Hypertension in pregnancy: NICE issues updated quality standard

The National Institute for Health and Care Excellence (NICE) has issued an updated quality standard focusing on diagnosis and management of hypertension and pre-eclampsia during pregnancy, labour and birth. Additionally, it provides advice for women with hypertension planning to conceive and postnatal care for women with a history of hypertension or pre-eclampsia. The updated quality standards aim to align with the recent NICE guidelines on hypertension in pregnancy.

The key goals of the quality standard are improvements in the following areas:

• Reducing premature mortality;
• Reducing mortality in babies and young children;
• Experience of maternity services for women and their families;
• Reducing the incidence of avoidable harm; and
• Safety of maternity services.

The quality standard covers the following six recommendations:

• Women of childbearing potential with treated hypertension should be provided necessary information every year regarding safe antihypertensive therapy during pregnancy.
• Pregnant women with a high risk for pre-eclampsia when the appointment was made should be offered 75-150 mg of aspirin to be taken daily from 12 weeks until birth.
• Pregnant women receiving antihypertensive drugs should have a blood pressure target of ≤135/85 mmHg.
• Pregnant women with severe hypertension should be admitted for a complete evaluation, performed by a healthcare professional with expertise in managing hypertension in pregnancy.
• Hospital admission and monitoring are recommended for pregnant women with pre-eclampsia having severe hypertension, an increased risk for adverse events or any other clinical concerns.
• A senior obstetrician should be involved in the decision-making process regarding the timing of birth for women with pre-eclampsia.
• Women who have experienced hypertension in pregnancy should receive a plan for ongoing antihypertensive management as a part of their postnatal care planning. The plan should be communicated to their general practitioner at the time of transfer to community care after birth.
• Women with a history of gestational hypertension or pre-eclampsia should discuss future pregnancy and lifetime cardiovascular risks at the time of their six- to eight-week postnatal medical review.