Hypertension in pregnancy

Quality statement

Women who have had gestational hypertension or pre-eclampsia discuss future pregnancy and lifetime cardiovascular risks during a medical review at their 6–8 week postnatal medical check.

Rationale

The long-term risks for women who have had hypertension in pregnancy include developing high blood pressure and an increased lifetime cardiovascular risk. Increased awareness and surveillance may lead to earlier intervention, such as antihypertensive treatment, with likely benefits for the woman. Women should be made aware of risks in future pregnancies resulting from hypertension in a previous pregnancy.

Quality measures

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

Service providers ensure that local arrangements are in place for women who have had gestational hypertension or pre-eclampsia to have a discussion about future related risks during the medical review at their 6–8 week postnatal medical check.

Healthcare practitioners discuss future related risks with women who have had gestational hypertension or pre-eclampsia during the medical review at their 6–8 week postnatal medical check.

Commissioners ensure that they commission services that discuss future related risks with women who have had gestational hypertension or pre-eclampsia during the medical review at their 6–8 week postnatal medical check.

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

Women who have had gestational hypertension (new high blood pressure starting after 20 weeks of pregnancy) or pre-eclampsia (a pregnancy-related rise in blood pressure with protein in the urine that happens in some pregnancies) have an appointment with their doctor or midwife 6 to 8 weeks after they have had their baby, at which they discuss their risk of having problems with their blood pressure or pregnancies in the future.

Source guidance

Definitions of terms used in this quality statement

Future pregnancy and lifetime cardiovascular risk
NICE clinical guideline 107 recommends that women who have had gestational hypertension or pre-eclampsia should be told that these conditions are associated with an increased risk of developing high blood pressure and its complications in later life.

NICE clinical guideline 107 recommends that women who have had gestational hypertension should be told that their risk of developing:

Women who have had pre-eclampsia should be told that their risk of developing:

Gestational hypertension New hypertension presenting after 20 weeks of pregnancy without significant proteinuria.

Medical review
NICE clinical guideline 107 recommends that women who have had gestational hypertension or pre-eclampsia should be offered a medical review at their postnatal check, which takes place 6–8 weeks after birth. (Topic expert group consensus was that this would be carried out by a GP or an appropriately trained midwife.)

Pre-eclampsia New hypertension presenting after 20 weeks of pregnancy with significant proteinuria (urinary protein:creatinine ratio greater than 30 mg/mmol or a validated 24‑hour urine collection result greater than 300 mg protein).

Equality and diversity considerations

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.