Advertisement

Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy

  • National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy*

      Abstract

      This report updates the 1990 “National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy” and focuses on classification, pathophysiologic features, and management of the hypertensive disorders of pregnancy. Through a combination of evidence-based medicine and consensus this report updates contemporary approaches to hypertension control during pregnancy by expanding on recommendations made in “The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.” The recommendations to use Korotkoff phase V for determination of diastolic pressure and to eliminate edema as a criterion for diagnosing preeclampsia are discussed. In addition, the use as a diagnostic criterion of blood pressure increases of 30 mm Hg systolic or 15 mm Hg diastolic with blood pressure <140/90 mm Hg has not been recommended, because available evidence shows that women with blood pressures fitting this description are not more likely to have adverse outcomes. Management distinctions are made between chronic hypertension that is present before pregnancy and hypertension that occurs as part of the pregnancy-specific condition of preeclampsia, as well as management considerations for women with comorbid conditions. A discussion of the pharmacologic treatment of hypertension during pregnancy includes recommendations for specific agents. The use of low-dose aspirin, calcium, or other dietary supplements in the prevention of preeclampsia is described, and expanded sections on counseling women for future pregnancies and recommendations for future research are included. (Am J Obstet Gynecol 2000;183:S1-S22.)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American College of Obstetricians and Gynecologists
        Hypertension in pregnancy.
        (ACOG Technical Bulletin No.: 219)in: The College, Washington, DC1996: 1-8
        • Anonymous
        The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure [published erratum appears in Arch Intern Med 1998;158:573]).
        Arch Intern Med. 1997; 157 (Pr): 2413-2446
      1. 3rd ed. A dictionary of epidemiology. Oxford University Press, New York1995
        • Anonymous
        National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy.
        Am J Obstet Gynecol. 1990; 163 (Pr): 1691-1712
        • Hughes EC.
        Obstetric-gynecologic terminology.
        in: FA Davis, Philadelphia1972: 422
        • Anonymous
        Management of hypertension in pregnancy: executive summary. Australasian Society for the Study of Hypertension in Pregnancy.
        Med J Aust. 1993; 158: 700-702
        • Helewa ME
        • Burrows RF
        • Smith J
        • Williams K
        • Brain P
        • Rabkin SW.
        Report of the Canadian Hypertension Society Consensus Conference: 1. Definitions, evaluation and classification of hypertensive disorders in pregnancy.
        CMAJ. 1997; 157: 715-725
        • Brown MA
        • Hague WM
        • Higgins J
        • Lowe S
        • Mcowan L
        • Oates J
        • et al.
        The detection, investigation and management of hypertension in pregnancy, full consensus statement of recommendations from the Council of the Australasian Society for the Study of Hypertension in Pregnancy (ASSHP).
        Aust N Z J Obstet Gynaecol. 2000; 40: 139-156
        • Johenning AR
        • Barron WM.
        Indirect blood pressure measurement in pregnancy: Korotkoff phase 4 versus phase 5.
        Am J Obstet Gynecol. 1992; 167: 577-580
        • Gallery ED
        • Brown MA
        • Ross MR
        • Reiter L.
        Diastolic blood pressure in pregnancy: phase IV or phase V Korotkoff sounds?.
        Hypertens Pregnancy. 1994; 13: 285-292
        • López MC
        • Belizán JM
        • Villar J
        • Bergel E
        The measurement of diastolic blood pressure during pregnancy: which Korotkoff phase should be used?.
        Am J Obstet Gynecol. 1994; 170: 574-578
        • Perry IJ.
        Diastolic blood pressure in pregnancy: phase IV or phase V Korotkoff sounds? [letter].
        Hypertens Pregnancy. 1996; 15: 139-141
        • Brown MA
        • Buddle ML
        • Farrell T
        • Davis G
        • Jones M.
        Randomised trial of management of hypertensive pregnancies by Korotkoff phase IV or phase V.
        Lancet. 1998; 352: 777-781
        • North RA
        • Taylor RS
        • Schellenberg JC.
        Evaluation of a definition of pre-eclampsia.
        Br J Obstet Gynaecol. 1999; 106: 767-773
        • Levine RJ
        Should the definition of preeclampsia include a rise in diastolic blood pressure ≥15 mm Hg?.
        [abstract] Am J Obstet Gynecol. 2000; 182: 225
        • Abuelo JG.
        Validity of dipstick analysis as a method of screening for proteinuria in pregnancy [letter].
        Am J Obstet Gynecol. 1993; 169: 1654
        • Meyer NL
        • Mercer BM
        • Friedman SA
        • Sibai BM.
        Urinary dipstick protein: a poor predictor of absent or severe proteinuria.
        Am J Obstet Gynecol. 1994; 170: 137-141
        • Kuo VS
        • Koumantakis G
        • Gallery ED.
        Proteinuria and its assessment in normal and hypertensive pregnancy.
        Am J Obstet Gynecol. 1992; 167: 723-728
        • Robertson WB
        • Brosens I
        • Dixon G.
        Maternal uterine vascular lesions in the hypertensive complications of pregnancy.
        in: Hypertension in pregnancy. John Wiley, New York1976: 115-129
        • Pijnenborg R.
        Trophoblast invasion and placentation in the human: morphological aspects.
        Trophoblast Res. 1990; 4: 33-47
        • Zhou Y
        • Fisher SJ
        • Janatpour M
        • Genbacev O
        • Dejana E
        • Wheelock M
        • et al.
        Human cytotrophoblasts adopt a vascular phenotype as they differentiate: a strategy for successful endovascular invasion?.
        J Clin Invest. 1997; 99: 2139-2151
        • Zhou Y
        • Damsky CH
        • Chiu K
        • Roberts JM
        • Fisher SJ.
        Preeclampsia is associated with abnormal expression of adhesion molecules by invasive cytotrophoblasts.
        J Clin Invest. 1993; 91: 950-960
        • Fox H.
        The placenta in pregnancy hypertension.
        in: Handbook of hypertension, volume 10: hypertension in pregnancy. Elsevier, New York1988: 16-37
        • Harrison GA
        • Humphrey KE
        • Jones N
        • Badenhop R
        • Guo G
        • Elakis G
        • et al.
        A genomewide linkage study of preeclampsia/eclampsia reveals evidence for a candidate region on 4q.
        Am J Hum Genet. 1997; 60: 1158-1167
        • Kovats S
        • Main EK
        • Librach C
        • Stubblebine M
        • Fisher SJ
        • DeMars R.
        A class I antigen, HLA-G, expressed in human trophoblasts.
        Science. 1990; 248: 220-223
        • Main E
        • Chiang M
        • Colbern G.
        Nulliparous preeclampsia (PE) is associated with placental expression of a variant allele of the new histocompatibility gene: HLA-G [abstract].
        Am J Obstet Gynecol. 1994; 170: 289
        • Taylor RN.
        Review: immunobiology of preeclampsia.
        Am J Reprod Immunol. 1997; 37: 79-86
        • Sibai BM
        • Ewell M
        • Levine RJ
        • Klebanoff MA
        • Esterlitz J
        • Catalano PM
        • et al.
        Risk factors associated with preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group.
        Am J Obstet Gynecol. 1997; 177: 1003-1010
        • Higgins JR
        • Walshe JJ
        • Halligan A
        • O’Brien E
        • Conroy R
        • Darling MR
        Can 24-hour ambulatory blood pressure measurement predict the development of hypertension in primigravidae?.
        Br J Obstet Gynaecol. 1997; 104: 356-362
        • Kyle PM
        • Clark SJ
        • Buckley D
        • Kissane J
        • Coats AJ
        • De Swiet M
        • et al.
        Second trimester ambulatory blood pressure in nulliparous pregnancy: a useful screening test for pre-eclampsia?.
        Br J Obstet Gynaecol. 1993; 100: 914-919
        • Conrad KP
        • Lindheimer MD.
        Renal and cardiovascular alterations.
        in: Hypertensive disorders in pregnancy. Appleton and Lange, Stamford (CT)1999: 263-326
        • Visser W
        • Wallenburg HC.
        Central hemodynamic observations in untreated preeclamptic patients.
        Hypertension. 1991; 17: 1072-1077
        • Gant NF
        • Daley GL
        • Chand S
        • Whalley PJ
        • MacDonald PC.
        A study of angiotensin II pressor response throughout primigravid pregnancy.
        J Clin Invest. 1973; 52: 2682-2689
        • Ayala DE
        • Hermida RC
        • Mojón A
        • Fernández JR
        • Iglesias M
        Circadian blood pressure variability in healthy and complicated pregnancies.
        Hypertension. 1997; 30: 603-610
        • Ferrazzani S
        • De Carolis S
        • Pomini F
        • Testa AC
        • Mastromarino C
        • Caruso A
        The duration of hypertension in the puerperium of preeclamptic women: relationship with renal impairment and week of delivery.
        Am J Obstet Gynecol. 1994; 171 (F): 506-512
        • Walsh SW.
        Preeclampsia: an imbalance in placental prostacyclin and thromboxane production.
        Am J Obstet Gynecol. 1985; 152: 335-340
        • Fitzgerald DJ
        • Rocki W
        • Murray R
        • Mayo G
        • FitzGerald GA.
        Thromboxane A2 synthesis in pregnancy-induced hypertension.
        Lancet. 1990; 335: 751-754
        • Mills JL
        • DerSimonian R
        • Raymond E
        • Morrow JD
        • Roberts 2nd, LJ
        • Clemens JD
        • et al.
        Prostacyclin and thromboxane changes predating clinical onset of preeclampsia: a multicenter prospective study.
        JAMA. 1999; 282: 356-362
        • Baylis C
        • Beinder E
        • Sütö T
        • August P
        Recent insights into the roles of nitric oxide and renin-angiotensin in the pathophysiology of preeclamptic pregnancy.
        Semin Nephrol. 1998; 18: 208-230
        • Baylis C
        • Engels K.
        Adverse interactions between pregnancy and a new model of systemic hypertension produced by chronic blockade of endothelial derived relaxing factor (EDRF) in the rat.
        Clin Exp Hypertens (B Pregnancy). 1992; 11: 117-129
        • Molnár M
        • Sütö T
        • Tóth T
        • Hertelendy F
        Prolonged blockage of nitric oxide synthesis in gravid rats produces sustained hypertension, proteinuria, thrombocytopenia, and intrauterine growth retardation.
        Am J Obstet Gynecol. 1994; 170: 1458-1466
        • Seligman SP
        • Buyon JP
        • Clancy RM
        • Young BK
        • Abramson SB.
        The role of nitric oxide (NO) in the pathogenesis of preeclampsia.
        Am J Obstet Gynecol. 1994; 171: 944-948
        • Begum S
        • Yamasaki M
        • Michizuki M.
        Urinary levels of nitric oxide metabolites in normal pregnancy and preeclampsia.
        J Obstet Gynaecol Res. 1996; 22: 551-559
        • Roberts JM
        • Taylor RN
        • Musci TJ
        • Rodgers GM
        • Hubel CA
        • McLaughlin MK.
        Preeclampsia: an endothelial cell disorder.
        Am J Obstet Gynecol. 1989; 161: 1200-1204
        • Roberts JM
        • Edep ME
        • Goldfien A
        • Taylor RN.
        Sera from preeclamptic women specifically activate human umbilical vein endothelial cells in vitro: morphological and biochemical evidence.
        Am J Reprod Immunol. 1992; 27: 101-108
        • Davidge ST
        • Signorella AP
        • Hubel CA
        • Lykins DL
        • Roberts JM.
        Distinct factors in plasma of preeclamptic women increase endothelial nitric oxide or prostacyclin.
        Hypertension. 1996; 28: 758-764
        • Taylor RN
        • Casal DC
        • Jones LA
        • Varma M
        • Martin Jr, JN
        • Roberts JM.
        Selective effects of preeclamptic sera on human endothelial cell procoagulant protein expression.
        Am J Obstet Gynecol. 1991; 165: 1705-1710
        • Hubel CA
        • Roberts JM
        • Taylor RN
        • Musci TJ
        • Rogers GM
        • McLaughlin MK.
        Lipid peroxidation in pregnancy: new perspectives on preeclampsia.
        Am J Obstet Gynecol. 1989; 161: 1025-1034
        • Hubel CA
        • Kagan VE
        • Kisin ER
        • McLaughlin MK
        • Roberts JM.
        Increased ascorbate radical formation and ascorbate depletion in plasma from women with preeclampsia: complications for oxidative stress.
        Free Radic Biol Med. 1997; 23: 597-609
        • Barden A
        • Beilin LJ
        • Ritchie J
        • Croft KD
        • Walters BN
        • Michael CA.
        Plasma and urinary 8-iso-prostane as an indicator of lipid peroxidation in pre-eclampsia and normal pregnancy.
        Clin Sci (Colch). 1996; 91: 711-718
        • Poranen AK
        • Ekblad U
        • Uotila P
        • Ahotupa M.
        Lipid peroxidation and antioxidants in normal and pre-eclamptic pregnancies.
        Placenta. 1996; 17: 401-405
        • Schobel HP
        • Fischer T
        • Heuszer K
        • Geiger H
        • Schmieder RE
        Preeclampsia—a state of sympathetic overactivity.
        N Engl J Med. 1996; 335: 1480-1485
        • August P
        • Marcaccio B
        • Gertner JM
        • Druzin ML
        • Resnick LM
        • Laragh JH.
        Abnormal 1,25-dihydroxyvitamin D metabolism in preeclampsia.
        Am J Obstet Gynecol. 1992; 166: 1295-1299
        • Seely EW
        • Wood RJ
        • Brown EM
        • Graves SW.
        Lower serum ionized calcium and abnormal calciotropic hormone levels in preeclampsia.
        J Clin Endocrinol Metab. 1992; 74: 1436-1440
        • Lorentzen B
        • Birkeland KI
        • Endresen MJ
        • Henriksen T.
        Glucose intolerance in women with preeclampsia.
        Acta Obstet Gynecol Scand. 1998; 77: 22-27
        • Long PA
        • Abell DA
        • Beischer NA.
        Importance of abnormal glucose tolerance (hypoglycemia and hyperglycemia) in the etiology of pre-eclampsia.
        Lancet. 1977; 1: 923-925
        • Solomon CG
        • Graves SW
        • Greene MF
        • Seely EW.
        Glucose intolerance as a predictor of hypertension in pregnancy.
        Hypertension. 1994; 23: 717-721
        • Roberts JM.
        Endothelial dysfunction in preeclampsia.
        Semin Reprod Endocrinol. 1998; 16: 5-15
        • Bardicef M
        • Bardicef O
        • Sorokin Y
        • Altura BM
        • Altura BT
        • Cotton DB
        • et al.
        Extracellular and intracellular magnesium depletion in pregnancy and gestational diabetes.
        Am J Obstet Gynecol. 1995; 172: 1009-1013
        • Lang RM
        • Pridjian G
        • Feldman T
        • Neumann A
        • Lindheimer M
        • Borow KM.
        Left ventricular mechanics in preeclampsia.
        Am Heart J. 1991; 121: 1768-1775
        • Cunningham FG
        • Pritchard JA
        • Hankins GD
        • Anderson PL
        • Lucas MK
        • Armstrong KF.
        Peripartum heart failure: Idiopathic cardiomyopathy or compounding cardiovascular events?.
        Obstet Gynecol. 1986; 67: 157-163
        • Lindheimer MD
        • Katz AI.
        Renal physiology, disease in pregnancy in the kidney.
        in: 2nd ed. The kidney: physiology and pathophysiology.vol 3. Raven Press, New York1992: 3371-3429
        • Fisher KA
        • Luger A
        • Spargo BH
        • Lindheimer MD
        Hypertension in pregnancy: clinical-pathological correlations and remote prognosis.
        Medicine (Baltimore. 1981; 60 (F): 267-276
        • Packham DK
        • Mathews DC
        • Fairley KF
        • Whitworth JA
        • Kincaid-Smith PS.
        Morphometric analysis of pre-eclampsia in women biopsied in pregnancy and post-partum.
        Kidney Int. 1988; 34: 704-711
        • Gaber LW
        • Lindheimer MD.
        Pathology of the kidney, liver, and brain.
        in: Hypertensive disorders in pregnancy. Appleton and Lange, Stamford (CT)1999: 231-262
        • Pertuiset N
        • Grünfeld JP
        Acute renal failure in pregnancy.
        Baillieres Clin Obstet Gynaecol. 1994; 8: 333-351
        • Taufield PA
        • Ales KL
        • Resnick LM
        • Druzin ML
        • Gertner JM
        • Laragh JH.
        Hypocalciuria in preeclampsia.
        N Engl J Med. 1987; 316: 715-718
        • Brown MA
        • Gallery ED
        • Ross MR
        • Esber RP.
        Sodium excretion in normal and hypertensive pregnancy: a prospective study.
        Am J Obstet Gynecol. 1988; 159: 297-307
        • August P
        • Sealey JE.
        The renin-angiotensin system in normal and hypertensive pregnancy and in ovarian function.
        in: Hypertension: pathophysiology, diagnosis, and management. Raven Press, New York1990: 1761-1778
        • Castro LC
        • Hobel CJ
        • Gornbein J.
        Plasma levels of atrial natriuretic peptide in normal and hypertensive pregnancies: a meta-analysis.
        Am J Obstet Gynecol. 1994; 171: 1642-1651
        • Bond AL
        • August P
        • Druzin ML
        • Atlas SA
        • Sealey JE
        • Laragh JH.
        Atrial natriuretic factor in normal and hypertensive pregnancy.
        Am J Obstet Gynecol. 1989; 160: 1112-1116
        • Barron WM
        • Heckerling P
        • Hibbard JU
        • Fisher S.
        Reducing unnecessary coagulation testing in hypertensive disorders of pregnancy.
        Obstet Gynecol. 1999; 94: 364-370
        • Lockwood CJ
        • Peters JH.
        Increased plasma levels of ED1+ cellular fibronectin precede the clinical signs of preeclampsia.
        Am J Obstet Gynecol. 1990; 162: 358-362
        • Baker PN
        • Cunningham FG.
        Platelet and coagulation abnormalities.
        in: Hypertensive disorders in pregnancy. Appleton and Lange, Stamford (CT)1999: 349-374
        • Burrows RF
        • Hunter DJ
        • Andrew M
        • Kelton JG.
        A prospective study investigating the mechanism of thrombocytopenia in preeclampsia.
        Obstet Gynecol. 1987; 70: 334-338
        • Pritchard JA
        • Cunningham FG
        • Pritchard SA
        • Mason RA.
        How often does maternal preeclampsia-eclampsia incite thrombocytopenia in the fetus?.
        Obstet Gynecol. 1987; 69: 292-295
        • Sheehan HL
        • Lynch JB.
        Pathology of toxaemia of pregnancy.
        Churchill Livingstone, London1973
        • Sibai BM
        • Kustermann L
        • Velasco J.
        Current understanding of severe preeclampsia, pregnancy-associated hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, hemolysis, elevated liver enzymes, and low platelet syndrome, and postpartum acute renal failure: different clinical syndromes or just different names?.
        Curr Opin Nephrol Hypertens. 1994; 3: 436-445
        • Weinstein L.
        Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy.
        Am J Obstet Gynecol. 1982; 142: 159-167
        • Ohno Y
        • Kawai M
        • Wakahara Y
        • Kitagawa T
        • Kakihara M
        • Arii Y.
        Transcranial assessment of maternal cerebral blood flow velocity in patients with pre-eclampsia.
        Acta Obstet Gynecol Scand. 1997; 76: 928-932
        • Belfort MA
        • Saade GR
        • Grunewald C
        • Dildy GA
        • Abedejos P
        • Herd JA
        • et al.
        Association of cerebral perfusion pressure with headache in women with pre-eclampsia.
        Br J Obstet Gynaecol. 1999; 106: 814-821
        • Richards A
        • Graham D
        • Bullock R.
        Clinicopathological study of neurological complications due to hypertensive disorders of pregnancy.
        J Neurol Neurosurg Psychiatry. 1988; 51: 416-421
        • Dahmus MA
        • Barton JR
        • Sibai BM.
        Cerebral imaging in eclampsia: magnetic resonance imaging versus computed tomography.
        Am J Obstet Gynecol. 1992; 167: 935-941
        • Moodley J
        • Bobat SM
        • Hoffman M
        • Bill PL.
        Electroencephalogram and computerised cerebral tomography findings in eclampsia.
        Br J Obstet Gynaecol. 1993; 100: 984-988
        • Drislane FW
        • Wang AM.
        Multifocal cerebral hemorrhage in eclampsia and severe pre-eclampsia.
        J Neurol. 1997; 244: 194-198
        • Morriss MC
        • Twickler DM
        • Hatab MR
        • Clarke GD
        • Peshock RM
        • Cunningham FG.
        Cerebral blood flow and cranial magnetic resonance imaging in eclampsia and severe preeclampsia.
        Obstet Gynecol. 1997; 89: 561-568
        • Friedman SA
        • Lindheimer MD
        Prediction and differential diagnosis.
        in: Chesley’s hypertensive disorders in pregnancy. Appleton and Lange, Stamford (CT)1999: 201-227
        • Sibai BM
        • Lindheimer MD
        • Hauth J
        • Caritis S
        • VanDorsten P
        • Klebanoff M
        • et al.
        Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension.
        N Eng J Med. 1998; 339 (F): 667-671
        • Caritis S
        • Sibai B
        • Hauth J
        • Lindheimer MD
        • Klebanoff M
        • Thom E
        • et al.
        Low-dose aspirin to prevent preeclampsia in women at high risk. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units.
        N Engl J Med. 1998; 338 (Ra): 701-705
        • Jones DC
        • Hayslett JP
        Outcome of pregnancy in women with moderate or severe renal insufficiency.
        N Engl J Med. 1996; 335 (F): 226-232
        • Cunningham FG
        • Cox SM
        • Harstad TW
        • Mason RA
        • Pritchard JA
        Chronic renal disease and pregnancy outcome.
        Am J Obstet Gynecol. 1990; 163 (F): 453-459
        • Jungers P
        • Chauveau D
        • Choukroun G
        • Moynot H
        • Skhiri H
        • Houillier P
        • et al.
        Pregnancy in women with impaired renal function.
        Clin Nephrol. 1997; 47 (F): 281-288
        • Packham DK
        • Fairley KF
        • Ihle BU
        • Whitworth JA
        • Kincaid-Smith P
        Comparison of pregnancy outcome between normotensive and hypertensive women with primary glomerulonephritis.
        Clin Exp Hypertens. 1988; B6 (Re): 387-399
        • Clapp 3rd, JF
        Morphometric and neurodevelopmental outcome at age five years of the offspring of women who continued to exercise regularly throughout pregnancy.
        J Pediatr. 1996; 129 (F): 856-863
        • Clapp 3rd, JF
        • Simonian S
        • Lopez B
        • Appleby-Wineberg S
        • Harcar-Sevcik R
        The one-year morphometric and neurodevelopmental outcome of the offspring of women who continued to exercise regularly throughout pregnancy.
        Am J Obstet Gynecol. 1998; 178 (F): 594-599
        • 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 (Ra): 960-965
        • Anonymous
        Nifedipine versus expectant management in mild to moderate hypertension in pregnancy. Gruppo di Studio Ipertensione in Gravidanza.
        Br J Obstet Gynaecol. 1998; 105 (Ra): 718-722
        • De Swiet M.
        Maternal blood pressure and birthweight [editorial].
        Lancet. 2000; 355: 81
        • 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 (M): 87-92
        • Sibai BM
        Treatment of hypertension in pregnant women.
        N Engl J Med. 1996; 335 (Pr): 257-265
        • Rey E
        • Couturier A
        The prognosis of pregnancy in women with chronic hypertension.
        Am J Obstet Gynecol. 1994; 171 (F): 410-416
        • Sibai BM
        Diagnosis and management of chronic hypertension in pregnancy.
        Obstet Gynecol. 1991; 78 (Pr): 451-461
        • Cunningham FG
        Common complications of pregnancy: hypertensive disorders in pregnancy.
        in: Williams obstetrics, 20th ed. Appleton and Lange, Stamford (CT)1997: 693-744 (Pr)
        • Montan S
        • Anandakumar C
        • Arulkumaran S
        • Ingemarsson I
        • Ratnam SS
        Effects of methyldopa on uteroplacental and fetal hemodynamics in pregnancy-induced hypertension.
        Am J Obstet Gynecol. 1993; 168 (F): 152-156
        • Cockburn J
        • Moar VA
        • Ounsted M
        • Redman CW
        Final report of study on hypertension during pregnancy: the effects of specific treatment on the growth and development of the children.
        Lancet. 1982; 1 (F): 647-649
        • Magee LA
        • Ornstein MP
        • von Dadelszen P
        Fortnightly review: management of hypertension in pregnancy.
        BMJ. 1999; 318 (M): 1332-1336
        • Lydakis C
        • Lip GY
        • Beevers M
        • Beevers DG
        Atenolol and fetal growth in pregnancies complicated by hypertension.
        Am J Hypertens. 1999; 12 (Re): 541-547
        • Lip GY
        • Beevers M
        • Churchill D
        • Shaffer LM
        • Beevers DG
        Effect of atenolol on birth weight.
        Am J Cardiol. 1997; 79 (F): 1436-1438
        • Butters L
        • Kennedy S
        • Rubin PC
        Atenolol in essential hypertension during pregnancy.
        BMJ. 1990; 301 (Ra): 587-589
        • Magee LA
        • Schick B
        • Donnenfeld AE
        • Sage SR
        • Conover B
        • Cook L
        • et al.
        The safety of calcium channel blockers in human pregnancy: a prospective, multicenter cohort study.
        Am J Obstet Gynecol. 1996; 174 (F): 823-828
        • Hays PM
        • Cruikshank DP
        • Dunn LJ
        Plasma volume determination in normal and preeclamptic pregnancies.
        Am J Obstet Gynecol. 1985; 151 (F): 958-966
        • Arias F
        • Zamora J
        Antihypertensive treatment and pregnancy outcome in patients with mild chronic hypertension.
        Obstet Gynecol. 1979; 53 (Ra): 489-494
        • Sibai BM
        • Grossman RA
        • Grossman HG
        Effects of diuretics on plasma volume in pregnancies with long-term hypertension.
        Am J Obstet Gynecol. 1984; 150 (Ra): 831-835
        • Collins R
        • Yusuf S
        • Peto R
        Overview of randomised trials of diuretics in pregnancy.
        BMJ (Clin Res Ed). 1985; 290 (M): 17-23
        • Hanssens M
        • Keirse MJ
        • Vankelecom F
        • Van Assche FA
        Fetal and neonatal effects of treatment with angiotensin-converting enzyme inhibitors in pregnancy.
        Obstet Gynecol. 1991; 78 (Pr): 128-135
        • Schubiger G
        • Flury G
        • Nussberger J.
        Enalapril for pregnancy-induced hypertension: acute renal failure in a neonate [published erratum appears in Ann Intern Med 1988;108:777].
        Ann Intern Med. 1988; 108: 215-216
        • Rosa FW
        • Bosco LA
        • Graham CF
        • Milstien JB
        • Dreis M
        • Creamer J
        Neonatal anuria with maternal angiotensin-converting enzyme inhibition.
        Obstet Gynecol. 1989; 74 (Re): 371-374
        • Scott AA
        • Purohit DM.
        Neonatal renal failure: a complication of maternal antihypertensive therapy.
        Am J Obstet Gynecol. 1989; 160: 1223-1224
        • Sibai BM
        • Anderson GD
        Pregnancy outcome of intensive therapy in severe hypertension in first trimester.
        Obstet Gynecol. 1986; 67 (F): 517-522
        • Jungers P
        • Chauveau D
        Pregnancy in renal disease.
        Kidney Int. 1997; 52 (Pr): 871-885
        • Packham DK
        • North RA
        • Fairley KF
        • Kloss M
        • Whitworth JA
        • Kincaid-Smith P
        Primary glomerulonephritis and pregnancy.
        Q J Med. 1989; 71 (Re): 537-553
        • Hou SH
        The kidney in pregnancy.
        in: 2nd ed. Primer on kidney diseases. National Kidney Foundation, Alexandria (VA)1998: 388-394 (Pr)
        • Okundaye I
        • Abrinko P
        • Hou S
        Registry of pregnancy in dialysis patients.
        Am J Kidney Dis. 1998; 31 (X): 766-773
        • Bagon JA
        • Vernaeve H
        • De Muylder X
        • Lafontaine JJ
        • Martens J
        • Van Roost GV
        Pregnancy and dialysis.
        Am J Kidney Dis. 1998; 31 (Re): 756-765
        • Hou S
        Pregnancy in chronic renal insufficiency and end-stage renal disease.
        Am J Kidney Dis. 1999; 33 (Pr): 235-252
        • Armenti VT
        • Moritz MJ
        • Davison JM
        Medical management of the pregnant transplant recipient.
        Adv Ren Replace Ther. 1998; 5 (Re): 14-23
        • Mabie WC
        • Ratts TE
        • Ramanathan KB
        • Sibai BM
        Circulatory congestion in obese hypertensive women: a subset of pulmonary edema in pregnancy.
        Obstet Gynecol. 1988; 72 (C): 553-558
        • Hou SH
        Grossman SD, Madias NE. Pregnancy in women with renal disease and moderate renal insufficiency.
        Am J Med. 1985; 78 (F): 185-194
        • Breitzka RL
        • Sandritter TL
        • Hatzopoulos FK
        Principles of drug transfer into breast milk and drug deposition in the nursing infant.
        J Hum Lactation. 1997; 13 (Pr): 155-158
        • Briggs GG
        • Freeman RK
        • Yergey AL
        Drugs in pregnancy and lactation.
        Williams and Wilkins, Baltimore1994 (Pr)
        • Anonymous
        American Academy of Pediatrics Committee on Drugs: The transfer of drugs and other chemicals into human milk.
        Pediatrics. 1994; 93 (Pr): 137-150
        • White WB
        Management of hypertension during lactation.
        Hypertension. 1984; 6 (Pr): 297-300
        • Healy M.
        Suppressing lactation with oral diuretics [letter].
        Lancet. 1961; 1: 1353-1354
        • Knowles JA.
        Drugs in milk.
        Pediatr Curr. 1972; 21: 28-32
        • Anonymous
        Low-dose aspirin in prevention and treatment of intrauterine growth retardation and pregnancy-induced hypertension. Italian study of aspirin in pregnancy.
        Lancet. 1993; 341 (Ra): 396-400
        • Sibai BM
        • Caritis SN
        • Thom E
        • Klebanoff M
        • McNellis D
        • Rocco L
        • et al.
        Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous pregnant women. The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units.
        N Engl J Med. 1993; 329 (Ra): 1213-1218
        • Anonymous
        CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group.
        Lancet. 1994; 343 (Ra): 619-629
        • Anonymous
        ECPPA: randomised trial of low dose aspirin for the prevention of maternal and fetal complications in high risk pregnant women. ECPPA (Estudo Colaborativo para Prevenção da Pré-eclampsia com Aspirina) Collaborative Group.
        Br J Obstet Gynaecol. 1996; 103 (Ra): 39-47
        • Rotchell YE
        • Cruickshank JK
        • Gay MP
        • Griffiths J
        • Stewart A
        • Farrell B
        • et al.
        Barbados Low Dose Aspirin Study in Pregnancy (BLASP): a randomised trial for the prevention of pre-eclampsia and its complications.
        Br J Obstet Gynaecol. 1998; 105 (Ra): 286-292
        • Hauth JC
        • Goldenberg RL
        • Parker Jr, CR
        • Philips 3d, JB
        • Copper RL
        • DuBard MB
        • et al.
        Low-dose aspirin therapy to prevent preeclampsia.
        Am J Obstet Gynecol. 1993; 168 (Ra): 1083-1091
        • Golding J
        A randomised trial of low dose aspirin for primiparae in pregnancy. The Jamaica Low Dose Aspirin Study Group.
        Br J Obstet Gynaecol. 1998; 105 (Ra): 293-299
        • Sibai BM
        Prevention of preeclampsia: a big disappointment.
        Am J Obstet Gynecol. 1998; 179 (Pr): 1275-1278
        • US Institute of Medicine Standing Committee on the Scientific Evaluation of Dietary Reference Intakes
        Dietary reference intakes: for calcium, phosphorus, magnesium, vitamin D, and fluoride. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes.
        in: Food, and Nutrition Board, Institute of Medicine. National Academy Press, Washington, DC1997: 87 (Pr)
        • Levine RJ
        • Hauth JC
        • Curet LB
        • Sibai BM
        • Catalano PM
        • Morris CD
        • et al.
        Trial of calcium to prevent preeclampsia.
        N Engl J Med. 1997; 337 (Ra): 69-76
        • Herrera JA
        • Arevalo-Herrera M
        • Herrera S
        Prevention of preeclampsia by linoleic acid and calcium supplementation: a randomized controlled trial.
        Obstet Gynecol. 1998; 91 (Ra): 585-590
        • Crowther CA
        • Hiller JE
        • Pridmore B
        • Bryce R
        • Duggan P
        • Hague WM
        • et al.
        Calcium supplementation in nulliparous women for the prevention of pregnancy-induced hypertension, preeclampsia and preterm birth: an Australian randomized trial. FRACOG and the ACT Study Group.
        Aust N Z J Obstet Gynaecol. 1999; 39 (Ra): 12-18
        • López-Jaramillo P
        • Narváez M
        • Weigel RM
        • Yépez R
        Calcium supplementation reduces the risk of pregnancy-induced hypertension in an Andes population.
        Br J Obstet Gynaecol. 1989; 96 (Ra): 648-655
        • López-Jaramillo P
        • Narváez M
        • Felix C
        • Lopez A
        Dietary calcium supplementation and prevention of pregnancy hypertension [letter].
        Lancet. 1990; 335 (Ra): 293
        • López-Jaramillo P
        • Delgado F
        • Jacome P
        • Teran E
        • Ruano C
        • Rivera J
        Calcium supplementation and the risk of preeclampsia in Ecuadorian pregnant teenagers.
        Obstet Gynecol. 1997; 90 (Ra): 162-167
        • Sanchez-Ramos L
        • Briones DK
        • Kaunitz AM
        • Delvalle GO
        • Gaudier FL
        • Walker CD
        Prevention of pregnancy-induced hypertension by calcium supplementation in angiotensin II-sensitive patients.
        Obstet Gynecol. 1994; 84 (Ra): 349-353
        • Belizán JM
        • Villar J
        • Gonzalez L
        • Campodonico L
        • Bergel E
        Calcium supplementation to prevent hypertensive disorders of pregnancy.
        N Engl J Med. 1991; 325 (Ra): 1399-1405
        • Spätling L
        • Spätling G
        Magnesium supplementation in pregnancy: a double-blind study.
        Br J Obstet Gynaecol. 1988; 95 (Ra): 120-125
        • Sibai BM
        • Villar MA
        • Bray E
        Magnesium supplementation during pregnancy: a double-double-blind randomized controlled clinical trial.
        Am J Obstet Gynecol. 1989; 161 (Ra): 115-119
        • Bulstra-Ramakers MT
        • Huisjes HJ
        • Visser GH
        The effects of 3g eicosapentaenoic acid daily on recurrence of intrauterine growth retardation and pregnancy induced hypertension.
        Br J Obstet Gynaecol. 1995; 102 (Ra): 123-126
        • Onwude JL
        • Lilford RJ
        • Hjartardottir H
        • Staines A
        • Tuffnell D
        Arandomised double blind placebo controlled trial of fish oil in high risk pregnancy.
        Br J Obstet Gynaecol. 1995; 102 (Ra): 95-100
        • Salvig JD
        • Olsen SF
        • Secher NJ
        Effects of fish oil supplementation in late pregnancy on blood pressure: a randomised controlled trial.
        Br J Obstet Gynaecol. 1996; 103 (Ra): 529-533
        • Chappell LC
        • Seed PT
        • Briley AL
        • Kelly FJ
        • Lee R
        • Hunt BJ
        • et al.
        Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial.
        Lancet. 1999; 354 (Ra): 810-816
        • Roberts JM
        • Hubel CA.
        Is oxidative stress the link in the two-stage model of pre-eclampsia?.
        Lancet. 1999; 354: 788-789
        • Witlin AG
        • Sibai BM
        Hypertension.
        Clin Obstet Gynecol. 1998; 41 (Pr): 533-544
        • Twaddle S
        • Harper V
        An economic evaluation of daycare in the management of hypertension in pregnancy.
        Br J Obstet Gynaecol. 1992; 99 (F): 459-463
        • Helewa M
        • Heaman M
        • Robinson MA
        • Thompson L
        Community-based home-care program for the management of pre-eclampsia: an alternative.
        CMAJ. 1993; 149 (F): 829-834
        • Barton JR
        • Stanziano GJ
        • Sibai BM
        Monitored outpatient management of mild gestational hypertension remote from term.
        Am J Obstet Gynecol. 1994; 170 (F): 765-769
        • Barton JR
        • Stanziano GJ
        • Jacques DL
        • Bergauer NK
        • Sibai BM
        Monitored outpatient management of mild gestational hypertension remote from term in teenage pregnancies.
        Am J Obstet Gynecol. 1995; 173 (F): 1865-1868
        • Barton JR
        • Bergauer NK
        • Jacques DL
        • Coleman SK
        • Stanziano GJ
        • Sibai BM
        Does advanced maternal age affect pregnancy outcome in women with mild hypertension remote from term?.
        Am J Obstet Gynecol. 1997; 176 (F): 1236-1243
        • Mathews DD
        • Patel IR
        • Sengupta SM
        Out-patient management of toxaemia.
        J Obstet Gynaecol Br Commonw. 1971; 78 (F): 610-619
        • Crowther CA
        • Bouwmeester AM
        • Ashurst HM
        Does admission to hospital for bed rest prevent disease progression or improve fetal outcome in pregnancy complicated by non-proteinuric hypertension?.
        Br J Obstet Gynaecol. 1992; 99 (Ra): 13-17
        • Tuffnell DJ
        • Lilford RJ
        • Buchan PC
        • Prendiville VM
        • Tuffnell AJ
        • Holgate MP
        • et al.
        Randomised controlled trial of day care for hypertension in pregnancy.
        Lancet. 1992; 339 (Ra): 224-227
        • Sibai BM
        • Akl S
        • Fairlie F
        • Moretti M
        A protocol for managing severe preeclampsia in the second trimester.
        Am J Obstet Gynecol. 1990; 163 (F): 733-738
        • Sibai BM
        • Mercer BM
        • Schiff E
        • Friedman SA
        Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks’ gestation: a randomized controlled trial.
        Am J Obstet Gynecol. 1994; 171 (Ra): 818-822
        • Odendaal HJ
        • Pattinson RC
        • Bam R
        • Grove D
        • Kotze TJ
        Aggressive or expectant management for patients with severe preeclampsia between 28-34 weeks’ gestation: a randomized controlled trial.
        Obstet Gynecol. 1990; 76 (Ra): 1070-1075
        • Wide-Swensson DH
        • Ingemarsson I
        • Lunell NO
        • Forman A
        • Skajaa K
        • Lindberg B
        • et al.
        Calcium channel blockade (isradipine) in treatment of hypertension in pregnancy: a randomized placebo-controlled study.
        Am J Obstet Gynecol. 1995; 173 (Ra): 872-878
        • Schiff E
        • Friedman SA
        • Sibai BM
        Conservative management of severe preeclampsia remote from term.
        Obstet Gynecol. 1994; 84 (Pr): 626-630
        • Hood DD
        • Curry R
        Spinal versus epidural anesthesia for cesarean section in severely preeclamptic patients: a retrospective survey.
        Anesthesiology. 1999; 90 (Re): 1276-1282
        • Wallace DH
        • Leveno KJ
        • Cunningham FG
        • Giesecke AH
        • Shearer VE
        • Sidawi JE
        Randomized comparison of general and regional anesthesia for cesarean delivery in pregnancies complicated by severe preeclampsia.
        Obstet Gynecol. 1995; 86 (Ra): 193-199
        • Hawkins JL
        • Koonin LM
        • Palmer SK
        • Gibbs CP
        Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990.
        Anesthesiology. 1997; 86 (X): 277-284
        • Anonymous
        Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial [published erratum appears in Lancet 1995;346:258].
        Lancet. 1995; 345 (Ra): 1455-1463
        • Witlin AG
        • Sibai BM
        Magnesium sulfate therapy in preeclampsia and eclampsia.
        Obstet Gynecol. 1998; 92 (Pr): 883-889
        • Chien PF
        • Khan KS
        • Arnott N
        Magnesium sulphate in the treatment of eclampsia and pre-eclampsia: an overview of the evidence from randomised trials.
        Br J Obstet Gynaecol. 1996; 103 (M): 1085-1091
        • Coetzee EJ
        • Dommisse J
        • Anthony J
        A randomised controlled trial of intravenous magnesium sulfate versus placebo in the management of women with severe pre-eclampsia.
        Br J Obstet Gynecol. 1998; 105 (Ra): 300-303
        • Lucas MJ
        • Leveno KJ
        • Cunningham FG
        A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia.
        N Engl J Med. 1995; 333 (Ra): 201-205
        • Visser W
        • Wallenburg HC
        Temporising management of severe pre-eclampsia with and without the HELLP syndrome.
        Br J Obstet Gynaecol. 1995; 102 (Re): 111-117
        • Clark SL
        • Cotton DB
        Clinical indications for pulmonary artery catheterization in the patient with severe preeclampsia.
        Am J Obstet Gynecol. 1988; 158 (Pr): 453-458
        • Umans JG
        • Lindheimer MD
        Antihypertensive treatment.
        in: Hypertensive diseases in pregnancy. Appleton and Lange, Stamford (CT)1999: 581-604 (Pr)
        • Mabie WC
        • Gonzalez AR
        • Sibai BM
        • Amon E
        A comparative trial of labetalol and hydralazine in the acute management of severe hypertension complicating pregnancy.
        Obstet Gynecol. 1987; 70 (F): 328-333
        • Paterson-Brown S
        • Robson SC
        • Redfern N
        • Walkinshaw SA
        • De Swiet M
        Hydralazine boluses for the treatment of severe hypertension in pre-eclampsia.
        Br J Obstet Gynaecol. 1994; 101 (Re): 409-413
        • Scardo JA
        • Vermillion ST
        • Hogg BB
        • Newman RB
        Hemodynamic effects of oral nifedipine in preeclamptic hypertensive emergencies.
        Am J Obstet Gynecol. 1996; 175 (F): 336-338
        • Grossman E
        • Messerli FH
        • Grodzicki T
        • Kowey P
        Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and psuedoemergencies?.
        JAMA. 1996; 276 (Pr): 1328-1331
        • Impey L.
        Severe hypotension and fetal distress following sublingual administration of nifedipine to a patient with severe pregnancy induced hypertension at 33 weeks.
        Br J Obstet Gynaecol. 1993; 100: 959-961
        • Ben-Ami M
        • Giladi Y
        • Shalev E.
        The combination of magnesium sulfate and nifedipine: a cause of neuromuscular blockade.
        Br J Obstet Gynaecol. 1994; 101: 262-263
        • Brown MA
        • McCowan LM
        • North RA
        • Walters BN
        Withdrawal of nifedipine capsules: jeopardising the treatment of acute severe hypertension in pregnancy?.
        Med J Aust. 1997; 166 (Pr): 640-643
        • Hassall JJ
        • Millar JA
        • Langton PE.
        Withdrawal of nifedipine capsules: jeopardising the treatment of acute severe hypertension [letter].
        Med J Aust. 1998; 168: 43-44
        • 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 (F): 1011-1016
        • Sibai BM
        • Mercer B
        • Sarinoglu C
        Severe preeclampsia in the second trimester: recurrence risk and long-term prognosis.
        Am J Obstet Gynecol. 1991; 165 (F): 1408-1412
        • Chesley LC
        Hypertensive disorders of pregnancy.
        Appleton-Century-Crofts, New York1978 (Pr)
        • Sibai BM
        • Ramadan MK
        • Chari RS
        • Friedman SA
        Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis.
        Am J Obstet Gynecol. 1995; 172 (F): 125-129
        • Trupin LS
        • Simon LP
        • Eskenazi B
        Change in paternity: a risk factor for preeclampsia in multiparas.
        Epidemiology. 1996; 7 (Re): 240-244
        • Dekker GA
        • de Vries JI
        • Doelitzsch PM
        • Huijgens PC
        • von Blomberg BM
        • Jakobs C
        • van Geijn HP
        Underlying disorders associated with severe early-onset preeclampsia.
        Am J Obstet Gynecol. 1995; 173 (F): 1042-1048
        • Kupferminc MJ
        • Eldor A
        • Steinman N
        • Many A
        • Bar-Am A
        • Jaffa A
        • et al.
        Increased frequency of genetic thrombophilia in women with complications of pregnancy.
        N Engl J Med. 1999; 340 (F): 9-13
        • Sibai BM
        Thrombophilias and adverse outcomes of pregnancy—what should a clinician do?.
        [editorial] N Engl J Med. 1999; 340: 50-52
        • van Pampus MG
        • Dekker GA
        • Wolf H
        • Huijgens PC
        • Koopman MM
        • von Blomberg BM
        • et al.
        High prevalence of hemostatic abnormalities in women with a history of severe preeclampsia.
        Am J Obstet Gynecol. 1999; 180 (Re): 1146-1150
        • Sibai BM
        • Sarinoglu C
        • Mercer BM
        Eclampsia VII. Pregnancy outcome after eclampsia and long-term prognosis.
        Am J Obstet Gynecol. 1992; 166 (F): 1757-1761