The new American guidelines on the hypertensive disorders of pregnancy

Chronic hypertension with related drug treatment of pregnant women and congenital abnormalities in their offspring: a population-based study

Chronic hypertension (CH) is a common chronic disease and occurs frequently in pregnant women. The teratogenic/fetotoxic effect of certain antihypertensive drugs has been shown. The objective of this study was to investigate the association between pregnant women with CH and the possible risk of congenital abnormalities (CAs) among their offspring. The prevalence of medically recorded CH in the prenatal maternity logbook was compared between 1030 pregnant women who later had offspring with CA (case group) and 1579 pregnant women with CH who later delivered newborn infants without CA (control group). Control newborn infants were matched to cases in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities during 1980-1996. Of 23 different CA groups with informative offspring, esophageal atresia/stenosis was a greater risk in pregnant women with CH (adjusted odds ratios with 95% confidence intervals: 3.1, 1.4-6.8). In conclusion, a higher risk of esophageal atresia/stenosis was found in the offspring of pregnant women with severe CH, which could not be explained by related drug treatments. This finding requires confirmation or lack thereof by future studies.

The efficacy of antihypertensive treatment in pregnant women with chronic and gestational hypertension: a population-based study

The efficacy of antihypertensive treatment was investigated in pregnant women with chronic hypertension (CH) or gestational hypertension (GH) on the basis of the occurrence of pregnancy complications and adverse birth outcomes. Medically recorded pregnancy complications and birth outcomes of 1579 pregnant women with CH and 1098 pregnant women with GH were compared to 34,633 pregnant women without CH, GH, preeclampsia-eclampsia or any secondary hypertension who delivered newborn infants without defects in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. Of 1579 (4.1%) pregnant women with CH, 1522 (96.4%) were treated with antihypertensive drugs. Of 1098 (2.9%) pregnant women with GH, 657 (59.8%) were treated. Pregnant women with treated CH had a higher risk of threatened abortion, preterm delivery, and placental disorders, in addition to low-birthweight newborns. However, pregnant women with untreated CH and GH had no higher risk of pregnancy complications or adverse pregnancy outcomes. Antihypertensive treatments were not able to neutralize the harm of severe CH in pregnant women, the antihypertensive treatments were not appropriate and/or effective, or related drug treatments may contribute to these adverse effects.