Abstract
Hypertensive disorders of pregnancy continue to be significant contributors to adverse
perinatal outcome and maternal mortality, as well as inducing life-long cardiovascular
health impacts that are proportional to the severity and frequency of pregnancy complications.
The placenta is the interface between the mother and fetus and its failure to undergo
vascular maturation in tandem with maternal cardiovascular adaptation by the end of
the first trimester predisposes to hypertensive disorders and fetal growth restriction.
While primary failure of trophoblastic invasion with incomplete maternal spiral artery
remodeling has been considered central to the pathogenesis of preeclampsia, cardiovascular
risk factors associated with abnormal first trimester maternal blood pressure and
cardiovascular adaptation produce identical placental pathology leading to hypertensive
pregnancy disorders. Outside pregnancy blood pressure treatment thresholds are identified
with the goal to prevent immediate risks from severe hypertension >160/100 mm Hg and
long-term health impacts that arise from elevated blood pressures as low as 120/80 mm
Hg. Until recently, the trend for less aggressive blood pressure management during
pregnancy was driven by fear of inducing placental malperfusion without a clear clinical
benefit. However, placental perfusion is not dependent on maternal perfusion pressure
during the first trimester and risk-appropriate blood pressure normalization may provide
the opportunity to protect from the placental maldevelopment that predisposes to hypertensive
disorders of pregnancy. Recent randomized trials set the stage for more aggressive
risk-appropriate blood pressure management that may offer a greater potential for
prevention for hypertensive disorders of pregnancy.
Key Points
-
Optimal management of maternal blood pressure to prevent preeclampsia and its risks
is undefined.
-
Early gestational rheological damage to the intervillous space predisposes to preeclampsia
and FGR.
-
First trimester blood pressure management may need to aim for normotension to prevent
preeclampsia.
Keywords
blood pressure - preeclampsia - prevention - first trimester - cardiovascular disease
- hypertension
