Hypertensive Disorders of Pregnancy: A Systematic Review of International Clinical Practice Guidelines
Open accessAbstract
BACKGROUND: Clinical practice guidelines (CPGs) are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy) to inform clinical practice. METHODOLOGY & PRINCIPAL FINDINGS: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of Abstracts of Reviews of Effects (Ovid interface), Grey Matters, Google Scholar, and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13) in English, French, Dutch, or German. Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3-1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ≧80% on every domain of the AGREE II, a tool for assessing guideline methodological quality; two CPGs did so for 5/6 domains. Consistency was seen for (i) definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii) pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii) antihypertensive treatment of severe hypertension; (iv) MgSO4 for eclampsia and severe pre-eclampsia; (v) antenatal corticosteroids at <34 wks when delivery is probable within 7 days; (vi) delivery for women with severe pre-eclampsia pre-viability or pre-eclampsia at term; and (vii) active management of the third stage of labour with oxytocin. Notable inconsistencies were in: (i) definitions of pre-eclampsia and severe pre-eclampsia; (ii) target BP for non-severe hypertension; (iii) timing of delivery for women with pre-eclampsia and severe pre-eclampsia; (iv) MgSO4 for non-severe pre-eclampsia, and (v) postpartum maternal monitoring. CONCLUSIONS: Existing international HDP CPGs have areas of consistency with which clinicians and researchers can work to develop auditable standards, and areas of inconsistency that should be addressed by future research.
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Home BP at the 50th centile for gender and height represents the 'usual' HBP level, whereas HBP equal or higher than the 95th percentile represents the threshold for home hypertension.
“Home BP at the 50th centile for gender and height represents the ‘usual’ HBP level, whereas HBP equal or higher than the 95th percentile represents the threshold for home hypertension [183]”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [183]
The Results, Definitions/classification section defines hypertension in pregnancy using fixed BP thresholds, not home BP centiles. Searches for the 50th and 95th centiles and for home BP thresholds found no passage addressing the claimed gender- and height-specific definitions. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe normalcy range of HBP has been investigated in a single cross-sectional school-based study in 778 children and adolescents, which provided percentile tables according to gender and height.
“The normalcy range of HBP has been investigated in a single cross-sectional school-based study in 778 children and adolescents, which provided percentile tables according to gender and height (Table 3) [183]”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [183]
The Introduction and Results discuss clinical practice guidelines for hypertension in pregnancy, not normal home blood pressure ranges in children. Searches for the 778-child school-based study and for pediatric home blood pressure percentiles found no passage addressing the claimed study or its gender- and height-specific tables. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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- Authors
- Gillon, T. E. R., Pels, A., von Dadelszen, P., MacDonell, K., & Magee, L. A.
- Affiliations
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- College of Physicians and Surgeons of British Columbia (CA)
- University of British Columbia (CA)
- Corresponding author
- Magee, Laura A.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-12-01
- Volume
- 9
- Issue
- 12
- Pages
- e113715
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4249974
- OpenAlex
- W2131408636
- Cited by
- 210
- References
- 43
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 12 · 2023: 10 · 2022: 21 · 2021: 16 · 2020: 28 · 2019: 21 · 2018: 21 · 2017: 23 · 2016: 21 · 2015: 17
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
- Keywords
- hypertensive disorders of pregnancy, guideline quality assessment, AGREE II, preeclampsia, gestational hypertension, eclampsia, magnesium sulfate, antihypertensive therapy, antenatal corticosteroids, timing of delivery, low-dose aspirin, calcium supplementation, guideline consistency
- MeSH terms
- Female, Humans, Pregnancy, Databases, Bibliographic, Practice Guidelines as Topic, Hypertension, Pregnancy-Induced
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