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Hypertension in pregnancy - Draft

Checked: 23-02-2021 by Vicky Ryan Next Review: 23-02-2022

Hypertension in pregnancy

There are CKS guidelines on management of Hypertension in Pregnancy (1) - includes advice on pre-eclampsia and post partum follow-up.

Aspirin in pregnancy

***Update June 2025** There is currently no local guidance or an established formulary position regarding the use of aspirin in pregnancy in BNSSG. The antenatal teams and midwives may advise on use of aspirin which is currently off label.

The BNSSG Formulary team are currently involved in a research project with the University of Bristol – the Medicines Adherence in Pregnancy Study – Aspirin (MAP-A), which aims to investigate the factors influencing adherence to low-dose aspirin in pregnancy. As part of this work, a formulary application through the Joint Formulary Group will be submitted to support a formal position on the off-label use of aspirin for this indication.

The CKS guidelines give advice on managing women at high risk of, or exhibiting clinical features of pre-eclampsia (1) which advises the following:

Be aware that women are considered to be at high risk of pre-eclampsia if they have:
- One of the following high-risk factors:
  - A history of hypertensive disease during a previous pregnancy.
  - Chronic kidney disease.
  - Autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome.
  - Type 1 or type 2 diabetes.
  - Chronic hypertension.
- Two or more of the following moderate risk factors:
  - First pregnancy.
  - Aged 40 years or older.
  - Pregnancy interval of more than 10 years.
  - Body mass index (BMI) of 35 kg/m²or greater at the first visit.
  - Family history of pre-eclampsia.
  - Multiple pregnancy.

Prescribing aspirin for women assessed to be at high risk of pre-eclampsia:

Refer for consultant-led care at booking for specialist input to assess and manage the obstetric risk.
Ensure that aspirin 75—150 mg daily is prescribed from 12 weeks' gestation until birth. This is usually arranged in secondary care, but should be initiated in primary care if the woman will not be seen by a specialist until after 12 weeks.
- Seek specialist advice before prescribing aspirin to girls younger than 16 years of age, and in those with thrombophilia or uncontrolled blood pressure. There is no evidence that use of low-dose aspirin in pregnancy is associated with an increased risk of congenital abnormalities or other foetal complications. (1)

Other trusts and ICBs have existing information for patients on use of aspirin in pregnancy that may also be useful (2,3).

Referral

Please see the Maternity Services section for advice on how to refer.

Postpartum Hypertension

Please see the CKS guidelines below for advice on management during the postpartum period:

Postpartum follow-up | Management | Hypertension in pregnancy | CKS | NICE

The guideline gives the following advice about follow up of this group of patients:

Reduce antihypertensive treatment if blood pressure falls below 130/80 mmHg..
Review antihypertensive treatment 2 weeks postnatally.
Ensure that women with chronic hypertension are offered a medical review 6–8 weeks after the birth either in primary care, or with a specialist as appropriate.

The Remedy team are not aware of any more specific national or local guidelines about how to wean anti-hypertensive medication and suggest a pragmatic approach using the above as a guide.

Resources

The secondary care NBT Guideline Hypertension in Pregnancy includes pathways on management of pre-eclampsia and eclampsia.

(1) Hypertension in pregnancy | Health topics A to Z | CKS | NICE

(2) Low-dose aspirin in pregnancy to prevent pre-eclampsia - Overview | Guy's and St Thomas' NHS Foundation Trust

(3) Low dose aspirin (150mg) in pregnancy - East Sussex.pdf

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.