To treat or not to treat pregnant women with mild chronic hypertension: that has been a longtime concern and unanswered question for Dr. Joseph Bell, section chief of maternal fetal medicine for St. Luke’s University Health Network (SLUHN), and his obstetrician-gynecologist colleagues in the United States.
They have been concerned that, while blood pressure medications would protect the mothers from serious cardiovascular complications such as stroke, and pregnancy-related complications, such as preeclampsia and premature delivery, the drugs might adversely affect fetal growth by reducing blood flow to the baby. Current guidelines in the U.S. do not recommend routine medical treatment of mild chronic hypertension during pregnancy.
The answer to the question, now, is yes, that standard antihypertensive medications are effective for protecting mothers’ health and are safe for their babies. The conclusion came on April 2 in the authoritative article, “Treatment for Mild Chronic Hypertension in Pregnancy,” published in the New England Journal of Medicine (NEJM). The article reports on the outcomes of a six-year research study involving over 2,400 women and 61 research centers throughout the U.S., including Bell and St. Luke’s. Bell’s Maternal Fetal Medicine group enrolled the seventh largest number of patients of those centers in the U.S. participating in the study.
Erin Cudworth, who had mild chronic hypertension, enrolled in the study and was randomized to have no treatment. But at 34 weeks, she developed severe hypertension and was started on antihypertensive medication.
“I was totally fine on meds,” said Cudworth, a nurse in St. Luke’s labor and delivery unit at the St. Luke’s Anderson Campus. She delivered a healthy five-pound, 12-ounce, 19-inch baby girl, Gracelynn, 18 months ago, at 37 weeks gestation following a diagnosis of preeclampsia.
She’s pregnant with her second child and is pleased that the research outcomes are favorable for medication treatment, information that she’ll also be sharing with the couples she teaches in prenatal classes at St. Luke’s Dr. Bell, the region’s only contributing researcher and author in this study, “Chronic Hypertension in Pregnancy (CHAP),” and article, says, “This groundbreaking study will now change how pregnant women with mild, chronic high blood pressure are treated.”
“For many years, we haven’t known how to most effectively and safely treat mild chronic hypertension in pregnancy, but the conclusions from this study now give us much-needed evidence and guidance for optimal care,” says Dr. Bell, who also served at the research’s principal investigator at St. Luke’s. “Knowing that medical management of this common condition is effective and safe is going to change our approach in a significant way because of this research, and this will benefit many women and their babies.”