BMJ review 2019
Antihypertensives in pregnancy AHA 2008

• very difficult to define and there have been many loose definitions
• the diagnosis endorsed by the International Society for the Study of Hypertension in Pregnancy (ISSHP) embraces new onset hypertension (sBP>140mmHg & dBP>90mmHg) plus ≥1
  • proteinuria
  • other maternal organ dysfunction including liver, kidney, neurological or hematological
  • uteroplacental dysfunction, such as fetal growth restriction
  • abnormal Doppler ultrasound findings of uteroplacental blood flow

The National Institute of Health and Care Excellence (NICE) defines pre-eclampsia as new onset of hypertension (over 140 mmHg systolic or over 90 mmHg diastolic) after 20 weeks of pregnancy and the coexistence of 1 or more of the following new-onset conditions:

• Proteinuria, or
• Other maternal organ dysfunction:
  • Renal insufficiency (creatinine 90 micromol/litre or more, 1.02 mg/100 ml or more).
  • Liver involvement (elevated transaminases [alanine aminotransferase or aspartate aminotransferase over 40 IU/litre] with or without right upper quadrant or epigastric abdominal pain).
  • Neurological complications such as eclampsia, altered mental status, blindness, stroke, clonus, severe headaches or persistent visual scotomata.
  • Haematological complications such as thrombocytopenia (platelet count below 150,000/microlitre), disseminated intravascular coagulation or haemolysis.
  • Uteroplacental dysfunction such as fetal growth restriction, abnormal umbilical artery doppler waveform analysis, or stillbirth.

• Methyldopa remains one of the most widely used drugs for the treatment of hypertension in pregnancy.