Module Content

 

 

 

Chronic Medical Conditions                                                

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Pregnancy is affected by and affects the management of many chronic medical conditions. Because it would be near impossible to cover them all in this module, we have decided to focus on two conditions ubiquitously prevalent in the U.S. – Hypertension (HTN) and Diabetes (DM).  Because the preconception management of both these conditions affects pregnancy outcomes, they are included in this module as critical elements of good preconception care.

 

Dunlop AL, Jack BW, Bottalico JN, et al. The clinical content of preconception care: women with chronic medical conditions. Am J of Obstet and Gynecol [Internet]. 2008 Dec [cited 2009 Jul 20]; Suppl 2:199(6):S310-27. Available from http://www.ajog.org/.

 

 

Chronic Hypertension

 

 

Before discussing the topic of preconception management of chronic HTN, first make sure you know the difference between these different conditions characterized by high blood pressure.

 

Conditions Characterized by High Blood Pressure

  • Preeclampsia: This potentially serious disorder is characterized by high blood pressure and proteinuria. It usually develops after the 20th week of pregnancy and goes away after delivery.

  • Gestational hypertension (formerly known as pregnancy-induced hypertension): This form of high blood pressure develops after the 20th week of pregnancy and goes away after delivery. Affected women do not have protein in the urine. However, some women with gestational hypertension develop preeclampsia later in pregnancy.

  • Chronic hypertension: This is high blood pressure that is diagnosed before pregnancy or before the 20th week of pregnancy. It does not go away after delivery.

  • Chronic hypertension with superimposed preeclampsia: About 25 percent of women with chronic hypertension also develop preeclampsia.

    • Recall that the most recent report (2003) from the JNC divides chronic HTN into the following groups:

  • PreHTN = 120-139/80-89 mm Hg
  • Stage I (also known as mild/well-treated) HTN = 140-159/90-99 mm Hg
  • Stage II (also known as moderate) HTN = >160 or 100 mm Hg
    •