Quality statement 1: Pre-pregnancy advice for women with treated hypertension

Quality statement

Women of childbearing potential with treated hypertension are given information annually about safe antihypertensive treatment during pregnancy.

Rationale

Information can be provided to women who may become pregnant about safe antihypertensive treatment during pregnancy as part of an annual review of hypertension care. Women should be informed about potential risks, including the risk of congenital abnormalities, linked to particular antihypertensive drugs. This should enable women to arrange a discussion with the healthcare professional responsible for managing their hypertension about alternative antihypertensive treatments if they are planning pregnancy or become pregnant.

Quality measures

Structure

Evidence of local arrangements to ensure that women of childbearing potential with treated hypertension are given information annually about safe antihypertensive treatment during pregnancy.

Data source: Local data collection.

Process

Proportion of women who have had treated hypertension for 12 months or longer who received information about safe antihypertensive treatment during pregnancy in the past 12 months.

Numerator – the number of women in the denominator who received information about safe antihypertensive treatment during pregnancy in the past 12 months.

Denominator – the number of women of childbearing potential who have had treated hypertension for 12 months or longer.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners and commissioners

Service providers ensure that systems are in place to give women of childbearing potential with treated hypertension information annually about safe antihypertensive treatment in pregnancy.

Healthcare practitioners give information annually to women of childbearing potential with treated hypertension about safe antihypertensive treatment in pregnancy.

Commissioners ensure they commission services that give information annually to women of childbearing potential with treated hypertension about safe antihypertensive treatment in pregnancy.

What the quality statement means for patients, service users and carers

Women who are having treatment for hypertension (high blood pressure) and who may become pregnant are given information annually about safe treatment for high blood pressure during pregnancy.

Source guidance

Definitions of terms used in this quality statement

Safe antihypertensive treatment
NICE clinical guideline 107 recommends that:

  • Women taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) should be provided with information to advise that there is an increased risk of congenital abnormalities if these drugs are taken during pregnancy, and discuss other antihypertensive treatment with the healthcare professional responsible for managing their hypertension, if they are planning pregnancy.

  • Women taking chlorothiazide should be provided with information to advise that: there may be an increased risk of congenital abnormality and neonatal complications if these drugs are taken during pregnancy, and to discuss other antihypertensive treatment with the healthcare professional responsible for managing their hypertension, if they are planning pregnancy.

  • Women who take antihypertensive treatments other than ACE inhibitors, ARBs or chlorothiazide should be provided with information to advise that the limited evidence available has not shown an increased risk of congenital malformation with such treatments.

Treated hypertension is hypertension that is treated with 1 or more antihypertensive drug.

Equality and diversity considerations

'Childbearing potential' should be determined for women on an individual basis. Access to information about safe antihypertensive treatment during pregnancy should not be determined solely by age, because childbearing potential is also dependent on factors other than age.

Where information is provided, there must be equal access to information for all women, including those with additional needs, such as physical or learning disabilities, and those who do not speak or read English. Women receiving information should have access to an interpreter or advocate if needed.