CHRONIC HYPERTENSION IN PREGNANCY

Blood pressure >140/90 present before the pregnancy or starting before 20 weeks.

Pregnant women with chronic hypertension should continue to follow the lifestyle modifications for controlling
hypertension such as:

  • No alcohol
  • Regular moderate exercise, brisk walking for 30 minutes at least 3 times a week
  • Smoking cessation.

Health worker should:

  • Ask mother about foetal movements at each visit
  • Aim for BP <140/90 mmHg
  • Consider labour if BP is persistently ≥160/90 mmHg, pregnancy ≥37 weeks gestation, and if there is maternal or foetal compromise, e.g. poor SFH growth

MANAGEMENT

Switch chronic antihypertensive medication to or start

  • Methyldopa 250 mg 8 hourly, increase as necessary, max 500 mg 6 hourly

And/or

  • Nifedipine 20-40 mg every 12 hours

If not controlled or any sign of pre eclampsia: refer to hospital

Caution
  • ACE inhibitors, ARBs are contraindicated in pregnancy
  • Avoid beta blockers and diuretics