The complications of hypertension in pregnancy

Abstract

The hypertensive disorders of pregnancy remain a leading cause of maternal and perinatal morbidity and mortality in Europe and North America. Pre-eclampsia, which is proteinuric gestational hypertension, accounts for the majority of the excess risks and is defined by the maternal syndrome. The maternal syndrome of pre-eclampsia is characterised by a systemic inflammatory response and its sequelae. Systematic multisystem evaluation of pre-eclampsia, evidence-based antihypertensive therapy, and the use of MgSO4 to prevent and treat the seizures of eclampsia can reduce maternal risks. For mild-to-moderate pregnancy hypertension, maternal risks are small, and there may be adverse perinatal consequences of blood pressure normalisation. Early-onset and severe pre-eclampsia predict an excess risk of later cardiovascular morbidity and mortality. Both Chlamydophila pneumoniae and cytomegalovirus have bee associated with pre-eclampsia and atherosclerosis, and may provide a mechanistic link between pre-eclampsia and the recognised cardiovascular risk. Women with a history of either early-onset and/or severe pre-eclampsia should be considered to be at increased risk for later cardiovascular disease, and it may be prudent for them to have regular lipid profiles and tests for urinary microalbumin excretion.