What is the dangerous level of blood pressure during pregnancy?

According to a new study, rates of high blood pressure could almost double in women of childbearing age if the latest guidelines are used. But the researchers say more research is needed to determine whether these goals of reducing blood pressure in pregnant women are safe or effective.

The study, published on September 10 in the journal Hypertension, sought to see how the blood pressure guidelines published last November by the American Heart Association and the American College of Cardiology would influence women of childbearing age. These guidelines lowered the threshold for hypertension in adults to 130/80. The guidelines for pregnant women established by the American College of Obstetricians and Gynecologists define a high blood pressure of 140/90.

The AHA / ACC guidelines apply to all adults and do not specifically address blood pressure goals during pregnancy. He notes that hypertension during pregnancy has special requirements and provides recommendations on the types of antihypertensive drugs to use or avoid during pregnancy. Although the scope of the AHA / ACC guidelines does not take into account pregnancy in detail, it is based on the ACOG guidelines for determining how to manage high blood pressure in pregnant women.

Researchers at the Emory University School of Medicine in Atlanta analyzed data from women aged 20 to 44 and found that the number of women considered to be hypertensive almost doubled. The number went from 10.2% under ACOG guidelines to 18.9% according to the guidelines of the AHA / ACC.

"Based on new guidelines, about twice as many women of childbearing age will carry a diagnosis of hypertension," said lead author of the study, Dr. Matthew Topel, a researcher in cardiology at Emory. "It may be reasonable to consider lowering the blood pressure threshold for hypertensive pregnancy disorders to 130/80, but further investigations on this issue are needed."

Topel said that young women generally have a low risk of adverse effects related to hypertension. But in pregnant women, hypertension is associated with risks for the mother and the child, including stillbirths, fetal growth restriction and preeclampsia.

Preeclampsia is a serious disease characterized by high blood pressure and high protein content in the urine. This can endanger the life of the child and the mother. Women with high blood pressure during pregnancy are also five times more likely to have a stroke than those with normal blood pressure.

Dr. Alisse Hauspurg, an obstetrician and researcher who did not participate in the new study, said the findings could, in theory, have important implications for how doctors and pregnant women control the condition. ;hypertension.

Obstetricians do not usually recommend major lifestyle changes in pregnant women with high blood pressure, as they could do in nonpregnant women with hypertension, said Hauspurg, specialist in maternal medicine and fetal medicine at the University of Pittsburgh Medical Center. Instead, they focus on increased monitoring of the mother and fetus, including growth ultrasound and fetal heart monitoring.

The study finally revealed that it was unclear whether low blood pressure targets would actually benefit pregnant women.

"It's not as simple as in the non-pregnant population," Hauspurg said. "During pregnancy, blood flow to the uterus and placenta is also important to ensure adequate fetal growth.If we lower blood pressure of women outside of pregnancy, we know that they reduce the risk of stroke and heart disease, or baby's growth.We still do not know the answer to that. "

Until additional research is done, she stated that she would continue to use the ACOG guidelines, as these specifically aim to treat pregnant women suffering from pain and suffering. hypertension.

"The study is an important step in understanding the impact of the new guidelines," she said. "But we would still need larger scale studies and a definitive clinical trial before making any changes to our obstetrical practice."

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