Hypertension and Diabetes Management During Pregnancy

Importance of Hypertension Control

Hypertension complicates 5 to 10% of all pregnancies and is a major cause of maternal and fetal morbidity and mortality, with the majority of maternal deaths occurring after delivery, when blood pressure peaks, leading to complications like stroke and cardiomyopathy 1, 2
Women with hypertensive disorders of pregnancy have a significantly increased risk of persistent hypertension and future cardiovascular events 2

For women with mild to moderate gestational hypertension (systolic blood pressure <160 mmHg or diastolic blood pressure <110 mmHg), medical treatment is generally not necessary, according to the American Diabetes Association 3, 4
For pregnant women requiring antihypertensive treatment, recommended blood pressure levels are 110-135/85 mmHg to optimize maternal health without harming the fetus, as suggested by the American Diabetes Association 4, 5
Safe antihypertensive medications during pregnancy include methyldopa, labetalol, and long-acting nifedipine, as recommended by the American Diabetes Association 3, 5
ACE inhibitors, angiotensin receptor antagonists (ARAs), direct renin inhibitors, mineralocorticoid receptor antagonists, and neprilysin inhibitors are contraindicated during pregnancy due to potential fetal harm, according to the American Diabetes Association 5

Patients who had gestational hypertension, preeclampsia, or superimposed preeclampsia should have their blood pressure monitored for 72 hours in the hospital and for 7 to 10 days after delivery, as recommended by the American Diabetes Association 3, 4
Long-term follow-up is recommended for these women as they have an increased cardiovascular risk throughout their lives, according to the American Diabetes Association 3, 5

For patients with blood pressure >120/80 mmHg, lifestyle interventions include weight loss if overweight or obese, a DASH-style diet (Dietary Approaches to Stop Hypertension) with reduced sodium and increased potassium intake, moderate alcohol consumption, and increased physical activity, as recommended by the American Diabetes Association 4, 5