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About the development history and definition of hypertension during pregnancy

2021.12.03 / Friday
About the development history and definition of hypertension during pregnancy

In 2016, "The Lancet" published an article on the survey and analysis of global pregnant women from 1990 to 2015. The article pointed out that the main causes of maternal death are still obstetric hemorrhage and hypertensive diseases; in 2018, the European Heart

Association issued guidelines for the management of cardiovascular disease in pregnancy, which clearly pointed out that cardiovascular disease in pregnancy can lead to cerebrovascular events, Organ failure, maternal placental abruption and diffuse intravascular coagulation and other serious complications; in 2020, the American Association of Obstetricians and Gynecologists survey found that hypertension during pregnancy is also the main cause of increased maternal and fetal mortality. In recent years, eclampsia The incidence of pre-eclampsia has increased year by year; in the same year, the Journal of the American College of Cardiology (JACC) confirmed that the incidence of cardiovascular and metabolic diseases in patients with preeclampsia and hypertension during pregnancy and hypertension increased significantly.

Definition and classification

In 2018, the International Society for the Study of Hypertension in Pregnancy defined hypertension in pregnancy as systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg, and divided it into two categories and six subtypes.

The first category is hypertension that occurs before pregnancy (before 20 weeks of pregnancy):

1. White coat hypertension, 50% develop hypertension during pregnancy, 8% develop preeclampsia;

2. Chronic hypertension, 25% develop preeclampsia; 

3. Occult hypertension, lack of research. 

The second category is hypertension that occurs after pregnancy (after 20 weeks of pregnancy, including 20 weeks): 

1. Transient hypertension during pregnancy, about 20% can develop into hypertension during pregnancy, and 20% can develop into preeclampsia; 

2. Preeclampsia, including new onset or chronic hypertension combined with preeclampsia; 

3. High blood pressure during pregnancy, without proteinuria, organ dysfunction, and fetal growth restriction. Among them, white coat hypertension, occult hypertension, and transient pregnancy hypertension are defined as special types of new hypertension during pregnancy by ISSHP.

In April 2020, the Gestational Hypertension Disorders Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association updated and released the "Guidelines for the Diagnosis and Treatment of Hypertensive Disorders in Pregnancy (2020 Edition)" based on international guidelines and combined with my country’s national conditions. There are four categories including hypertension during pregnancy, preeclampsia-eclampsia, chronic hypertension during pregnancy, and chronic hypertension associated with preeclampsia.