D, Seravalli V, Miller JL, Block-Abraham D, Blitzer MG. Maternal blood-pressure trends throughout pregnancy and development of pre-eclampsia in women receiving first-trimester aspirin prophylaxis. Ultrasound Obstet Gynecol 2018; 52 (06) 728-733
    CrossrefPubMedGoogle Scholar
  • 73 Scantlebury DC, Schwartz GL, Acquah LA, White WM, Moser M, Garovic VD. The treatment of hypertension during pregnancy: when should blood pressure medications be started?. Curr Cardiol Rep 2013; 15 (11) 412-418
    CrossrefPubMedGoogle Scholar
  • 74 Kannel WB, Wolf PA. Framingham Study insights on the hazards of elevated blood pressure. JAMA 2008; 300 (21) 2545-2547
    CrossrefPubMedGoogle Scholar
  • 75 Liszka HA, Mainous III AG, King DE, Everett CJ, Egan BM. Prehypertension and cardiovascular morbidity. Ann Fam Med 2005; 3 (04) 294-299
    CrossrefPubMedGoogle Scholar
  • 76 Whelton PK, Carey RM, Aronow WS. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 71 (19) e127-e248
    CrossrefPubMedGoogle Scholar
  • 77 Moser M, Brown CM, Rose CH, Garovic VD. Hypertension in pregnancy: is it time for a new approach to treatment?. J Hypertens 2012; 30 (06) 1092-1100
    CrossrefPubMedGoogle Scholar
  • 78 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 203: chronic hypertension in pregnancy. Obstet Gynecol 2019; 133 (01) e26-e50
    CrossrefPubMedGoogle Scholar
  • 79 van der Tuuk K, Tajik P, Koopmans CM. et al; HYPITAT study group. Blood pressure patterns in women with gestational hypertension or mild preeclampsia at term. Eur J Obstet Gynecol Reprod Biol 2017; 210: 360-365
    CrossrefPubMedGoogle Scholar
  • 80 Bakker R, Steegers EA, Hofman A, Jaddoe VW. Blood pressure in different gestational trimesters, fetal growth, and the risk of adverse birth outcomes: the generation R study. Am J Epidemiol 2011; 174 (07) 797-806
    CrossrefPubMedGoogle Scholar
  • 81 Macdonald-Wallis C, Silverwood RJ, Fraser A. et al. Gestational-age-specific reference ranges for blood pressure in pregnancy: findings from a prospective cohort. J Hypertens 2015; 33 (01) 96-105
    CrossrefPubMedGoogle Scholar
  • 82 Gaillard R, Bakker R, Willemsen SP, Hofman A, Steegers EA, Jaddoe VW. Blood pressure tracking during pregnancy and the risk of gestational hypertensive disorders: the Generation R Study. Eur Heart J 2011; 32 (24) 3088-3097
    CrossrefPubMedGoogle Scholar
  • 83 Macdonald-Wallis C, Lawlor DA, Fraser A, May M, Nelson SM, Tilling K. Blood pressure change in normotensive, gestational hypertensive, preeclamptic, and essential hypertensive pregnancies. Hypertension 2012; 59 (06) 1241-1248
    CrossrefPubMedGoogle Scholar
  • 84 Block-Abraham DM, Adamovich D, Turan OM, Doyle LE, Blitzer MG, Baschat AA. Maternal blood pressures during pregnancy and the risk of delivering a small-for-gestational-age neonate. Hypertens Pregnancy 2016; 35 (03) 350-360
    CrossrefPubMedGoogle Scholar
  • 85 McCowan LM, Thompson JM, Taylor RS. et al; SCOPE Consortium. Clinical prediction in early pregnancy of infants small for gestational age by customised birthweight centiles: findings from a healthy nulliparous cohort. PLoS One 2013; 8 (08) e70917
    CrossrefPubMedGoogle Scholar
  • 86 Darwin KC, Federspiel JJ, Schuh BL, Baschat AA, Vaught AJ. ACC-AHA diagnostic criteria for hypertension in pregnancy identifies patients at intermediate risk of adverse outcomes. Am J Perinatol 2021; 38 (S 01): e249-e255
    Article in Thieme ConnectPubMedGoogle Scholar
  • 87 Nzelu D, Dumitrascu-Biris D, Kay P, Nicolaides KH, Kametas NA. Severe hypertension, preeclampsia and small for gestational age in women with chronic hypertension diagnosed before and during pregnancy. Pregnancy Hypertens 2018; 14: 200-204
    CrossrefPubMedGoogle Scholar
  • 88 Warland J, McCutcheon H. Is there an association between maternal hypotension and poor pregnancy outcome? A review of contemporary literature. Aust J Midwifery 2002; 15 (04) 22-26
    CrossrefPubMedGoogle Scholar
  • 89 Grünberger W, Leodolter S, Parschalk O. Maternal hypotension: fetal outcome in treated and untreated cases. Gynecol Obstet Invest 1979; 10 (01) 32-38
    CrossrefPubMedGoogle Scholar
  • 90 Grünberger W, Leodolter S, Parschalk O. [Pregnancy hypotension and fetal outcome]. Fortschr Med 1979; 97 (04) 141-144
    PubMedGoogle Scholar
  • 91 Steer PJ, Little MP, Kold-Jensen T, Chapple J, Elliott P. Maternal blood pressure in pregnancy, birth weight, and perinatal mortality in first births: prospective study. BMJ 2004; 329 (7478): 1312
    CrossrefPubMedGoogle Scholar
  • 92 Ng PH, Walters WA. The effects of chronic maternal hypotension during pregnancy. Aust N Z J Obstet Gynaecol 1992; 32 (01) 14-16
    CrossrefPubMedGoogle Scholar
  • 93 Warland J, McCutcheon H, Baghurst P. Maternal blood pressure in pregnancy and stillbirth: a case-control study of third-trimester stillbirth. Am J Perinatol 2008; 25 (05) 311-317
    Article in Thieme ConnectPubMedGoogle Scholar
  • 94 von Dadelszen P, Ornstein MP, Bull SB, Logan AG, Koren G, Magee LA. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis. Lancet 2000; 355 (9198): 87-92
    CrossrefPubMedGoogle Scholar
  • 95 Easterling TR, Brateng D, Schmucker B, Brown Z, Millard SP. Prevention of preeclampsia: a randomized trial of atenolol in hyperdynamic patients before onset of hypertension. Obstet Gynecol 1999; 93 (5 pt 1): 725-733
    PubMedGoogle Scholar
  • 96 Easterling TR, Carr DB, Brateng D, Diederichs C, Schmucker B. Treatment of hypertension in pregnancy: effect of atenolol on maternal disease, preterm delivery, and fetal growth. Obstet Gynecol 2001; 98 (03) 427-433
    PubMedGoogle Scholar
  • 97 Tita AT, Szychowski JM, Boggess K. et al; Chronic Hypertension and Pregnancy (CHAP) Trial Consortium. Treatment for mild chronic hypertension during pregnancy. N Engl J Med 2022; 386: 1781-1792
    CrossrefPubMedGoogle Scholar
  • 98 Panaitescu AM, Baschat AA, Akolekar R, Syngelaki A, Nicolaides KH. Association of chronic hypertension with birth of small-for-gestational-age neonate. Ultrasound Obstet Gynecol 2017; 50 (03) 361-366
    CrossrefPubMedGoogle Scholar
  • 99 Waugh J, Perry IJ, Halligan AW. et al. Birth weight and 24-hour ambulatory blood pressure in nonproteinuric hypertensive pregnancy. Am J Obstet Gynecol 2000; 183 (03) 633-637
    CrossrefPubMedGoogle Scholar
  • 100 Corwin J, Herrick WW. Relation of hypertensive toxemia of pregnancy to chronic cardiovascular disease. J Am Med Assoc 1927; 88: 457-459
    CrossrefPubMedGoogle Scholar
  • 101 Campos O. Doppler echocardiography during pregnancy: physiological and abnormal findings. Echocardiography 1996; 13 (02) 135-146
    CrossrefPubMedGoogle Scholar
  • 102 Melchiorre K, Sharma R, Khalil A, Thilaganathan B. Maternal cardiovascular function in normal pregnancy: evidence of maladaptation to chronic volume overload. Hypertension 2016; 67 (04) 754-762
    Google Scholar
  • 103 Melchiorre K, Sutherland GR, Liberati M, Thilaganathan B. Preeclampsia is associated with persistent postpartum cardiovascular impairment. Hypertension 2011; 58 (04) 709-715
    CrossrefPubMedGoogle Scholar
  • 104 Nicolini G, Degli Esposti D, Ianniello E. et al. Long-term consequences of previous preeclampsia and complicated pregnancy: analysis of echocardiographic aspects. J Cardiovasc Med (Hagerstown) 2021; 22 (12) 939-945
    CrossrefPubMedGoogle Scholar
  • 105 Tihtonen KM, Kööbi T, Uotila JT. Arterial stiffness in preeclamptic and chronic hypertensive pregnancies. Eur J Obstet Gynecol Reprod Biol 2006; 128 (1-2): 180-186
    CrossrefPubMedGoogle Scholar
  • 106 Bosio PM, McKenna PJ, Conroy R, O'Herlihy C. Maternal central hemodynamics in hypertensive disorders of pregnancy. Obstet Gynecol 1999; 94 (06) 978-984
    PubMedGoogle Scholar
  • 107 Bamfo JE, Kametas NA, Chambers JB, Nicolaides KH. Maternal cardiac function in normotensive and pre-eclamptic intrauterine growth restriction. Ultrasound Obstet Gynecol 2008; 32 (05) 682-686
    CrossrefPubMedGoogle Scholar
  • 108 Zanati Bazan SG, Borges VM, Martin LC. et al. Disproportionate pregnancy-induced myocardial hypertrophy in women with essential hypertension. Am J Hypertens 2013; 26 (06) 816-821
    CrossrefPubMedGoogle Scholar
  • 109 Smith GN, Walker MC, Liu A. et al; Pre-Eclampsia New Emerging Team (PE-NET). A history of preeclampsia identifies women who have underlying cardiovascular risk factors. Am J Obstet Gynecol 2009; 200 (01) 58.e1-58.e8
    CrossrefPubMedGoogle Scholar
  • 110 Svensson A, Andersch B, Hansson L. Prediction of later hypertension following a hypertensive pregnancy. J Hypertens Suppl 1983; 1 (02) 94-96
    PubMedGoogle Scholar
  • 111 Block-Abraham DM, Turan OM, Doyle LE. et al. First trimester maternal characteristics, Doppler parameters and serum analytes after preeclampsia. Hypertens Pregnancy 2014; 33 (02) 204-214
    CrossrefPubMedGoogle Scholar
  • 112 Scholten RR, Hopman MT, Lotgering FK, Spaanderman ME. Aerobic exercise training in formerly preeclamptic women: effects on venous reserve. Hypertension 2015; 66 (05) 1058-1065
    Google Scholar
  • 113 Bellamy L, Casas J-P, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007; 335 (7627): 974
    CrossrefPubMedGoogle Scholar
  • 114 Sibai BM, el-Nazer A, Gonzalez-Ruiz A. Severe preeclampsia-eclampsia in young primigravid women: subsequent pregnancy outcome and remote prognosis. Am J Obstet Gynecol 1986; 155 (05) 1011-1016
    CrossrefPubMedGoogle Scholar
  • 115 Amougou SN, Mbita SMM, Danwe D, Tebeu PM. Factor associated with progression to chronic arterial hypertension in women with preeclampsia in Yaoundé, Cameroon. Pan Afr Med J 2019; 33: 200
    CrossrefPubMedGoogle Scholar
  • 116 Hermes W, Franx A, van Pampus MG. et al. Cardiovascular risk factors in women who had hypertensive disorders late in pregnancy: a cohort study. Am J Obstet Gynecol 2013; 208 (06) 474.e1-474.e8
    CrossrefPubMedGoogle Scholar
  • 117 Hermes W, Ket JC, van Pampus MG. et al. Biochemical cardiovascular risk factors after hypertensive pregnancy disorders: a systematic review and meta-analysis. Obstet Gynecol Surv 2012; 67 (12) 793-809
    CrossrefPubMedGoogle Scholar
  • 118 McDonald SD, Malinowski A, Zhou Q, Yusuf S, Devereaux PJ. Cardiovascular sequelae of preeclampsia/eclampsia: a systematic review and meta-analyses. Am Heart J 2008; 156 (05) 918-930
    CrossrefPubMedGoogle Scholar
  • 119 Fraser A, Nelson SM, Macdonald-Wallis C. et al. Associations of pregnancy complications with calculated cardiovascular disease risk and cardiovascular risk factors in middle age: the Avon Longitudinal Study of Parents and Children. Circulation 2012; 125 (11) 1367-1380
    CrossrefPubMedGoogle Scholar
  • 120 Funai EF, Friedlander Y, Paltiel O. et al. Long-term mortality after preeclampsia. Epidemiology 2005; 16 (02) 206-215
    CrossrefPubMedGoogle Scholar
  • 121 Theilen LH, Fraser A, Hollingshaus MS. et al. All-cause and cause-specific mortality after hypertensive disease of pregnancy. Obstet Gynecol 2016; 128 (02) 238-244
    CrossrefPubMedGoogle Scholar
  • 122 Theilen LH, Meeks H, Fraser A, Esplin MS, Smith KR, Varner MW. Long-term mortality risk and life expectancy following recurrent hypertensive disease of pregnancy. Am J Obstet Gynecol 2018; 219 (01) 107.e1-107.e6
    CrossrefPubMedGoogle Scholar
  • 123 Irgens HU, Reisaeter L, Irgens LM, Lie RT. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. BMJ 2001; 323 (7323): 1213-1217
    CrossrefPubMedGoogle Scholar
  • 124 Wikström AK, Haglund B, Olovsson M, Lindeberg SN. The risk of maternal ischaemic heart disease after gestational hypertensive disease. BJOG 2005; 112 (11) 1486-1491
    CrossrefPubMedGoogle Scholar
  • 125 Luoto R, Kharazmi E, Whitley E, Raitanen J, Gissler M, Hemminki E. Systolic hypertension in pregnancy and cardiovascular mortality: a 44-year follow-up study. Hypertens Pregnancy 2008; 27 (01) 87-94
    CrossrefPubMedGoogle Scholar
  • 126 Kessous R, Shoham-Vardi I, Pariente G, Sergienko R, Sheiner E. Long-term maternal atherosclerotic morbidity in women with pre-eclampsia. Heart 2015; 101 (06) 442-446
    CrossrefPubMedGoogle Scholar
  • 127 Brouwers L, van der Meiden-van Roest AJ, Savelkoul C. et al. Recurrence of pre-eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta-analysis. BJOG 2018; 125 (13) 1642-1654
    CrossrefPubMedGoogle Scholar
  • 128 Ray JG, Vermeulen MJ, Schull MJ, Redelmeier DA. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet 2005; 366 (9499): 1797-1803
    CrossrefPubMedGoogle Scholar
  • 129 Ray JG, Schull MJ, Kingdom JC, Vermeulen MJ. Heart failure and dysrhythmias after maternal placental syndromes: HAD MPS study. Heart 2012; 98 (15) 1136-1141
    CrossrefPubMedGoogle Scholar
  • 130 Arnadottir GA, Geirsson RT, Arngrimsson R, Jonsdottir LS, Olafsson O. Cardiovascular death in women who had hypertension in pregnancy: a case-control study. BJOG 2005; 112 (03) 286-292
    CrossrefPubMedGoogle Scholar
  • 131 Jónsdóttir LS, Arngrímsson R, Geirsson RT, Sigvaldason H, Sigfússon N. Death rates from ischemic heart disease in women with a history of hypertension in pregnancy. Acta Obstet Gynecol Scand 1995; 74 (10) 772-776
    CrossrefPubMedGoogle Scholar
  • 132 Skjaerven R, Wilcox AJ, Klungsøyr K. et al. Cardiovascular mortality after pre-eclampsia in one child mothers: prospective, population based cohort study. BMJ 2012; 345: e7677
    CrossrefPubMedGoogle Scholar
  • 133 Garovic VD, Hayman SR. Hypertension in pregnancy: an emerging risk factor for cardiovascular disease. Nat Clin Pract Nephrol 2007; 3 (11) 613-622
    CrossrefPubMedGoogle Scholar
  • 134 Mabuchi A, Yamamoto R, Ishii K. et al. Significance of high-normal blood pressure during early second trimester for predicting the onset of hypertensive disorders in pregnancy. Hypertens Pregnancy 2016; 35 (02) 234-241
    CrossrefPubMedGoogle Scholar
  • 135 Bullarbo M, Rylander R. Diastolic blood pressure increase is a risk indicator for pre-eclampsia. Arch Gynecol Obstet 2015; 291 (04) 819-823
    CrossrefPubMedGoogle Scholar
  • 136 Sattar N, Greer IA. Pregnancy complications and maternal cardiovascular risk: opportunities for intervention and screening?. BMJ 2002; 325 (7356): 157-160
    Google Scholar
  • 137 Chobanian AV, Bakris GL, Black HR. et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee. National High Blood Pressure Education Program Coordinating Committee. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003; 289 (19) 2560-2572
    CrossrefPubMedGoogle Scholar
  • 138 Unger T, Borghi C, Charchar F. et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension 2020; 75 (06) 1334-1357
    CrossrefPubMedGoogle Scholar
  • 139 Arias F, Zamora J. Antihypertensive treatment and pregnancy outcome in patients with mild chronic hypertension. Obstet Gynecol 1979; 53 (04) 489-494
    PubMedGoogle Scholar
  • 140 Sibai BM, Mabie WC, Shamsa F, Villar MA, Anderson GD. A comparison of no medication versus methyldopa or labetalol in chronic hypertension during pregnancy. Am J Obstet Gynecol 1990; 162 (04) 960-966 , discussion 966–967
    CrossrefPubMedGoogle Scholar
  • 141 Abalos E, Duley L, Steyn DW, Gialdini C. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev 2018; 10 (10) CD002252
    PubMedGoogle Scholar
  • 142 Magee LA, Abalos E, von Dadelszen P, Sibai B, Easterling T, Walkinshaw S. CHIPS Study Group. How to manage hypertension in pregnancy effectively. Br J Clin Pharmacol 2011; 72 (03) 394-401
    CrossrefPubMedGoogle Scholar
  • 143 Scott G, Gillon TE, Pels A, von Dadelszen P, Magee LA. Guidelines-similarities and dissimilarities: a systematic review of international clinical practice guidelines for pregnancy hypertension. Am J Obstet Gynecol 2022; 226 (2S): S1222-S1236
    CrossrefPubMedGoogle Scholar
  • 144 Sridharan K, Sequeira RP. Drugs for treating severe hypertension in pregnancy: a network meta-analysis and trial sequential analysis of randomized clinical trials. Br J Clin Pharmacol 2018; 84 (09) 1906-1916
    CrossrefPubMedGoogle Scholar
  • 145 Duley L, Meher S, Jones L. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev 2013; 2013 (07) CD001449
    PubMedGoogle Scholar
  • 146 Sibai BM, Anderson GD. Pregnancy outcome of intensive therapy in severe hypertension in first trimester. Obstet Gynecol 1986; 67 (04) 517-522
    PubMedGoogle Scholar
  • 147 Ankumah N, Tita A, Cantu J. et al. Pregnancy outcome vary by blood pressure level in women with mild-range chronic hypertension. Am J Obstet Gynecol 2013; 208: S261
    CrossrefPubMedGoogle Scholar
  • 148 Magee LA, von Dadelszen P, Rey E. et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med 2015; 372 (05) 407-417
    CrossrefPubMedGoogle Scholar
  • 149 Greene MF, Williams WW. Treating hypertension in pregnancy. N Engl J Med 2022; 386 (19) 1846-1847
    CrossrefPubMedGoogle Scholar
  • 150 Ambitious trial prompts a rethink on common pregnancy ailment. Nature 2022; 604: 405-405
    CrossrefPubMedGoogle Scholar
  • 151 Ballantyne JW. The maternity hospital, with its antenatal and neo-natal departments. BMJ 1921; 1 (3137): 221-224
    CrossrefPubMedGoogle Scholar
  • 152 Bujold E, Roberge S, Lacasse Y. et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010; 116 (2 pt 1): 402-414
    CrossrefPubMedGoogle Scholar
  • 153 Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol 2017; 216 (02) 110-120.e6
    CrossrefPubMedGoogle Scholar
  • 154 Rolnik DL, Wright D, Poon LC. et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017; 377 (07) 613-622
    CrossrefPubMedGoogle Scholar
  • 155 Kametas NA, Nzelu D, Nicolaides KH. Chronic hypertension and superimposed preeclampsia: screening and diagnosis. Am J Obstet Gynecol 2022; 226 (2S): S1182-S1195
    CrossrefPubMedGoogle Scholar
  • 156 Orbach H, Matok I, Gorodischer R. et al. Hypertension and antihypertensive drugs in pregnancy and perinatal outcomes. Am J Obstet Gynecol 2012
    PubMedGoogle Scholar
  • 157 Oliveira N, Magder LS, Blitzer MG, Baschat AA. First-trimester prediction of pre-eclampsia: external validity of algorithms in a prospectively enrolled cohort. Ultrasound Obstet Gynecol 2014; 44 (03) 279-285
    CrossrefPubMedGoogle Scholar