Skip to main content

Advertisement

SpringerLink
Log in

Treatment of Preeclampsia: Current Approach and Future Perspectives

  • Preeclampsia (VD Garovic, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Hypertension is the most common medical disorder encountered during pregnancy, occurring in about 6–8 % of pregnancies. Preeclampsia is a pregnancy-specific disorder that occurs after 20 weeks’ gestation, characterized by hypertension and proteinuria. Preeclampsia can also occur superimposed upon chronic hypertension. Eclampsia is the convulsive form of preeclampsia, and affects 0.1 % of all pregnancies. In low-income and middle-income countries, preeclampsia and eclampsia are associated with 10–15 % of direct maternal deaths. Women who develop preeclampsia in pregnancy are at greater risk of cardiovascular and cerebrovascular events even years after their pregnancies. There is significant progress in the elucidation of the underlying mechanisms and pathophysiology of preeclampsia, although its therapeutics remains challenging; delivery of the fetus is still the definitive treatment. Different international societies have produced recommendations and guidelines for clinicians treating preeclampsia, with an overall goal of improving maternal and fetal outcomes. In this review, we focus on the level of blood pressure at which to commence treatment and the current clinical management strategies available to treat and possibly prevent preeclampsia. We also briefly outline some newer perspectives on management of the disorder.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183(1):S1–22.

  2. ACOG Committee on Practice Bulletins. ACOG practice bulletin. Chronic hypertension in pregnancy. Obstet Gynecol. 2001;98(1 suppl):177–85.

    Google Scholar 

  3. Practice ACoO. Practice bulletin #33: diagnosis and management of preeclampsia and eclampsia. Obstet Gynecol. 2002;99(1):159–67.

  4. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014. These are important recent statistics on causes of maternal death due to hypertension in pregnancy.

  5. Brown CM, Garovic VD. Drug treatment of hypertension in pregnancy. Drugs. 2014;74(3):283–96. doi:10.1007/s40265-014-0187-7.

    Article  CAS  PubMed  Google Scholar 

  6. Magee LA, Helewa M, Moutquin JM, von Dadelszen P, Hypertension Guideline Committee, Society of Obstetricians and Gynaecologists of Canada. Treatment of the hypertensive disorders of pregnancy. In: Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. J Obstet Gynaecol Canada: JOGC J d’Obstet Gynecol Can JOGC. 2008;30(3 Suppl 1):S24–36.

  7. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357. doi:10.1097/01.hjh.0000431740.32696.cc. This provides comprehensive guidelines on the treatment of hypertension in pregnancy.

    Article  CAS  PubMed  Google Scholar 

  8. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105–87. doi:10.1097/HJH.0b013e3281fc975a.

    Article  CAS  PubMed  Google Scholar 

  9. Excellence NIfHaC. Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. London: NICE 2010. Report No.: Contract No.: CG107.

  10. Lowe SA, Brown MA, Dekker GA, Gatt S, McLintock CK, McMahon LP, et al. Guidelines for the management of hypertensive disorders of pregnancy 2008. Aust N Z J Obstet Gynaecol. 2009;49(3):242–6. doi:10.1111/j.1479-828X.2009.01003.x.

    Article  PubMed  Google Scholar 

  11. Homer CS, Brown MA, Mangos G, Davis GK. Non-proteinuric pre-eclampsia: a novel risk indicator in women with gestational hypertension. J Hypertens. 2008;26(2):295–302. doi:10.1097/HJH.0b013e3282f1a953.

    Article  CAS  PubMed  Google Scholar 

  12. Pettit F, Brown MA. The management of pre-eclampsia: what we think we know. Eur J Obstet Gynecol Reprod Biol. 2012;160(1):6–12. doi:10.1016/j.ejogrb.2011.09.049.

    Article  PubMed  Google Scholar 

  13. Trogstad L, Magnus P, Stoltenberg C. Pre-eclampsia: risk factors and causal models. Best Pract Res Clinical Obstet Gynaecol. 2011;25(3):329–42.

    Article  Google Scholar 

  14. Wang A, Rana S, Karumanchi SA. Preeclampsia: the role of angiogenic factors in its pathogenesis. Physiology. 2009;24:147–58. doi:10.1152/physiol.00043.2008.

    Article  PubMed  Google Scholar 

  15. Hertig A, Liere P. New markers in preeclampsia. Clin Chim Acta Int J Clin Chem. 2010;411(21–22):1591–5. doi:10.1016/j.cca.2010.07.020.

    Article  CAS  Google Scholar 

  16. Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376(9741):631–44. doi:10.1016/S0140-6736(10)60279-6.

    Article  PubMed  Google Scholar 

  17. Cetin I, Huppertz B, Burton G, Cuckle H, Gonen R, Lapaire O, et al. Pregenesys pre-eclampsia markers consensus meeting: what do we require from markers, risk assessment and model systems to tailor preventive strategies? Placenta. 2011;32(Suppl):S4–16. doi:10.1016/j.placenta.2010.11.022.

    Article  PubMed  Google Scholar 

  18. American College of Obstetricians and Gynecologists, Task Force on Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122–31. doi:10.1097/01.AOG.0000437382.03963.88. This is an important recent statement from ACOG on hypertension in pregnancy.

    Article  Google Scholar 

  19. Podymow T, August P. Antihypertensive drugs in pregnancy. Semin Nephrol. 2011;31(1):70–85. doi:10.1016/j.semnephrol.2010.10.007. This provides a comprehensive review of antihypertensives used in pregnancy.

    Article  CAS  PubMed  Google Scholar 

  20. Magee LA. Drugs in pregnancy. Antihypertensives. Best Pract Res Clin Obstet Gynaecol. 2001;15(6):827–45. doi:10.1053/beog.2001.0232.

    Article  CAS  PubMed  Google Scholar 

  21. Duley L, Gulmezoglu AM, Henderson-Smart DJ, Chou D. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev. 2010;11, CD000025. doi:10.1002/14651858.CD000025.pub2.

    PubMed  Google Scholar 

  22. Duley L, Henderson-Smart DJ, Walker GJ, Chou D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev. 2010;12, CD000127. doi:10.1002/14651858.CD000127.pub2.

    PubMed  Google Scholar 

  23. Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2007;2, CD004659. doi:10.1002/14651858.CD004659.pub2.

    PubMed  Google Scholar 

  24. Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2010;8, CD001059. doi:10.1002/14651858.CD001059.pub3.

    PubMed  Google Scholar 

  25. European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147–97. doi:10.1093/eurheartj/ehr218. These guidelines provide up-to-date information on the management of cardiovascular disease in pregnancy.

    Article  PubMed  Google Scholar 

  26. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92(9):3517–22. doi:10.1210/jc.2007-0718.

    Article  CAS  PubMed  Google Scholar 

  27. De-Regil LM, Palacios C, Ansary A, Kulier R, Pena-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2012;2, CD008873. doi:10.1002/14651858.CD008873.pub2.

    PubMed Central  PubMed  Google Scholar 

  28. Roberts JM, Myatt L, Spong CY, Thom EA, Hauth JC, Leveno KJ, et al. Vitamins C and E to prevent complications of pregnancy-associated hypertension. N Engl J Med. 2010;362(14):1282–91. doi:10.1056/NEJMoa0908056.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Sorensen JD, Olsen SF, Pedersen AK, Boris J, Secher NJ, FitzGerald GA. Effects of fish oil supplementation in the third trimester of pregnancy on prostacyclin and thromboxane production. Am J Obstet Gynecol. 1993;168(3 Pt 1):915–22.

    Article  CAS  PubMed  Google Scholar 

  30. Makrides M, Duley L, Olsen SF. Marine oil, and other prostaglandin precursor, supplementation for pregnancy uncomplicated by pre-eclampsia or intrauterine growth restriction. Cochrane Database Syst Rev. 2006;3, CD003402. doi:10.1002/14651858.CD003402.pub2.

    PubMed  Google Scholar 

  31. Olsen SF, Osterdal ML, Salvig JD, Weber T, Tabor A, Secher NJ. Duration of pregnancy in relation to fish oil supplementation and habitual fish intake: a randomised clinical trial with fish oil. Eur J Clin Nutr. 2007;61(8):976–85. doi:10.1038/sj.ejcn.1602609.

    Article  CAS  PubMed  Google Scholar 

  32. Mostello D, Jen Chang J, Allen J, Luehr L, Shyken J, Leet T. Recurrent preeclampsia: the effect of weight change between pregnancies. Obstet Gynecol. 2010;116(3):667–72. doi:10.1097/AOG.0b013e3181ed74ea.

    Article  PubMed  Google Scholar 

  33. Maggard MA, Yermilov I, Li Z, Maglione M, Newberry S, Suttorp M, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA J Am Med Assoc. 2008;300(19):2286–96. doi:10.1001/jama.2008.641.

    Article  CAS  Google Scholar 

  34. Meher S, Duley L. Rest during pregnancy for preventing pre-eclampsia and its complications in women with normal blood pressure. Cochrane Database Syst Rev. 2006;2, CD005939. doi:10.1002/14651858.CD005939.

    PubMed  Google Scholar 

  35. Meher S, Abalos E, Carroli G. Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database Syst Rev. 2005;4, CD003514. doi:10.1002/14651858.CD003514.pub2.

    PubMed  Google Scholar 

  36. Duley L, Henderson-Smart D, Meher S. Altered dietary salt for preventing pre-eclampsia, and its complications. Cochrane Database Syst Rev. 2005;4, CD005548. doi:10.1002/14651858.CD005548.

    PubMed  Google Scholar 

  37. Meher S, Duley L. Nitric oxide for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2007;2, CD006490. doi:10.1002/14651858.CD006490.

    PubMed  Google Scholar 

  38. Dorniak-Wall T, Grivell RM, Dekker GA, Hague W, Dodd JM. The role of L-arginine in the prevention and treatment of pre-eclampsia: a systematic review of randomised trials. J Hum Hypertens. 2014;28(4):230–5. doi:10.1038/jhh.2013.100. This recent paper provides some insight into possible future therapies.

    Article  CAS  PubMed  Google Scholar 

  39. Wang K, Ahmad S, Cai M, Rennie J, Fujisawa T, Crispi F, et al. Dysregulation of hydrogen sulfide producing enzyme cystathionine gamma-lyase contributes to maternal hypertension and placental abnormalities in preeclampsia. Circulation. 2013;127(25):2514–22. doi:10.1161/CIRCULATIONAHA.113.001631.

    Article  CAS  PubMed  Google Scholar 

  40. George EM, Cockrell K, Aranay M, Csongradi E, Stec DE, Granger JP. Induction of heme oxygenase 1 attenuates placental ischemia-induced hypertension. Hypertension. 2011. doi:10.1161/hypertensionaha.111.169755.

    Google Scholar 

  41. Walsh SK, English FA, Crocker IP, Johns EJ, Kenny LC. Contribution of PARP to endothelial dysfunction and hypertension in a rat model of pre-eclampsia. Br J Pharmacol. 2012;166(7):2109–16. doi:10.1111/j.1476-5381.2012.01906.x.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Craici IM, Wagner SJ, Weissgerber TL, Grande JP, Garovic VD. Advances in the pathophysiology of pre-eclampsia and related podocyte injury. Kidney Int. 2014. doi:10.1038/ki.2014.17. This is a comprehensive review of podocyte injury in preeclampsia.

    Google Scholar 

  43. Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke J Cereb Circ. 2014;45(5):1545–88. doi:10.1161/01.str.0000442009.06663.48. These recommendations provide important guidance for stroke prevention in women with a history of preeclampsia.

    Article  Google Scholar 

  44. Mitka M. New guidelines focus on preventing stroke in women. JAMA J Am Med Assoc. 2014;311(10):1003–4. doi:10.1001/jama.2014.1775.

    Article  CAS  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Ecaterina Berzan, Ross Doyle, and Catherine M. Brown each declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Nephrology, University Hospital Waterford, Dunmore Road, Waterford, Ireland

    Ecaterina Berzan, Ross Doyle & Catherine M. Brown

Authors
  1. Ecaterina Berzan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ross Doyle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Catherine M. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherine M. Brown.

Additional information

This article is part of the Topical Collection on Preeclampsia

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berzan, E., Doyle, R. & Brown, C.M. Treatment of Preeclampsia: Current Approach and Future Perspectives. Curr Hypertens Rep 16, 473 (2014). https://doi.org/10.1007/s11906-014-0473-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11906-014-0473-5

Keywords

Search

Navigation