AHA/ASA guideline recommendations for prevention of stroke in women pregnancy and complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]

2014 AHA/ASA Guideline Recommendations for Prevention of Stroke in Women (DO NOT EDIT)[1]

Prevention of Preeclampsia

Class I
"1. Women with chronic primary or secondary hypertension or previous pregnancy-related hypertension should take low-dose aspirin from the 12th week of gestation until delivery.[2] (Level of Evidence: A). "
"2. Calcium supplementation (of ≥1 g/d, orally) should be considered for women with low dietary intake of calcium (<600 mg/d) to prevent preeclampsia.[3] (Level of Evidence: A). "

Treatment of Hypertension in Pregnancy and Post Partum

Class I
" Severe hypertension in pregnancy should be treated with safe and effective antihypertensive medications, such as methyldopa,[4][5] labetalol, and nifedipine,[6][7] with consideration of maternal and fetal side effects. (Level of Evidence: A). "
Class III (Harm)
" Atenolol,[8][9] angiotensin receptor blockers,[10][11] and direct renin inhibitors are contraindicated in pregnancy and should not be used. (Level of Evidence: C) "
Class IIa
"1. Consideration may be given to treatment of moderate hypertension in pregnancy with safe and effective antihypertensive medications, given the evidence for possibly increased stroke risk at currently defined systolic and diastolic BP cutoffs, as well as evidence for decreased risk for the development of severe hypertension with treatment (although maternal-fetal risk-benefit ratios have not been established)(Level of Evidence: B)"
"2. After giving birth, women with chronic hypertension should be continued on their antihypertensive regimen, with dosage adjustments to reflect the decrease in volume of distribution and glomerular filtration rate that occurs after delivery. They should also be monitored carefully for the development of postpartum preeclampsia. (Level of Evidence: C)"

Prevention of Stroke in a Woman with a History of Preeclampsia

Class IIa
" Because of the increased risk of future hypertension and stroke 1 to 30 years after delivery in women with a history of preeclampsia (Level of Evidence: B), it is reasonable to:"
"1. Consider evaluating all women starting 6 months to 1 year post partum, as well as those who are past childbearing age, for a history of preeclampsia/eclampsia and document their history of preeclampsia/eclampsia as a risk factor, and

2. Evaluate and treat for cardiovascular risk factors including hypertension, obesity, smoking, and dyslipidemia (Level of Evidence: C)"

References

  1. Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL; et al. (2014). "Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. doi:10.1161/01.str.0000442009.06663.48. PMID 24503673.
  2. Duley L, Henderson-Smart DJ, Meher S, King JF (2007). "Antiplatelet agents for preventing pre-eclampsia and its complications". Cochrane Database Syst Rev (2): CD004659. doi:10.1002/14651858.CD004659.pub2. PMID 17443552.
  3. Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L (2010). "Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems". Cochrane Database Syst Rev (8): CD001059. doi:10.1002/14651858.CD001059.pub3. PMID 20687064. Review in: Evid Based Med. 2011 Apr;16(2):40-1
  4. Lindheimer MD, Taler SJ, Cunningham FG, American Society of Hypertension (2009). "ASH position paper: hypertension in pregnancy". J Clin Hypertens (Greenwich). 11 (4): 214–25. doi:10.1111/j.1751-7176.2009.00085.x. PMID 19614806.
  5. Cockburn J, Moar VA, Ounsted M, Redman CW (1982). "Final report of study on hypertension during pregnancy: the effects of specific treatment on the growth and development of the children". Lancet. 1 (8273): 647–9. PMID 6121965.
  6. "Nifedipine versus expectant management in mild to moderate hypertension in pregnancy. Gruppo di Studio Ipertensione in Gravidanza". Br J Obstet Gynaecol. 105 (7): 718–22. 1998. PMID 9692411.
  7. Abalos E, Duley L, Steyn DW, Henderson-Smart DJ (2007). "Antihypertensive drug therapy for mild to moderate hypertension during pregnancy". Cochrane Database Syst Rev (1): CD002252. doi:10.1002/14651858.CD002252.pub2. PMID 17253478. Review in: ACP J Club. 2007 Jul-Aug;147(1):9 Review in: Evid Based Med. 2007 Aug;12(4):116
  8. Lydakis C, Lip GY, Beevers M, Beevers DG (1999). "Atenolol and fetal growth in pregnancies complicated by hypertension". Am J Hypertens. 12 (6): 541–7. PMID 10371362.
  9. Easterling TR, Brateng D, Schmucker B, Brown Z, Millard SP (1999). "Prevention of preeclampsia: a randomized trial of atenolol in hyperdynamic patients before onset of hypertension". Obstet Gynecol. 93 (5 Pt 1): 725–33. PMID 10912975.
  10. Barr M, Cohen MM (1991). "ACE inhibitor fetopathy and hypocalvaria: the kidney-skull connection". Teratology. 44 (5): 485–95. doi:10.1002/tera.1420440503. PMID 1771591.
  11. Hanssens M, Keirse MJ, Vankelecom F, Van Assche FA (1991). "Fetal and neonatal effects of treatment with angiotensin-converting enzyme inhibitors in pregnancy". Obstet Gynecol. 78 (1): 128–35. PMID 2047053.


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