Hypertensive Disorders Management in Pregnancy

Hypertensive disorders of pregnancy encompass chronic hypertension, gestational hypertension and pre-eclampsia, affecting around 5–10% of pregnancies worldwide and contributing substantially to maternal and perinatal morbidity and mortality. Pre-eclampsia is characterised by new-onset hypertension after 20 weeks’ gestation accompanied by proteinuria or organ dysfunction and is driven by abnormal placental development and systemic endothelial dysfunction. Management begins with early risk identification and preventive measures—such as low-dose aspirin and calcium supplementation—followed by close maternal and foetal monitoring. Antihypertensive therapy (commonly labetalol, methyldopa or nifedipine) is deployed to control severe blood pressure elevations, while magnesium sulphate remains the cornerstone for seizure prophylaxis and treatment. Timing of delivery is individualised to balance maternal risks against foetal maturity, with planned preterm delivery considered in late preterm pre-eclampsia to reduce adverse outcomes. In high-resource settings, multidisciplinary care pathways and ambulatory blood pressure monitoring enhance safety, whereas in low-resource environments simplified risk scores guide referral and the allocation of limited resources. Emerging advances in predictive modelling and precision medicine promise more tailored surveillance and intervention strategies across diverse healthcare systems.

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Hypertensive Disorders Management in Pregnancy publication trend

The graph below shows the total number of articles in hypertensive disorders management in pregnancy across all publications each year (not limited to Nature Index journals).

Technical terms

Pre-eclampsia: New-onset hypertension after 20 weeks’ gestation with proteinuria or evidence of end-organ dysfunction.
Gestational hypertension: Elevated blood pressure developing after 20 weeks’ gestation without proteinuria or end-organ involvement.
Magnesium sulphate: Anticonvulsant used to prevent and treat eclamptic seizures.
Low-dose aspirin prophylaxis: Daily administration of aspirin (75–150 mg) from early pregnancy to reduce pre-eclampsia risk in high-risk women.
Risk stratification model: A predictive algorithm that estimates an individual’s likelihood of adverse outcomes to guide monitoring and intervention.

References

1. Planned delivery or expectant management for late preterm pre-eclampsia in low-income and middle-income countries (CRADLE-4): a multicentre, open-label, randomised controlled trial. The Lancet (2023).
2. Machine learning-enabled maternal risk assessment for women with pre-eclampsia (the PIERS-ML model): a modelling study. The Lancet Digital Health (2024).
3. A Risk Prediction Model for the Assessment and Triage of Women with Hypertensive Disorders of Pregnancy in Low-Resourced Settings: The miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) Multi-country Prospective Cohort Study. PLOS Medicine (2014).
4. Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population‐based study. BMC Pregnancy and Childbirth (2021).
5. Hypertensive Disorders of Pregnancy: A Systematic Review of International Clinical Practice Guidelines. PLOS ONE (2014).
6. Preeclampsia: Recent Advances in Predicting, Preventing, and Managing the Maternal and Fetal Life-Threatening Condition. International Journal of Environmental Research and Public Health (2023).