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This systematic review evaluates international clinical practice guidelines on hypertensive disorders of pregnancy (HDPs) published between 2015 and 2025, highlighting both advancements and persistent inconsistencies in recommendations. Key findings indicate improved consistency in antihypertensive treatment and aspirin dosage for preeclampsia prevention, while notable variability remains in the definitions and management strategies for severe preeclampsia. The review emphasizes the need for establishing auditable standards and further research to enhance guideline robustness and optimize pregnancy outcomes.

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Systematic Reviews ajog.

org

Hypertensive disorders of pregnancy: a systematic

review of international clinical practice guidelines
Micol Febles, BSc; Georgia Scott, MBChB; Tessa Gillon, MD; Anouk Pels, MD, PhD; Kristina Klepp, MD;
Maria Laura Costa, MD; Peter von Dadelszen, MBChB, DPhil; Laura A. Magee, MD

Introduction
The hypertensive disorders of pregnancy OBJECTIVE: This systematic review updates a 2020 analysis of clinical practice
(HDPs) are estimated to complicate about guidelines regarding hypertensive disorders of pregnancy, aiming to both support
10% of pregnancies, with 1% to 2% evidence-based practice and inform future research.
chronic hypertension, 5% to 6% gesta- DATA SOURCES: Searches were conducted in Embase, MEDLINE, and the Cochrane
tional hypertension, and 2% to 4% pre- Central Register of Controlled Trials. The search strategy used combinations of keywords
eclampsia.1 HDP prevalence has been and Medical Subject Headings terms relating to “pregnancy,” “hypertension,” “hyper-
rising modestly over time,2 globally, likely tensive disorders of pregnancy,” and “guidelines,” alongside Boolean operators to refine
related to secular trends in maternal the search. Language and date filters were applied to restrict the results to documents
published from January 2015 to January 2025 and in eligible languages.
STUDY ELIGIBILITY CRITERIA: We included international and national clinical practice
From the Department of Women and Children’s guidelines published between 2015 and 2025, in English, Dutch, French, German,
Health, and School of Life Course and Norwegian, or Spanish.
Population Sciences, King’s College London, STUDY APPRAISAL AND SYNTHESIS METHODS: A comprehensive search of biblio-
London, UK (Febles, von Dadelszen and
Magee); Pregnancy and Heart Disease Centre,
graphic databases and gray literature identified 23 clinical practice guidelines, including
Royal Brompton Hospital, London, UK (Scott); 15 updates and 8 newly identified guidelines. The Appraisal of Guidelines for Research
Point-F, Women’s Medical Centre, Fribourg, and Evaluation II (AGREE II) tool was used to assess guideline characteristics. Data
Switzerland (Gillon); Amsterdam UMC, abstraction was by 2 independent reviewers, with disagreement resolved by consensus,
University of Amsterdam, Department of with a third reviewer resolving outstanding difference of opinion. The results are pre-
Obstetrics and Gynecology, Amsterdam, The
Netherlands (Pels); Norwegian Research
sented descriptively.
Centre for Women’s Health, Oslo University RESULTS: Half of clinical practice guidelines were scored as being ‘clinically useful’,
Hospital and Institute of Clinical Medicine, while the other half were scored as useful with modifications, using the AGREE II score.
Faculty of Medicine, University of Oslo, Oslo, Notable evolution since 2020 includes greater consistency in recommending antihy-
Norway (Klepp); and Department of pertensive treatment for nonsevere hypertension in women with chronic hypertension
Gynecology and Obstetrics, Universidade
Estadual de Campinas, Campinas, Brazil
(endorsed by 9 clinical practice guidelines; advice remains more discordant for women
(Costa). with either gestational hypertension or preeclampsia) and improved guidance regarding
Received Dec. 22, 2025; revised Feb. 23, 2026; maternal and fetal monitoring for women either at an increased risk of or with (endorsed
accepted Feb. 25, 2026. by 9 clinical practice guidelines) preeclampsia, although the former remains under-
D.P.V. and M.L.A. are senior authors. addressed. Aspirin dosage (for preeclampsia prevention) recommendations, while still
P.V.D. and L.A.M. are coauthors of the varied, now fall within a more consistent range of 75 to 162 mg/d. Persistent in-
International Society for the Study of consistencies remain in the definition of ‘severe’ preeclampsia, timing of birth for pre-
Hypertension in Pregnancy, International term preeclampsia, and specific aspirin dosages and timing for commencement.
Federation of Gynecology and Obstetrics, and CONCLUSION: While several areas of consensus exist between clinical practice guide-
Society of Obstetricians and Gynaecologists of
lines, variability persists in key recommendations, and establishing auditable standards
Canada guidelines cited in this review. M.F.,
G.S., T.G., A.P., K.K., and M.L.C. report no is essential for effective implementation. Where discrepancies reflect insufficient or
conflict of interest. inconclusive evidence, further research is paramount to support robust guideline
There was funding for this research. development to optimize pregnancy outcomes.
This narrative systematic review was registered Key words: clinical practice guideline, definitions, management, prediction, pregnancy
with, and can be accessed at, Open Science
hypertension, prevention
Framework (January 23, 2025; [Link]
10.17605/[Link]/B9J4M).
Corresponding author: Laura A. Magee, MD.
[Link]@[Link] characteristics, such as increasing The HDPs are a major cause of
0002-9378/$36.00
maternal age and obesity prevalence; maternal and fetal morbidity and mortal-
ª 2026 Published by Elsevier Inc. perhaps confounded by improving ity, and their management is complex. As
[Link] detection in low- and middle-income such, HDP definitions, prediction, pre-
countries where the rising disease vention, early identification, and
burden has been most notable. evidence-based management are essential.

280 American Journal of Obstetrics & Gynecology AUGUST 2026

Descargado para rafael martinez (rafamartinez.71@[Link]) en Universidad Libre - Campus Barranquilla de [Link] por Elsevier en agosto 17,
2026. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2026. Elsevier Inc. Todos los derechos reservados.
[Link] Systematic Reviews

Dutch, English, French, German, or

AJOG at a glance Norwegian (ie, languages in which the
Why was this study conducted? review team were fluent). Of note,
This systematic review updates a 2020 analysis of clinical practice guidelines updated versions of CPGs included in
covering the care of the hypertensive disorders of pregnancy, aiming to support Gillon et al3 and Scott et al4 were
evidence-based practice and inform future research. included.
Exclusion criteria were: (1) docu-
Key findings ments not deemed to be evidence-based,
Notable evolution since 2020 includes greater consistency in recommending a due to the absence of references to pri-
more consistent range of aspirin dosage for preeclampsia prevention (75—162 mary literature; (2) CPGs that had been
mg/day), antihypertensive treatment for nonsevere hypertension in women with fully adapted from another guideline,
chronic hypertension (but neither gestational hypertension nor preeclampsia), without independent evidence review;
and improved guidance regarding maternal and fetal monitoring for women and (3) regional or local guidelines
either at an increased risk of or with preeclampsia, although the former remains when an equivalent national-level
underaddressed. Persistent inconsistencies remain in the timing of aspirin guideline was already eligible for
commencement, the definition of ‘severe’ preeclampsia, and timing of birth for inclusion.
preterm preeclampsia. A structured search strategy was
employed to replicate those used by
What does this add to what is known? Gillon et al3 and Scott et al.4 Searches
Despite some variations, there is notable consistency in certain aspects of clinical were conducted in Embase, MEDLINE,
practice guideline content, indicating that the strength of recommendations and and the Cochrane Central Register of
the quality of supporting evidence are robust. To ensure effective implementa- Controlled Trials. The search strategy
tion, auditable standards should be established. However, inconsistencies persist, used combinations of keywords and
which may arise from factors such as the adaptation of recommendations to local Medical Subject Headings terms
contexts. Crucially, when discrepancies stem from inconclusive or weak evi- relating to “pregnancy,” “hypertension,”
dence, further research is essential to establish definitive recommendations. “hypertensive disorders of pregnancy,”
and “guidelines,” alongside Boolean
operators to refine the search. Language
There are many relevant interna- evaluate the extent of their alignment, and date filters were applied to restrict
tional and national clinical practice with the goal of supporting improved, the results to documents published from
guidelines (CPGs) that have addressed evidence-based care of the HDPs, dur- January 2015 to January 2025 and in
evidence-based care of the HDPs. These ing pregnancy and postpartum. eligible languages.
CPGs have been summarized in 2 sys- To identify updates of previously
tematic reviews.3,4 Gillon et al3 and Scott Methods included guidelines, searches were con-
et al4 each highlighted key areas of Eligibility criteria, information ducted of the official websites of organi-
between-CPG consensus, including the sources, and search strategy zations responsible for CPG publication.
definitions of hypertension and pro- Eligibility criteria were adapted from To otherwise capture CPGs not indexed
teinuria, the role of low-dose aspirin in Scott et al,4 maintaining consistency in databases, gray literature sources were
preeclampsia prevention, the manage- with prior systematic reviews, following explored; these included “Guide-
ment of severe hypertension with anti- Preferred Reporting Items for System- [Link]” and Google Scholar.
hypertensive therapy, and the use of atic Reviews and Meta-Analyses gu‑ Search terms such as “hypertensive dis-
magnesium sulfate for eclampsia pre- idance.5 orders of pregnancy,” “preeclampsia,”
vention and treatment. However, both A CPG was defined as an evidence- and “gestational hypertension” were
reviews identified areas of variability, based document issued by a govern- combined with “clinical practice guide-
particularly concerning the classifica- mental agency, professional medical line” or “guideline.” As in Scott et al,4
tion of “severe” preeclampsia, antenatal society, or similar authoritative body, only the first 100 Google Scholar results
maternal and fetal surveillance, and intended to provide structured recom- were screened, based on relevance-
optimal timing of delivery in women mendations for clinical care in health- ranking principles.
with preeclampsia at viable gestational care settings. CPGs were eligible for
ages. inclusion if they: (1) were multidisci- Study selection
plinary in authorship or sponsorship; All search results were imported into
Objectives (2) were published between January Rayyan for duplicate removal and
This systematic review aimed to assess 2015 and January 2025; (3) addressed screening. Two reviewers independently
whether recent updates to CPGs for the the diagnosis, assessment, or manage- assessed titles and abstracts, and full
HDPs have addressed previous in- ment of at least one HDP; and (4) were texts against the inclusion and exclusion
consistencies between guidelines and to written in or officially translated into criteria (M.F. and either L.A.M. or

AUGUST 2026 American Journal of Obstetrics & Gynecology 281

P.v.D.). Discrepancies were resolved were included (Table 1).6—35 For details of (USPSTF) graded only their recom-
through discussion. the screening process, see Figure 1 mendations, and the Irish Health Ser-
(PRISMA). Of note, there were 4 exclu- vice Executive and Royal College of
Data extraction sions based on language. Fifteen CPGs Physicians of Ireland (HSE & RCPI),
Data abstraction tables developed in included in Scott et al4 remained in our National Partnership for Maternal
Gillon et al3 and Scott et al4 were reused review, many of which had been Safety (NPMS), and Tunisian Society of
to systematically extract recommenda- updated6,7,10—17,19,20,24—32,34; one CPG Gynecology and Obstetrics (STGO) did
tions across 6 domains3,4: (1) HDP from Scott et al4 was excluded, based on neither.
diagnosis and classification, (2) pre- publication before 2015.36 Eight new
eclampsia diagnosis, (3) prediction of CPGs were identified.8,9,18,21—23,33,35 Synthesis of results
preeclampsia, (4) prevention of pre- We present our findings in 5 thematic
eclampsia, (5) HDP management, and Study characteristics tables for ease of reference by readers
(6) maternal and fetal monitoring. Five guidelines were intended for in- with varying clinical and academic foci.
Entire guidelines were reviewed if they ternational use, with the remainder Tables summarize approaches to diag-
were <10 pages in length; for longer intended for national use. The National nosis and measurement (Table 2), clas-
documents, only numbered/bulleted Institute for Health and Care Excellence sification of the HDPs (Table 3),
recommendations and the contents of (NICE) and Health New Zealand (HNZ) prediction and prevention of pre-
tables and figures were abstracted, with guidelines were published by govern- eclampsia (Table 4), place of care, ther-
targeted searches within text for clini- ment organizations, and with the apeutic cointerventions, timing of birth
cally substantial updates of critical exception of the World Health Organi- (Table 5), and fetal and maternal
importance to clinical practice. zation (WHO) guidelines, the monitoring (Table 6).
remainder were published by profes-
Assessment of risk of bias sional societies. The number of pages of Practice recommendations
The AGREE II instrument was used to relevance to HDPs ranged from 3 Hypertension and proteinuria: diagnosis
appraise the methodological quality of (European Society of Cardiology [ESC]) and measurement
each included guideline. AGREE II to 226 (WHO). Only one of the ESC Hypertension was defined uniformly as
evaluates 6 domains: scope and purpose, documents and Society of Obstetric systolic blood pressure (sBP) ≥140
stakeholder involvement, rigor of Medicine of Australia and New Zealand mmHg or diastolic blood pressure
development, clarity of presentation, (SOMANZ) had less than 10 pages; (dBP) ≥90 mmHg (N=19 CPGs).
applicability, and editorial indepen- therefore, for these 2 guidelines, we When defined, severe hypertension was
dence. Each guideline was indepen- abstracted data from the entire guide- stated to be sBP ≥160 mmHg or dBP
dently assessed by 2 reviewers (M.F. and line. All other guidelines had at least 10 ≥110 mmHg (N=15), with only the
one of L.A.M., P.v.D., T.G., G.S., or pages and only bulleted recommenda- 2023 SOMANZ CPG retaining sBP
A.P.), with a third reviewer (either tions were abstracted. For further details ≥170 mmHg in the definition (Table 2).
L.A.M. or P.v.D.) resolving outstanding of included CPGs, see Supplemental There was no consistent blood pres-
difference of opinion. Following indi- Table 1. Data extraction tables are sure (BP) measurement device recom-
vidual assessments, reviewers met to available on request. mended: mercury (N=7) or liquid
reach consensus on any differing scores. crystal sphygmomanometer (N=1), or
Domain-specific scores were converted Risk of bias of included studies automated devices validated for use in
into percentage values for comparative No CPGs scored >80% in all domains. pregnancy/preeclampsia (N=7),
purposes.4 Guidance was deemed to be Eight CPGs had 5/6 domains scoring although half of CPGs made no
‘clinically useful’ when a score was at >80%. Three CPGs had 4/6 domains recommendation at all (N=12), the
least 50%. scoring >80%. Five CPGs scored 3/6 French having removed that specific
>80%, while United States Preventative recommendation from their 2 docu-
Data synthesis Services Taskforce (USPSTF) scored 2/6 ments. With sphygmomanometer use,
This was a descriptive review, with re- >80%. Six guidelines scored 1/6 >80%, disappearance of the Korotkoff sounds
sults displayed as numbers of CPGs that and one CPG had no domains >80% (ie, phase V) was endorsed as desig-
described relevant guidance for each (Supplemental Table 1). nating dBP (N=6/7 relevant CPGs). For
topic covered. The majority of CPGs (17 of 23) rated automated devices, few CPGs provided
both the quality of evidence and the a link to information about devices
Results strength of their recommendations. validated for use in either pregnancy or
Study selection Two others (Ministerial National preeclampsia. However, if such a device
Our search (2015—2025) yielded 555 Committee on Confidential Enquiries was not used, 5 CPGs recommended
articles for screening. Following removal into Maternal Deaths in South Africa that the device used should be regularly
of duplicates, title/abstract screening, and [CEMDSA] and NICE) rated only the compared with a calibrated reference
full-text review, 23 CPGs (31 publications) quality of evidence, another CPG device. Of note, no CPG recommended

282 American Journal of Obstetrics & Gynecology AUGUST 2026

TABLE 1
Clinical practice guidelines included in this review
CPG abbreviation Year of publication CPG body full name and reference(s)
International (N=6)
ESC 2020 European Society of Cardiology6
ISSHP 2021 International Society for the Study of Hypertension in
Pregnancy7
ISUOG 2018 International Society of Ultrasound in Obstetrics and
Gynecology8
SMFM 2020 Society for Maternal and Fetal Medicine 20209
SOMANZ 2023 Society of Obstetric Medicine of Australia and New
Zealand 202310
WHO 2018—2021 World Health Organization, with updates regarding
calcium supplementation before and during pregnancy
for prevention of preeclampsia and its complications,
drug treatment for nonsevere and severe hypertension
in pregnancy, and antiplatelet agents for prevention of
preeclampsia11—15
The Americas (N=5)
ACOG 2018—2020 American College of Obstetricians and Gynecologists
with 2023 reaffirmation of committee opinions on low-
dose aspirin use, and 2020 reaffirmation of 2 2019
practice bulletins16,17
FECOLSOG 2022 Colombian Federation of Obstetrics and Gynecology18
NPMS 2017 National Partnership for Maternal Safety19
SOGC 2022 Society of Obstetricians and Gynaecologists of
Canada20
USPSTF 2021—2023 United States Preventative Services Taskforce
recommendations on aspirin use to prevent
preeclampsia (2021), and on screening for
hypertensive disorders of pregnancy (2023)21,22
Europe (N=7)
AIPE & SIMP 2024 Italian Association of Preeclampsia & The Italian
Society of Perinatal Medicine 202423
CNGOF 2023 National College of French Gynaecologists and
Obstetricians24
DGGG 2024 German Society of Gynecology and Obstetrics25
HSE & RCPI 2016—2019 Irish Health Service Executive & the Royal College of
Physicians of Ireland, with documents regarding the
hypertensive diorders of pregnancy (updated 2019)
and severe preeclampsia and eclampsia (updated
2016)26,27
NGF 2020 Norwegian Society of Obstetrics and Gynaecology28
NICE 2023 National Institute for Health and Clinical Excellence
update29
NVOG 2023 Dutch Society of Obstetrics and Gynaecology30
SFAR & CNGOF 2022 French Society of Anaesthesia and Resuscitation &
National College of French Gynaecologists and
Obstetricians31
Australasia (N=1)
HNZ 2022 Health New Zealand32
(continued)

AUGUST 2026 American Journal of Obstetrics & Gynecology 283

TABLE 1
Clinical practice guidelines included in this review (continued)
CPG abbreviation Year of publication CPG body full name and reference(s)
Africa (N=2)
CEMDSA 2019 Ministerial National Committee on Confidential
Enquiries into Maternal Deaths in South Africa33
STGO 2016 Tunisian Society of Gynecology and Obstetrics34
Asia (N=1)
MSH 2018 Malaysian Society of Hypertension, Ministry of Health
Malaysia & Academy of Medicine Malaysia35
Guideline abbreviations: ACOG, American College of Obstetricians and College of Obstetricians and Gynecologists; AIPE & SIMP, Associazione Italiana PreEclampsia and Società Italiana di Medicina
Perinatale; CEMDSA, Ministerial National Committee on Confidential Enquiries into Maternal Deaths in South Africa; CNGOF, Collège national des gynécologues et obstétriciens français; DGGG,
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe; ESC, European Society of Cardiology; FECOLSOG, Federación Colombiana de Obstetricia y Ginecologı́a; HNZ, Health New Zealand; HSE &
RCPI, Irish Health Service Executive & Royal College of Physicians of Ireland; ISSHP, International Society for the Study of Hypertension in Pregnancy; ISUOG, International Society of Ultrasound in
Obstetrics and Gynecology; MSH, Malaysian Society of Hypertension; NGF, Norsk gynekologisk Forening; NICE, National Institute for Health and Clinical Excellence; NPMS, National Partnership for
Maternal Safety; NVOG, Nederlandse Vereniging voor Obstetrie en Gynaecologie; SFAR & CNGOF, Société Française d’Anesthésie et de Réanimation and Collège national des gynécologues et
obstétriciens français; SMFM, Society of Maternal and Fetal Medicine; SOGC, Society of Obstetricians and Gynecologists of Canada; SOMANZ, Society of Obstetric Medicine of Australia and New
Zealand; STGO, Société Tunisienne de Gynécologie Obstétrique; USPSTF, United States Preventative Services Taskforce; WHO, World Health Organization.
Other abbreviations: CPG, clinical practice guideline.

use of an automated wrist device or testing were not available, then dipstick hypertension that does not resolve by 6
aneroid device (which SOMANZ high- proteinuria ≥1+ when repeated (N=2), weeks postpartum should also be regar-
lighted as having high potential for ≥1+ (N=1), or ≥2+ (N=4). A minor- ded as chronic hypertension.
error). ity of CPGs commented on when pro- Gestational hypertension was defined
BP measurement technique was often teinuria testing should be undertaken; 2 uniformly as new-onset hypertension
stated, with specification most often to: CPGs commented on routine protein- occurring after 20 weeks of gestation
be seated (N=11), use an appropriately uria screening at each antenatal visit, (N=17).
sized cuff (N=10), and rest before while others recommended testing Preeclampsia (de novo) was described
measurement (N=5) (Table 2). What when clinical concerns arise, such as in all guidelines that defined it as having
constitutes an appropriately sized cuff hypertension (N=4) or when pre- new-onset hypertension at at least 20
(ie, 1.5 times the arm circumference) eclampsia is otherwise suspected (N=3). weeks of gestation (N=17) as a diagnostic
was not usually mentioned (N=13). When initial detection by urinary criterion. Most CPGs (N=14) regarded
Recommended rest time was 5 minutes dipstick (N=10) was specified, a positive proteinuria as but one of a number of
(N=1) or not specified (N=5). Two result was considered to be ≥1+ (N=6), criteria reflecting maternal end-organ
CPGs commented on choosing the arm ≥2+ (N=5), or was not defined involvement, but 4 CPGs retained pro-
with the highest BP value for BP (N=12), but it was common to recom- teinuria as a mandatory criterion, in
measurement. mend confirmation of positive results by guidelines published in 2018 (Malaysian
Few CPGs recognized the importance quantitative testing (N=14). Society of Hypertension [MSH]), 2020
of out-of-office BP measurements. Only Classification of the hypertensive disor- (WHO), 2022 (Société Française d’Anes-
3 CPGs advised out-of-office BP mea- ders of pregnancy thésie et de Réanimation and Collège na-
surement to confirm raised BP in the HDP definitions were largely consistent tional des gynécologues et obstétriciens
office (ISSHP, SOGT, and SOMANZ). across CPGs, with the exception of the français), and 2024 (Collège national des
However, 8 CPGs recommended in- Associazione Italiana PreEclampsia and gynécologues et obstétriciens français
office BP measurement to confirm Società Italiana di Medicina Perinatale [CNGOF]). Only 7 CPGs listed the
raised BP out of the office (Table 2). The (AIPE & SIMP) and International So- maternal diagnostic criteria, as thrombo-
frequency of out-of-office monitoring ciety of Ultrasound in Obstetrics and cytopenia, renal insufficiency/acute kid-
was specified by few CPGs, as once or Gynecology (ISUOG) guidelines, which ney injury, hepatic involvement/raised
twice per week (N=2), or simply as did not provide definitions. transaminases, right upper quadrant or
“between appointments” (N=2). Chronic/preexisting hypertension was epigastric pain, pulmonary edema/hyp-
Proteinuria was usually defined most commonly defined (N=17) as hy- oxemia, neurological symptoms, hemoly-
(N=19 CPGs) (Table 2), as urinary pertension that predated pregnancy or sis, elevated liver enzymes, and low
protein:creatinine ratio ≥30 mg/mmol was detected before 20 weeks of gestation. platelets syndrome, and myocardial
(N=11), albumin:creatinine ratio ≥8 Three CPGs (American College of Ob- ischemia or other cardiac complications.
mg/mmol (N=11), 24-hour proteinuria stetricians and Gynecologists [ACOG], Nine CPGs considered uteroplacental
≥0.3 g/d (N=10), or if quantitative ESC, and SOMANZ) further noted that dysfunction as a diagnostic criterion; most

284 American Journal of Obstetrics & Gynecology AUGUST 2026

FIGURE 1
PRISMA flow diagram

PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

often, that dysfunction was described as hypertension complicated by new-onset Obstetrie en Gynaecologie (NVOG)
fetal growth restriction (N=8), stillbirth gestational hypertension with protein- (Netherlands), and Federación Colombi-
(N=6), placental abruption (N=7), or uria constitutes superimposed pre- ana de Obstetricia y Ginecología
abnormal fetal Dopplers (N=6). Two eclampsia. The ISSHP defines it as the (FECOLSOG) define superimposed pre-
CPGs (International Society for the Study occurrence, after 20 weeks’ gestation of eclampsia as chronic hypertension
of Hypertension in Pregnancy [ISSHP] any preeclampsia-associated maternal accompanied by new-onset proteinuria or
and Society of Obstetricians and Gynae- organ dysfunction or new proteinuria in a other maternal organ-system involve-
cologists of Canada [SOGC]) incorpo- woman with chronic hypertension. ment. AIPE & SIMP adds that BP must
rated angiogenic imbalance into the Similar definitions appear in the rise at least 30/15 mmHg over baseline
definition of preeclampsia, but 5 others SOMANZ guideline, which describes and be accompanied by proteinuria or
(ACOG, Deutsche Gesellschaft für Gynä- superimposed preeclampsia as pre- edema. HNZ and CEMDSA recognise
kologie und Geburtshilfe [DGGG] [Ger- eclampsia emerging on a background of preeclampsia occurring in a chronically
many], ESC, NICE, and SOMANZ) chronic hypertension or preexisting renal hypertensive woman after 20 weeks as
described use of angiogenic markers to disease. ACOG specifies that this diag- superimposed preeclampsia.
rule-in or rule-out preeclampsia (or that nosis is “likely” when a well-controlled ‘Severe’ preeclampsia was defined by
developing over a specified time period), hypertensive woman experiences a sud- 11 CPGs; SOGC alone includes feto-
which we regarded as contributing to den rise in BP or requires escalating placental dysfunction in their definition
diagnosis and choice of care pathway. antihypertensive therapy, or when new or of preeclampsia, and WHO acknowl-
Only 11 CPGs define superimposed increased proteinuria develops. The edges that choice, while the other defi-
preeclampsia. The ESC notes that chronic SOGC, Nederlandse Vereniging voor nitions of ‘severe’ preeclampsia are

AUGUST 2026 American Journal of Obstetrics & Gynecology 285

TABLE 2
Hypertension and proteinuria, diagnosis and measurement
N of CPGs (of 23
Recommendation included) CPGs reporting this topic
Blood pressure
Definition of hypertension
sBP of ≥140 mmHg or dBP of ≥90 mmHg 19 ACOG, CEMDSA, CNGOF, DGGG, ESC,
FECOLSOG, ISSHP, HNZ, HSE & RCPI, MSH,
NGF, NICE, NPMS, NVOG, STGO, SMFM,
SOGC, SOMANZ, USPSTF
Definition of severe hypertension
sBP ≥160 mmHg or dBP ≥110 mmHg 15 ACOG, CNGOF, DGGG, ESC, FECOLSOG,
ISSHP, HNZ, HSE & RCPI, NGF, NICE, NPMS,
SFAR&CNGOF, STGO, SOGC, USPSTF
sBP ≥170 mmHg or dBP ≥110 mmHg 1 SOMANZ
BP measurement device recommended
Sphygmomanometer
Mercury sphygmomanometer 7 ACOG, ESC, ISSHP, MSH, NPMS, STGO,
SOMANZ
Liquid crystal sphygmomanometer 1 ISSHP
Korotkoff phase for dBP (N=7)
Phase V 6/7 ESC, HSE & RCPI, ISSHP, MSH, SOMANZ
Phase IV if phase V absent 2/7 MSH, SOMANZ
Not mentioned 2/7 ACOG, NPMS
Automated device validated for use in pregnancy and 7 CEMDSA, DGGG, HSE & RCPI, ISSHP, NVOG,
preeclampsiaa STGO, USPSTF
Device should be regularly compared with a calibrated 5 ISSHP, NICE, STGO, SOGC, SOMANZ
reference device
Reference website provided 3 [Link] (ESC, SOMANZ), https://
[Link]/bp-monitors/for-specialistuse/
(SOMANZ)
Not wrist device 0 -
Not aneroid device 1 SOMANZ
BP measurement technique
Should be seated 11 ACOG, AIPE & SIMP, CEMDSA, ESC, ISSHP,
NICE, NPMS, NVOG, STGO, SOMANZ,
USPSTF
Rest before measurement 5 CEMDSA, NICE, NPMS, STGO, SOMANZ
Appropriately sized cuff 10 ACOG, CEMDSA, ESC, HSE & RCPI, ISSHP,
NPMS, NVOG, STGO, SOMANZ, USPSTF
Choose arm with higher value 2 ISSHP, STGO
When BP is first measured in office, out-of-office confirmation
Recommended 3 ISSHP, STGO, SOMANZ
When BP is first measured out-of-office, in-office confirmation
Recommended 8 ACOG, ESC, ISSHP, HNZ, NPMS, SOGC,
SOMANZ, USPSTF
BP self-monitoring
Once or twice per week 2 NICE, SOMANZ
(continued)

286 American Journal of Obstetrics & Gynecology AUGUST 2026

TABLE 2
Hypertension and proteinuria, diagnosis and measurement (continued)
N of CPGs (of 23
Recommendation included) CPGs reporting this topic
At least twice per week 0 -
“Between appointments” 2 ISSHP, SOGC
Proteinuria measurement
Proteinuria definedb 19 ACOG, CEMDSA, CNGOF, DGGG, ESC,
FECOLSOG, HSE & RCPI, ISSHP, HNZ, MSH,
NGF, NICE, NPMS, NVOG, STGO, SOGC,
SOMANZ, USPSTF, WHO
Urinary PrCr ≥30 mg/mmol 11 ACOG, CNGOF, DGGG, HSE & RCPI, ISSHP,
HNZ, MSH, NGF, NICE, NVOG, SOGC
Urinary ACR ≥8 mg/mmol 11 DGGG, ESC, FECOLSOG, ISSHP, MSH, NGF,
NICE, NVOG, SOGC, SOMANZ, WHO
24-hour urinary protein ≥0.3 g/d 10 CEMDSA, CNGOF, HSE & RCPI, ISSHP, NGF,
NPMS, NVOG, STGO, SOGC, USPSTF
If quantitative testing not available, dipstick value considered
diagnostic
≥1+ 1 NICE
≥1+ if repeated 2 ESC, NGF
≥2+ 4 ACOG, ISSHP, NPMS, USPSTF
b
Proteinuria screening recommended
At each antenatal visit (see below for criteria) 2 CEMDSA, ESC
When there is a clinical concern, as:
Hypertension (including chronic) 4 CEMDSA, ISSHP, SOGC, SOMANZ
Suspected preeclampsia 3 ISSHP, SOGC, USPSTF
Routine dipstick screening at each antenatal visit 10 ACOG, CEMDSA, ESC, FECOLSOG, ISSHP,
NGF, NICE, NPMS, SOMANZ, USPSTF
“Positive” dipstick proteinuria definition
≥1+ 6 ESC, HSE & RCPI, NGF, NICE, NPMS, STGO
≥2+ 5 ACOG, FECOLSOG, ISSHP, MSH, USPSTF
Not defined 12 AIPE & SIMP, CEMDSA, CNGOF, DGGG, HNZ,
ISUOG, NVOG, SFAR & CNGOF, SMFM,
SOGC, SOMANZ, WHO
Positive dipstick to be confirmed by quantitative testing 14 ACOG, CEMDSA, DGGG, ESC, FECOLSOG,
HSE & RCPI, ISSHP, NGF, NICE, NPMS,
NVOG, STGO, SOMANZ, USPSTF
Guideline abbreviations: ACOG, American College of Obstetricians and College of Obstetricians and Gynecologists; AIPE & SIMP, Associazione Italiana PreEclampsia and Società Italiana di Medicina
Perinatale; CEMDSA, Ministerial National Committee on Confidential Enquiries into Maternal Deaths in South Africa; CNGOF, Collège national des gynécologues et obstétriciens français; DGGG,
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe; ESC, European Society of Cardiology; FECOLSOG, Federación Colombiana de Obstetricia y Ginecologı́a; HNZ, Health New Zealand; HSE &
RCPI, Irish Health Service Executive & Royal College of Physicians of Ireland; ISSHP, International Society for the Study of Hypertension in Pregnancy; ISUOG, International Society of Ultrasound in
Obstetrics and Gynecology; MSH, Malaysian Society of Hypertension; NGF, Norsk gynekologisk Forening; NICE, National Institute for Health and Clinical Excellence; NPMS, National Partnership for
Maternal Safety; NVOG, Nederlandse Vereniging voor Obstetrie en Gynaecologie; SFAR & CNGOF, Société Française d’Anesthésie et de Réanimation and Collège national des gynécologues et
obstétriciens français; SMFM, Society of Maternal and Fetal Medicine; SOGC, Society of Obstetricians and Gynecologists of Canada; SOMANZ, Society of Obstetric Medicine of Australia and New
Zealand; STGO, Société Tunisienne de Gynécologie Obstétrique; USPSTF, United States Preventative Services Taskforce; WHO, World Health Organization.
Other abbreviations: ACR, albumin to creatinine ratio; BP, blood pressure; CPG, clinical practice guideline; dBP, diastolic blood pressure; PrCr, protein to creatinine ratio; sBP, systolic blood pressure.
a
CEMDSA specified use of the CRADLE-VSA device; b The options are not mutually exclusive.

limited maternal organ dysfunction of the term ‘severe’ preeclampsia, “as the Prediction of preeclampsia
alone. Two other CPGs (DGGG and clinical dynamics and severity can Screening for preeclampsia risk was
ISSHP) specifically advised against use change” (DGGG) (Table 3). most commonly recommended by

AUGUST 2026 American Journal of Obstetrics & Gynecology 287

TABLE 3
Classification of the hypertensive disorders of pregnancy
N of CPGs
Recommendation (of 23 included) CPGs reporting this topic
Chronic hypertension
Hypertension that predated pregnancy or was 17 ACOG, CEMDSA, CNGOF, DGGG,
detected before 20 weeks ESC, FECOLSOG, HNZ, HSE &
RCPI, ISSHP, MSH, NGF, NICE,
NVOG, SFAR & CNGOF, SOGC,
SOMANZ, USPSTF
Added criterion of hypertension persisting by 6 weeks postpartum 3 ACOG, ESC, SOMANZ
Gestational hypertension
New-onset hypertension occurring after 20 weeks 17 ACOG, CEMDSA, CNGOF, DGGG,
ESC, FECOLSOG, HNZ, HSE &
RCPI, ISSHP, MSH, NGF, NICE,
NVOG, SFAR & CNGOF, SOGC,
SOMANZ, USPSTF
Preeclampsia (de novo) 19 ACOG, CEMDSA, CNGOF, DGGG,
ESC, FECOLSOG, HNZ, HSE &
RCPI, ISSHP, MSH, NGF, NICE,
NPMS, NVOG, SFAR & CNGOF,
SOGC, SOMANZ, USPSTF, WHO
Diagnostic criteria
New-onset hypertension after 20 weeks 19 ACOG, CEMDSA, CNGOF, DGGG,
ESC, FECOLSOG, HNZ, HSE &
RCPI, ISSHP, MSH, NGF, NICE,
NPMS, NVOG, SFAR & CNGOF,
SOGC, SOMANZ, USPSTF, WHO
Proteinuria
Mandatory criterion 4 CNGOF, MSH, SFAR & CNGOF,
WHO
One of the number of criteria that reflects maternal 14 ACOG, DGGG, ESC, HNZ, HSE &
end-organ complications RCPI, ISSHP, NGF, NICE, NPMS,
NVOG, STGO, SOGC, SOMANZ,
USPSTF
Maternal end-organ complications listed
Thrombocytopenia 7 ACOG, HSE & RCPI, ISSHP, NGF,
NICE, STGO, SOGC
Renal insufficiency/acute kidney injury 7 ACOG, HSE & RCPI, ISSHP, NGF,
NICE, STGO, SOGC
Hepatic involvement 7 ACOG, HSE & RCPI, ISSHP, NGF,
NICE, STGO, SOGC
Right upper quadrant/epigastric pain 7 ACOG, HSE & RCPI, ISSHP, NGF,
NICE, STGO, SOGC
Pulmonary edema/hypoxemia 7 ACOG, HSE & RCPI, ISSHP, NGF,
NICE, STGO, SOGC
Neurological symptoms 7 ACOG, HSE & RCPI, ISSHP, NGF,
NICE, STGO, SOGC
HELLP syndrome 7 ACOG, HSE & RCPI, ISSHP, NGF,
NICE, STGO, SOGC
Myocardial ischemia/cardiac complications 1 SOGC
(continued)

288 American Journal of Obstetrics & Gynecology AUGUST 2026

TABLE 3
Classification of the hypertensive disorders of pregnancy (continued)
N of CPGs
Recommendation (of 23 included) CPGs reporting this topic
Uteroplacental dysfunction (any) 9 DGGG, ESC, HNZ, ISSHP, NGF,
NICE, NVOG, SOGC, SOMANZ
Fetal growth restriction 8 DGGG, ESC, HNZ, HSE & RCPI,
ISSHP, NGF, NICE, NVOG
Stillbirth 6 DGGG, ISSHP, HNZ, NICE, NVOG,
STGO
Placental abruption 7 DGGG, ISSHP, NGF, NVOG, STGO,
SOGC, SOMANZ
Abnormal fetal Dopplers 6 ESC, HNZ, ISSHP, NGF, NICE,
NVOG
Angiogenic imbalanceb 7 ACOG, ESCb, ISSHP, DGGGb,
NICEb, SOGC, SOMANZb
Superimposed preeclampsia 11 ACOG, AIPE & SIMP, CEMDSA,
ESC, FECOLSOG, HNZ, ISSHP,
NGF, NVOG, SOAMNZ, SOGC
‘Severe’ preeclampsia
Concept used 10 ACOGa, HNZ, HSE & RCPI, NGF,
NICEa NVOG, SFAR & CNGOF,
STGO, USPSTFa WHO
Explicitly advised against use of term 2 DGGG, ISSHP
Guideline abbreviations: ACOG, American College of Obstetricians and College of Obstetricians and Gynecologists; AIPE & SIMP, Associazione Italiana PreEclampsia and Società Italiana di Medicina
Perinatale; CEMDSA, Ministerial National Committee on Confidential Enquiries into Maternal Deaths in South Africa; CNGOF, Collège national des gynécologues et obstétriciens français; DGGG,
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe; ESC, European Society of Cardiology; FECOLSOG, Federación Colombiana de Obstetricia y Ginecologı́a; HNZ, Health New Zealand; HSE &
RCPI, Irish Health Service Executive & Royal College of Physicians of Ireland; ISSHP, International Society for the Study of Hypertension in Pregnancy; ISUOG, International Society of Ultrasound in
Obstetrics and Gynecology; MSH, Malaysian Society of Hypertension; NGF, Norsk gynekologisk Forening; NICE, National Institute for Health and Clinical Excellence; NPMS, National Partnership for
Maternal Safety; NVOG, Nederlandse Vereniging voor Obstetrie en Gynaecologie; SFAR & CNGOF, Société Française d’Anesthésie et de Réanimation and Collège national des gynécologues et
obstétriciens français; SMFM, Society of Maternal and Fetal Medicine; SOGC, Society of Obstetricians and Gynecologists of Canada; SOMANZ, Society of Obstetric Medicine of Australia and New
Zealand; STGO, Société Tunisienne de Gynécologie Obstétrique; USPSTF, United States Preventative Services Taskforce; WHO, World Health Organization.
Other abbreviations: CPG, clinical practice guideline; HELLP, hemolysis, elevated liver enzymes, and low platelets.
a
Preeclampsia with ‘severe features’ is how the concept of severe preeclampsia is expressed; b Any mention of angiogenic imbalance in ruling-in or ruling-out preeclampsia within a period of time
was regarded as incorporating angiogenic imbalance in the definition of preeclampsia for the purposes of care pathways.

identification of risk factors (N=19 nulliparity (N=13), interpregnancy in- mg, N=8), one tablet per day (75, 81, or
CPGs) (Table 4). Screening for pre- terval >10 years (N=11), family history 100 mg) (N=2), 2 tablets per day (totaling
eclampsia risk by multivariable model- of preeclampsia (N=9), and body mass 150 or 162 mg; N=2), or 100 to 160 mg/
ling, which includes placental growth index ≥35 kg/m2 (N=10) (Table 4). day (N=3). When aspirin should be
factor testing, was suggested as an op- Prevention of preeclampsia initiated varied. Most CPGs agreed that it
tion by a minority of CPGs (N=7), and 2 All women, including those at low risk of should begin at 12 to 16 weeks’ gestation
CPGs (CNGOF and HSE & RCPI) preeclampsia, were recommended to (N=13), with 3 specifying specifically that
advised against this approach. have calcium (N=5) and undertake aspirin should begin at the time of first-
Clinical risk factors were categorized moderate-intensity exercise (N=8) trimester screening for preeclampsia.
as high-risk or moderate-risk by most (Table 4). Most commonly, calcium was However, CNGOF accept aspirin initia-
CPGs (15/19) (Table 4). High-risk fac- recommended in the context of low tion up to 20 weeks. The WHO recom-
tors were: chronic hypertension intake (N=5), which was variably defined mended starting aspirin when antenatal
(N=17), preexisting type 1 or 2 diabetes as less than 600 to 1000 mg/day. care starts despite the frequency of
mellitus (N=16), chronic kidney disease For women at high-risk specifically, use booking beyond 20 weeks’ gestation.
(N=14), prior preeclampsia (N=12), of low-dose aspirin was universally sup- Calcium supplementation was recom-
autoimmune disease (N=14), anti- ported (N=21 CPGs) (Table 4); NPMS mended by an additional 7 CPGs. What
phospholipid syndrome (N=12), or any made no mention of it rather than rec- was not usually recommended was
prior HDP (N=7). Moderate-risk fac- ommending against it. However, what low-molecular-weight heparin (N=3),
tors were: multifetal gestation (N=14), constitutes ‘low-dose’ varied (17/21 which 3 CPGs recommended for speci-
maternal age ≥35 years (N=14), CPGs): one or 2 tablets per day (75—160 fic indications: previous “placental

AUGUST 2026 American Journal of Obstetrics & Gynecology 289

TABLE 4
Prediction and prevention of preeclampsia
N of CPGs
Recommendation (of N�23 included) CPGs reporting this topic
Prediction of preeclampsia
Preeclampsia risk screening methoda
Clinical risk factors 19 ACOG, CEMDSA, CNGOF, DGGG, ESC, HNZ, HSE & RCPI,
ISSHP, ISUOG, MSH, NGF, NICE, NVOG, STGO, SMFM,
SOGC, SOMANZ, USPSTF, WHO
Multivariable model recommended 7 AIPE & SIMP, HNZ, ISSHP, ISUOG, MSH, NGF, SOGC
Multivariable model advised against 2 CNGOF, HSE & RCPI
Clinical risk factors classified as high-risk or moderate-risk (N=19)
Yes 15 ACOG, CEMDSA, DGGG, ESC, HNZ, HSE & RCPI, ISSHP,
MSH, NGF, NICE, NVOG, SMFM, STGO, SOGC, USPSTF
No 4 CNGOF, ISUOG, SOMANZ, WHO
High-risk clinical risk factors
Chronic hypertension 17 ACOG, CEMDSA, DGGG, ESC, HNZ, HSE & RCPI, ISSHP,
MSH, NGF, NICE, NVOG, STGO, SMFM, SOGC,
SOMANZ, USPSTF, WHO
Type 1 or 2 diabetes mellitus 16 ACOG, CEMDSA, ESC, HNZ, HSE & RCPI, ISSHP, MSH,
NGF, NICE, NVOG, SMFM, STGO, SOGC, SOMANZ,
USPSTF, WHO
Chronic renal disease 14 ACOG, ESC, HNZ, HSE & RCPI, ISSHP, MSH, NGF, NICE,
NVOG, SMFM, STGO, SOGC, SOMANZ, USPSTF
Prior preeclampsia 12 ACOG, CEMDSA, DGGG, HNZ, ISSHP, MSH, NGF, NVOG,
SMFM, STGO, SOGC, USPSTF
Autoimmune disease 14 ACOG, ESC, HNZ, HSE & RCPI, ISSHP, MSH, NGF, NICE,
NVOG, SMFM, STGO, SOGC, SOMANZ, USPSTF
Antiphospholipid syndrome 12 CEMDSA, ESC, HNZ, HSE & RCPI, ISSHP, NGF, NICE,
SMFM, STGO, SOGC, SOMANZ, USPSTF
“Any” HDP in prior pregnancy 7 DGGG, ESC, HSE & RCPI, MSH, NGF, NICE, NVOG
Moderate-risk clinical risk factors
Multifetal gestation 14 ACOG, CEMDSA, ESC, HNZ, HSE & RCPI, ISSHP, MSH,
NGF, NICE, SMFM, SOGC, SOMANZ, USPSTF, WHO
Maternal age ≥35 years 14 ACOG, CEMDSA, ESC, HNZ, HSE & RCPI, ISSHP, MSH,
NGF, NICE, SMFM, STGO, SOGC, SOMANZ, USPSTF
Nulliparity 13 ACOG, CEMDSA, ESC, HNZ, HSE & RCPI, ISSHP, MSH,
NGF, NICE, SMFM, STGO, SOGC, USPSTF
Interpregnancy interval >10 years 11 ACOG, ESC, HNZ, HSE & RCPI, MSH, NGF, NICE, NVOG,
SMFM, SOMANZ, USPSTF
Family history of preeclampsia 9 ACOG, ESC, HNZ, MSH, NGF, NICE, SMFM, SOMANZ,
USPSTF
BMI ≥35 kg/m2 10 ACOG, ESC, HSE & RCPI, MSH, NGF, NICE, STGO,
SMFM, SOMANZ, USPSTF
Prevention of preeclampsia
All women (even at ‘low risk’)
Calcium supplementation 7 CEMDSA, ESC, HSE & RCPI, NGF, SOGC, SOMANZ,
STGO
Regardless of dietary intake 1 CEMDSA
(continued)

290 American Journal of Obstetrics & Gynecology AUGUST 2026

TABLE 4
Prediction and prevention of preeclampsia (continued)
N of CPGs
Recommendation (of N�23 included) CPGs reporting this topic
With low dietary intake 5 ESC,NGF, STGO, SOGC, SOMANZ
<600 mg/day 2 ESC, NGF
<900 mg/day 1 SOGC
<1000 mg/day 3 HSE & RCPI, SOMANZ, STGO
Recommended only in research context 1 WHO
Moderate intensity exercise 8 AIPE & SIMP, CNGOF, ESC, ISSHP, NGF, NICE, SOGC,
SOMANZ
For women at ‘high risk’
Aspirin prophylaxis 21 ACOG, AIPE & SIMP, CEMDSA, CNGOF, DGGG, ESC,
FECOLSOG, HNZ, HSE & RCPI, ISSHP, ISUOG, MSH,
NGF, NICE, NVOG, STGO, SMFM, SOGC, SOMANZ,
USPSTF, WHO
Dose of aspirin (N=21)
One or 2 tablets (75—162 mg/d) 8 FECOLSOG, ISSHP, MSH, NGF, NVOG, STGO, SOGC,
WHO
One tablet (75, 81, or 100 mg/d) 6 ACOG, HNZ, HSE & RCPI, NICE, SMFM, USPSTF
Two tablets (totaling 150 or 162 mg/d) 2 AIPE & SIMP, SOMANZ
100—160 mg/d 3 CNGOF, DGGG, ESC
Timing of aspirin commencementa (N=21)
12—16 weeks 13 CNGOF, DGGG, ESC, FECOLSOG, HNZ, ISSHP, ISUOG,
MSH, NGF, NICE, NVOG, STGO, SMFM, SOMANZ
12 weeks (first trimester screening) 3 ESC, ISUOG, NGF, NICE
16—20 weeks 1 CNGOF
12—28 weeks, but ideally at<16 weeks 1 ACOG
<20 weeks 1 USPSTF
<20 weeks or when antenatal care starts 1 WHO
Calcium supplementation 7 CEMDSA, ESC, HNZ, ISSHP, SOGC, SOMANZ, WHO
Low-molecular-weight heparin
With associated APS or SLE 1 NGF
When there is an aspirin allergy 1 SOMANZ
May be discussed with prior placental complication 1 SOGC
Recommended against 6 AIPE & SIMP, CNGOF, HSE & RCPI, ISSHP, NICE,
SOMANZ
Aspirin is marketed in different-sized tablets in different countries, such as 75 mg (UK), 81 mg (Canada), and 100 mg (Spain).
Guideline abbreviations: ACOG, American College of Obstetricians and College of Obstetricians and Gynecologists; AIPE & SIMP, Associazione Italiana PreEclampsia and Società Italiana di Medicina
Perinatale; CEMDSA, Ministerial National Committee on Confidential Enquiries into Maternal Deaths in South Africa; CNGOF, Collège national des gynécologues et obstétriciens français; DGGG,
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe; ESC, European Society of Cardiology; FECOLSOG, Federación Colombiana de Obstetricia y Ginecologı́a; HNZ, Health New Zealand; HSE &
RCPI, Irish Health Service Executive & Royal College of Physicians of Ireland; ISSHP, International Society for the Study of Hypertension in Pregnancy; ISUOG, International Society of Ultrasound in
Obstetrics and Gynecology; MSH, Malaysian Society of Hypertension; NGF, Norsk gynekologisk Forening; NICE, National Institute for Health and Clinical Excellence; NPMS, National Partnership for
Maternal Safety; NVOG, Nederlandse Vereniging voor Obstetrie en Gynaecologie; SFAR & CNGOF, Société Française d’Anesthésie et de Réanimation and Collège national des gynécologues et
obstétriciens français; SLE, systemic lupus erythematosus; SMFM, Society of Maternal and Fetal Medicine; SOGC, Society of Obstetricians and Gynecologists of Canada; SOMANZ, Society of Obstetric
Medicine of Australia and New Zealand; STGO, Société Tunisienne de Gynécologie Obstétrique; USPSTF, United States Preventative Services Taskforce; WHO, World Health Organization.
Other abbreviations: APS, antiphospholipid syndrome; BMI, body mass index; CPGs, clinical practice guidelines; HDP, hypertensive disorder of pregnancy.
a
The response options were not mutually exclusive.

AUGUST 2026 American Journal of Obstetrics & Gynecology 291

complications” (SOGC), systemic lupus did not specify a particular antihyper- often uncontrolled or worsening hy-
erythematosus or antiphospholipid syn- tensive, but stated that the choice should pertension (N=4) or eclampsia (N=5).
drome (Norsk gynekologisk Forening be “based on clinician’s experience, cost, Generally, the manner of timed birth
[NGF]), or depending on the woman’s and local availability”. Uniquely, AIPE and route of delivery were predicated on
clinical and obstetric history. However, 6 & SIMP offered hemodynamic-guided obstetric considerations (Table 5).
other CPGs specifically recommend therapy and recommended labetalol Viability to 33+6 weeks
against low-molecular-weight heparin for women with hyperdynamic circula- In women with chronic (N=10) or
(Table 4). tion and methyldopa for women with a gestational hypertension (N=14),
Place of care normal hemodynamic profile. expectant management is broadly
All CPGs that recommended place of For management of nonsevere hy- advised provided maternal BP is
care for women with severe hyperten- pertension, most CPGs (N=13) recom- controlled (according to the BP thresh-
sion (N=11 CPGs) or preeclampsia mended one/more agents as first-line: olds and goals set in the particular
(N=11) advised hospital admission; oral labetalol (N=11), methyldopa guideline) and fetal wellbeing is main-
however, for women with preeclampsia, (N=9), and nifedipine (N=8) (Table 5). tained. Similarly, for women with pre-
CNGOF stated that there was insuffi- The NVOG guideline stated that there eclampsia, 14 CPGs recommended
cient evidence to identify the optimal was “insufficient evidence” to recom- expectant care.
setting for care (Table 5). For women mend antihypertensives for mild hy- 34+0 to 36+6 weeks
with preeclampsia undergoing expec- pertension. CPGs commonly advised This late-preterm period represents a
tant management at <34 weeks, or those against the use of renin-angiotensin- critical inflection point. For chronic and
anticipated to have preterm birth, 4 aldosterone system blockers during gestational hypertension, most guide-
CPGs specified care at a center that pregnancy (N=12; angiotensin- lines favor continued pregnancy with
could provide maternal critical care and converting enzyme inhibitors [N=12], close monitoring. For preeclampsia,
neonatal intensive care. The WHO angiotensin II receptor blockers recommendations diverge; while 5
advised care for women with pre- [N=11], or direct renin inhibitors CPGs advise delivery in the presence of
eclampsia at a center able to provide [N=3]), as well as diuretics (N=5, of severe features, others (N=7) permit
magnesium sulfate therapy (Table 5). which 4 specified thiazides), and mag- expectant care until 37 weeks if maternal
Antihypertensive therapy nesium sulphate specifically as an anti- and fetal status remain stable. Thus,
BP thresholds for initiation of antihy- hypertensive (N=4). late-preterm birth is generally reserved
pertensive therapy were recommended In addition to the antihypertensives for maternal or fetal deterioration.
by most CPGs (N=16), and most listed, FECOLSOG also mentioned 37+0 weeks onwards
commonly as an sBP ≥140 mmHg or prazosin as a tertiary option for severe There is broad consensus that delivery
dBP ≥90 mmHg (N=12) (Table 5). refractory hypertension. should be initiated from 37 weeks for
However, 4 guidelines advised waiting Magnesium sulfate women with chronic hypertension,
until sBP is ≥160 mmHg or dBP ≥110 Magnesium sulfate is widely recom- gestational hypertension, or pre-
mmHg; they were published from 2017 mended for the treatment of eclampsia eclampsia, irrespective of severity. Some
(NPMS) to 2023 (NVOG), and 2 were (N=18) and its prevention, most guidelines (N=8 for chronic hyperten-
from low- and middle-income countries commonly according to the Magpie trial sion, N=4 for gestational hypertension)
(FECOLSOG and MSH). In contrast, criteria for ‘severe preeclampsia’31 allow extension of pregnancy beyond 37
fewer CPGs (N=9) specified a BP target (N=17) (Table 5). In addition, some weeks in women with well-controlled
for treatment, most often as <140/90 CPGs (N=6) advised the use of magne- hypertension, although this is the
mmHg (N=6) or 135/85 mmHg spe- sium sulfate for fetal neuroprotection, exception rather than the rule.
cifically (N=3/6) (Table 5). particularly in the setting of planned birth 38+0 to 39+6 weeks
For management of severe hyperten- at <32 weeks’ gestation (N=6) (Table 5). Several guidelines endorse 38 to 39
sion, most CPGs (N=18) recommended Antenatal corticosteroids weeks as the optimal timing for elective
one/more antihypertensive agents as Antenatal corticosteroids were recom- birth in women with chronic or gesta-
first-line: either intravenous (IV) labe- mended for women with preeclampsia tional hypertension, balancing maternal
talol (N=9), oral nifedipine (N=10), IV at <34 weeks, who are likely to deliver risk with neonatal maturity. In pre-
hydralazine (N=6), oral methyldopa within 1 week (N=9), with NICE also eclampsia, continuation beyond 37
(N=6), IV diazoxide (SOMANZ), including women at 35 to 36 weeks weeks is rarely advised.
nicardipine (SOGT), or IV urapidil (Table 5). 40+0 weeks and beyond
(DGGG) (Table 5). NGF and SOGC Labor and birth Continuation of pregnancy beyond 40
noted that oral methyldopa can be Maternal and/or fetal indications for weeks is discouraged. ACOG,
effective, but may often require the birth regardless of gestational age were CEMDSA, HSE & RCPI, ISSHP, and
addition of another antihypertensive, specified by 14 CPGs. CPGs usually MSH specify that delivery should not be
making labetalol and nifedipine more described ‘deterioration’, but when in- delayed past 40 weeks in chronic or
effective options, if available. The WHO dications were specified, they were most gestational hypertension. Post-term

292 American Journal of Obstetrics & Gynecology AUGUST 2026

TABLE 5
Management
N of CPGs
Management strategy (of N�23 included) CPGs reporting this topic
Place of care
For women with severe hypertension
In hospital 11 ACOG, CEMDSA, DGGG, ESC, HSE & RCPI,
ISSHP, NGF, NICE,e STGO, SOGC, SOMANZ
For women with preeclampsia
In hospital 11 ACOG, CEMDSA, DGGG, ESC, HNZ, ISSHP,
MSH, NGF, NICE,e SOGC, SOMANZ
Place unclear, based on insufficient evidence 1 CNGOF
At center able to provide magnesium sulfate 1 WHO
At <34 weeks or when preterm birth 4 ACOG, STGO, ISSHP, SOMANZ
anticipated, care at center with maternal
critical care and neonatal intensive care
provision
Antihypertensive therapy
BP threshold for initiation of treatmenta
160/110 mmHg 4 FECOLSOG, MSH, NVOG, NPMS
150/100 mmHg 2 HSE & RCPI, NGF
140/90 mmHg 12 ACOG, CEMDSA, CNOGF, DGGG, ESC, HNZ,
ISSHP, NICE,e STGO, SOGC, SOMANZ, WHO
BP target once therapy is initiated
sBP 140—160 mmHg and dBP 90—100 1 HNZ
mmHg
sBP <150 mmHg and dBP 80—100 mmHg (in 2 HSE & RCPI, NGF (but the ISSHP reference of
healthy women ideally below 85 mmHg is also presented)
without chronic kidney/cardiovascular
disease)
<140/90 mmHg 6 ACOGb, ESC, ISSHP, NICE,e STGO, SOGC,
SOMANZ
sBP 135 mmHg and/or dBP of 85 mmHg 4 ISSHP, NICE,e SOGC, SOMANZ
Choice of antihypertensive agent
First line for severe hypertensiona
Labetalol (IV) 11 ACOG, AIPE & SIMP, ESC, HNZ, HSE & RCPI,
ISSHP, NICE,e NVOG, SFAR & CNGOF, SOGC,
SOMANZ
Nifedipine (oral) 10 DGGG, ESC, FECOLSOG, HNZ, ISSHP, NGF,
NICE,e NVOG, SOGC, SOMANZ
Hydralazine (IV) 6 ACOG, DGGG, HNZ, ISSHP, SOGC, SOMANZ
Methyldopa (oral) 6 AIPE & SIMP, ESC, MSH, NVOG, CEMDSA,
SOGC
Other 3 DGGG, STGO, SOMANZ
Choice based on clinician’s experience, 1 WHO
familiarity, cost, or local availability
(continued)

AUGUST 2026 American Journal of Obstetrics & Gynecology 293

TABLE 5
Management (continued)
N of CPGs
Management strategy (of N�23 included) CPGs reporting this topic
a
First line for nonsevere hypertension
Labetalol (oral) 11 ACOG, ESC, HNZ, HSE & RCPI, ISSHP, NGF,
NICE,e STGO, SOGC, SOMANZ, WHO
Methyldopa (oral) 9 CEMDSA, ESC, HNZ, ISSHP, MSH, NGF,
STGO, SOMANZ, WHO
Nifedipine (oral) 8 ACOG, ESC, HNZ, ISSHP, NGF, STGO,
SOMANZ, SOGC
Insufficient evidence to recommend agents 1 NVOG
for nonsevere hypertension
Antihypertensive agents to AVOID*
Angiotensin-converting enzyme inhibitors 12 ACOG, ESC, HNZ, HSE & RCPI, ISSHP, NGF,
NICE,e NVOG, STGO, SOGC, SOMANZ, WHO
Angiotensin II receptor blockers 11 ACOG, ESC, HSE & RCPI, ISSHP, NGF, NICE,e
NVOG, STGO, SOGC, SOMANZ, WHO
Direct renin inhibitors 3 ESC, HSE & RCPI, NVOG
“Diuretics” (including thiazides) 5 ESC, ISSHP, MSH, NICE,e SOMANZ
Magnesium sulphate as antihypertensive 4 ACOG, ISSHP, NPMS, SOGC
Magnesium sulphate
For eclampsia treatment 18 ACOG, CEMDSA, DGGG, ESC, FECOLSOG,
HNZ, HSE & RCPI, ISSHP, MSH, NGF, NICE,e
NPMS, NVOG, SFAR & CNGOF, STGO, SOGC,
SOMANZ, WHO
For eclampsia prevention in women with
preeclampsia
Women with “severe” preeclampsiac 17 ACOG, CEMDSA, DGGG, ESC, FECOLSOG,
HNZ, ISSHP, MSH, NGF, NICE,e NPMS,
NVOG, SFAR & CNGOF, STGO, SOGC,
SOMANZ, WHO
Fetal neuroprotection 6 ISSHP, MSH, NGF, NICE,e SOGC, SOMANZ
Planned early birth at <32 weeks 5 ISSHP,NGF, NICE,e SOGC, SOMANZ
Antenatal corticosteroids
Preeclampsia at <34 weeks & likely delivery 9 CEMDSA, HNZ, ISSHP, NGF, NICE,e NVOG,
within 1 week STGO, SOGC, SOMANZ
Preeclampsia at <36 weeks 2 HSE & RCPI, NICEe
Labour and birth
Indications for birth regardless of gestational age
Women with “severe preeclampsia” who 12 ACOG, CEMDSA, ESC, HNZ, HSE & RCPI,
cannot be monitored or who have increasing ISSHP, NGF, NICE,e SFAR & CNGOF, STGO,
organ dysfunction or fetal distress SOMANZ, WHO
Preeclampsia meeting the criteria for 1 FECOLSOG
severity, birth within 24—48 hours
Uncontrolled/worsening hypertension 4 ACOGǁ, ISSHP, NICEd,e SOGC
Eclampsia 5 ACOG, ISSHP, NGF, NICE,e SOGC
(continued)

294 American Journal of Obstetrics & Gynecology AUGUST 2026

TABLE 5
Management (continued)
N of CPGs
Management strategy (of N�23 included) CPGs reporting this topic
Anesthesia/analgesia
Recommended 11 ACOG, AIPE & SIMP, CEMDSA, ESC, HNZ,
NGF, NICE,e SFAR & CNGOF, STGO, SOGC,
SOMANZ
Mode of birth
Based on clinical indications and woman’s 8 CEMDSA, DGG, ESC, HNZ, NGF, NICE,e
preference STGO, SOGC
Cesarean likely at early preterm gestations 1 HNZ
Active management of third stage of labor
Recommended 4 CEMDSA, HNZ, HSE & RCPI, SOGC
Ergometrine should not be used 4 HNZ, HSE & RCPI, STGO, SOGC
Guideline abbreviations: ACOG, American College of Obstetricians and College of Obstetricians and Gynecologists; AIPE & SIMP, Associazione Italiana PreEclampsia and Società Italiana di Medicina
Perinatale; CEMDSA, Ministerial National Committee on Confidential Enquiries into Maternal Deaths in South Africa; CNGOF, Collège national des gynécologues et obstétriciens français; DGGG,
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe; ESC, European Society of Cardiology; FECOLSOG, Federación Colombiana de Obstetricia y Ginecologı́a; HNZ, Health New Zealand; HSE &
RCPI, Irish Health Service Executive & Royal College of Physicians of Ireland; ISSHP, International Society for the Study of Hypertension in Pregnancy; ISUOG, International Society of Ultrasound in
Obstetrics and Gynecology; MSH, Malaysian Society of Hypertension; NGF, Norsk gynekologisk Forening; NICE, National Institute for Health and Clinical Excellence; NPMS, National Partnership for
Maternal Safety; NVOG, Nederlandse Vereniging voor Obstetrie en Gynaecologie; SFAR & CNGOF, Société Française d’Anesthésie et de Réanimation and Collège national des gynécologues et
obstétriciens français; SMFM, Society of Maternal and Fetal Medicine; SOGC, Society of Obstetricians and Gynecologists of Canada; SOMANZ, Society of Obstetric Medicine of Australia and New
Zealand; STGO, Société Tunisienne de Gynécologie Obstétrique; USPSTF, United States Preventative Services Taskforce; WHO, World Health Organization.
Other abbreviations: BP, blood pressure; CPG, clinical practice guideline; dBP, diastolic blood pressure; IV, intravenous; sBP, systolic blood pressure.
a
These response options are not mutually exclusive; b This BP goal is only for chronic hypertension; c Most commonly, the definition of ‘severe’ preeclampsia is based on the definition used in the
Magpie trial (Altman D, Carroli G, Duley L, et al. Do women with preeclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet
2002; 359(9321):1877—90. [Link] (published online girst: 2002/06/12); d After BP has been controlled and a course of antenatal corticosteroids has
been completed; e With any one of: abnormal neurological features, pulmonary oedema, progressive thrombocytopenia, abnormal rising serum creatinine, abnormal rising liver enzymes, hepatic
dysfunction, or nonreassuring fetal status.

pregnancy (≥41 weeks) is not recom- artery Doppler velocimetry at pre- (N=9) addressed some aspect of fetal
mended in any guideline for women determined gestational age intervals. monitoring: (1) ultrasound to assess
with hypertensive disorders. NICE recommends scans at 28, 32, and fetal growth, at diagnosis of hyperten-
Other aspects of labor and birth were 36 weeks of gestation, while the ISSHP sion (N=7) and then every 3 to 4 weeks
not usually addressed. Almost half made and the SOGC advocate monthly ultra- (N=3); (2) umbilical artery Doppler at
recommendations about anesthesia/ sound examinations for growth and diagnosis (N=6) and then at least
analgesia (N=11). A minority of CPGs Doppler assessments, increasing to monthly (N=2); (3) amniotic fluid
(N=9) addressed mode of birth in pre- every 2 weeks if preeclampsia or growth assessment at diagnosis (N=3) and then
eclampsia; all recommended that Ce- restriction develops. ACOG suggests a weekly (N=1) or monthly (N=2); (4)
sarean be undertaken for usual third-trimester growth scan and rec- placental visualization for women with
indications and women’s preferences, ommends commencing weekly or “symptoms” which would meet criteria
with HNZ and STGO emphasizing that twice-weekly antenatal testing at 32 for preeclampsia by most CPGs
induction of labor is less successful at weeks in women requiring antihyper- (ISUOG); and/or (5) biophysical profile
“early preterm gestations” (Table 5). tensive therapy or with comorbidities. (ISUOG, STGO), for which another
Active management of the third stage of Five guidelines additionally recommend CPG recommended against (ISSHP).
labor was endorsed by few CPGs (N=4), cardiotocography when abnormal fetal STGO does not specify the interval be-
with 4 specifically advising against use of activity is detected. MSH provides tween scans.
ergometrine. further recommendations: women sh‑ For women with preeclampsia
ould begin counting fetal movements (Table 6), CEMDSA emphasized that
Fetal and maternal monitoring daily using a chart from 28 to 30 weeks maternal stabilization should be ach-
Fetal monitoring and undergo monthly ultrasound mea- ieved prior to fetal monitoring. Rec-
For women with chronic hypertension surements of fetal biometry and ommendations for fetal monitoring
(Table 6), 9 CPGs advise ultrasono- amniotic-fluid index. were similar to those for gestational
graphic assessment of fetal growth, For women with gestational hyper- hypertension, with postdiagnosis fre-
amniotic-fluid volume, and umbilical- tension (Table 6), a minority of CPGs quency slightly higher and inclusion of

AUGUST 2026 American Journal of Obstetrics & Gynecology 295

TABLE 6
Fetal and maternal monitoring
N of CPGs
Recommendations (of N�23 included) CPGs endorsing
Fetal monitoring
Women with chronic hypertension
Ultrasound for fetal growth
Unspecified gestational age intervals 3 ESC, HSE & RCPI, STGO
At first trimester 1 SOMANZ
At 26 weeks and thereafter at 2—4 weekly intervals 2 ISSHP, SOGC
At 28 weeks 3 ACOG, NICE, SOMANZ
At 32 weeks 2 ACOG, NICE
At 36 weeks 2 ACOG, NICE
Amniotic fluid volume assessment
Unspecified gestational age intervals 2 ESC, STGO
At 26 weeks and thereafter at 2—4 weekly intervals 2 ISSHP, SOGC
At 28 weeks 2 NICE, SOMANZ
At 32 weeks 1 NICE
At 36 weeks 1 NICE
Umbilical artery Doppler velocimetry
Unspecified gestational age intervals 2 ESC, STGO
At 26 weeks and thereafter at 2—4 weekly intervals 2 ISSHP, SOGC
At 28 weeks 2 NICE, SOMANZ
At 32 weeks 1 NICE
At 36 weeks 1 NICE
Cardiotocography if fetal activity is abnormal 3 ACOG, ISSHP, MSH, NICE, SOGC
Monthly ultrasound measurements of fetal biometric parameters 1 MSH
Fetal-movement chart and count movements daily, at 28—30 weeks 1 MSH
Women with gestational hypertension
Ultrasound for fetal growth
At diagnosis 7 ACOG, CEMDSA, HSE & RCPI,
ISSHP, NGF, NICE, SOGC, SOMANZ
Then
Unspecified gestational age intervals 1 STGO
Every 2 weeks 1 HSE & RCPI
Every 3—4 weeks 1 ACOG
Monthly 2 ISSHP, SOGC
Umbilical artery Doppler
At diagnosis 6 ISSHP, ISUOG, NGF, NICE,
SOGC, SOMANZ
Then
Unspecified gestational age intervals 1 STGO
At least monthly 2 ISSHP, SOGC
(continued)

296 American Journal of Obstetrics & Gynecology AUGUST 2026

TABLE 6
Fetal and maternal monitoring (continued)
N of CPGs
Recommendations (of N�23 included) CPGs endorsing
Amniotic fluid assessment
At diagnosis 3 ISSHP, NICE, SOGC
Then
Unspecified gestational age intervals 1 STGO
At least weekly 1 ACOG
At least monthly 2 ISSHP, SOGC
a
Placental visualisation for women with symptoms 1 ISUOG
Biophysical profile
Recommended if maternal symptomsa or reduced fetal movements 2 ISUOG, STGO
Not recommended for use 1 ISSHP
Women with preeclampsia
Only monitor fetus once woman is stable 1 CEMDSA
Ultrasound for fetal growth
At diagnosis 7 AIPE & SIMP, ISSHP, ISUOG,
NGF, NICE, STGO, SOMANZ
Then
Unspecified gestational age intervals 1 STGO
Every 2 weeks 4 ISSHP, NICE, SOGC, SOMANZ
Every 3—4 weeks 1 ACOG
Umbilical artery Doppler
At diagnosis 6 ISUOG, ISSHP, NGF, NICE,
STGO, SOMANZ
Then
Unspecified gestational age intervals 1 STGO
Every 2 weeks 2 ISSHP, NICE, SOGC
Ductus venosus Doppler when fetal growth 3 NGF, STGO, SOMANZ
restriction present
Amniotic fluid assessment
At diagnosis 5 ACOG, ISSHP, NICE, SOGC, SOMANZ
Then
Unspecified gestational age intervals 1 STGO
Weekly 1 ACOG
Every 2 weeks 4 ISSHP, NICE, SOGC, SOMANZ
When there are maternal symptoms 1 ISUOG
a
Placental visualization for mothers with symptoms 1 ISUOG
Biophysical profile
Recommended if maternal symptomsa or reduced fetal movements 3 ISUOG, NGF, STGO
Not recommended for use 1 ISSHP
(continued)

AUGUST 2026 American Journal of Obstetrics & Gynecology 297

TABLE 6
Fetal and maternal monitoring (continued)
N of CPGs
Recommendations (of N�23 included) CPGs endorsing
Maternal monitoring (additional)
Women with chronic hypertension
Self-monitoring for symptoms 2 ISSHP, NICE
Home self-monitoring 2 ISSHP, SOMANZ
Women with gestational hypertension
Self-monitoring for symptoms 2 ISSHP, SOGC
BP monitoring
Once or twice per week 2 NICE, SOMANZ
“Between appointments” 2 ISSHP, SOGC
Routine self-monitoring specifically
Yes 3 ISSHP, NICE, SOMANZ
No 1 CNGOF
Proteinuria
Once or twice per week 2 HSE & RCPI, NICE
“Between appointments” 2 ISSHP, SOGC
Pulse oximetry
“Between appointments” 2 ISSHP, SOGC
b
Laboratory tests (‘routine’ )
At every antenatal visit 3 CEMDSA, HNZ, NICE
Women with preeclampsia
Clinical reassessment (holistic) at least twice per week 3 ISSHP, NICE, SOGC
Self-monitoring for symptoms 2 ACOG, NICE
BP monitoring
At least every 48 hours 1 NICE
At least twice per week 1 SOMANZ
At least weekly 1 HSE & RCPI
Frequency depends on clinical assessment 1 NGF
Self-monitor BP routinely
Yes 2 ACOG, SOGC
Proteinuria monitoring
Only if not previously detected 3 ISSHP, NGF, SOGC
Once or twice per week 1 HSE & RCPI
At least twice per week 1 NICE
“Between appointments” 0 -
Physical examination
Deep-tendon reflexes “regularly” as part of 1 DGGG
inpatient monitoring
Pulse oximetry
At least twice per week 2 ISSHP, SOGC
(continued)

298 American Journal of Obstetrics & Gynecology AUGUST 2026

TABLE 6
Fetal and maternal monitoring (continued)
N of CPGs
Recommendations (of N�23 included) CPGs endorsing
b
Laboratory tests (‘routine’ )
At least twice per week 2 ISSHP, SOGC
Insufficient data to recommend a method for proteinuria monitoring 1 CNGOF
Guideline abbreviations: ACOG, American College of Obstetricians and College of Obstetricians and Gynecologists; AIPE & SIMP, Associazione Italiana PreEclampsia and Società Italiana di Medicina
Perinatale; CEMDSA, Ministerial National Committee on Confidential Enquiries into Maternal Deaths in South Africa; CNGOF, Collège national des gynécologues et obstétriciens français; DGGG,
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe; ESC, European Society of Cardiology; FECOLSOG, Federación Colombiana de Obstetricia y Ginecologı́a; HNZ, Health New Zealand; HSE &
RCPI, Irish Health Service Executive & Royal College of Physicians of Ireland; ISSHP, International Society for the Study of Hypertension in Pregnancy; ISUOG, International Society of Ultrasound in
Obstetrics and Gynecology; MSH, Malaysian Society of Hypertension; NGF, Norsk gynekologisk Forening; NICE, National Institute for Health and Clinical Excellence; NPMS, National Partnership for
Maternal Safety; NVOG, Nederlandse Vereniging voor Obstetrie en Gynaecologie; SFAR & CNGOF, Société Française d’Anesthésie et de Réanimation and Collège national des gynécologues et
obstétriciens français; SMFM, Society of Maternal and Fetal Medicine; SOGC, Society of Obstetricians and Gynecologists of Canada; SOMANZ, Society of Obstetric Medicine of Australia and New
Zealand; STGO, Société Tunisienne de Gynécologie Obstétrique; USPSTF, United States Preventative Services Taskforce; WHO, World Health Organization.
Other abbreviations: BP, blood pressure; CPGs, clinical practice guidelines.
a
Symptoms are headache, abdominal pain, bleeding, and/or reduced fetal movement; b Laboratory tests to be routinely performed in women with gestational hypertension or preeclampsia have been
specified as: hemoglobin (NGF); platelet count (ISSHP, NGF, SOGC); serum creatinine (ISSHP, NGF, SOGC); serum aspartate aminotransferase (ISSHP, NGF, SOGC), alanine aminotransferase (ISSHP,
NGF, SOGC), or lactate dehydrogenase (NGF); and serum uric acid (NGF).

some additional testing: (1) ultrasound count, serum creatinine, and serum weekly, using the fullPIERS model (with
to assess fetal growth, at diagnosis of aspartate aminotransferase or alanine components of gestational age, chest
preeclampsia (N=8) and then every 2 aminotransferase). DGGG was the only pain or dyspnea, oxygen saturation,
weeks (N=4), every 3 to 4 weeks (N=1), guideline to advise regular assessment of platelet count, serum creatinine, and
or unspecified (N=1); (2) umbilical ar- deep tendon reflexes as part of inpatient AST)37,38, at least twice weekly.
tery Doppler at diagnosis (N=5) and monitoring. In fact, NGF explicitly rec-
then every 2 weeks (N=2), with NGF ommends against the assessment of Comment
and SOMANZ specifying ductus veno- deep tendon reflexes as hyperreflexia is Principal findings
sus Doppler when fetal growth restric- present in some healthy women. In this systematic review, we identified
tion is present; (3) amniotic fluid The frequency of monitoring and analyzed 23 CPGs on the topic of
assessment at diagnosis (N=5) and then appeared to be lower for women with HDPs. Using the AGREE II tool, 14
every 1 (N=1) or 2 weeks (N=4), or gestational hypertension (once/twice CPGs were deemed clinically useful,
when there are maternal symptoms per week if specified, N=2) than pre- compared with 6 of 15 identified by
(ISUOG); (4) placental visualization for eclampsia (as frequently as every 48 Scott et al.4 The remaining CPGs (N=9)
women with symptoms of preeclampsia hours, with laboratory tests at least were assessed as requiring modifica-
(ISUOG); and/or (5) biophysical profile twice/week), but there were few rec- tions. The highest-performing CPGs,
(N=2), for which another CPG recom- ommendations made for comparison scoring above 80% in 5 of 6 domains,
mended against (ISSHP). (Table 6). NICE emphasized BP moni- were CEMDSA, FECOLSOG, ISSHP,
Maternal monitoring toring once or twice per week for non- MSH, NICE, NVOG, SOGC, and WHO.
Maternal monitoring recommendations severe hypertension, until target BP is Regarding the content of the CPGs,
(beyond routine BP monitoring at each achieved. For women with gestational areas of consistency were largely similar
antenatal visit) were made by few CPGs hypertension, ongoing proteinuria to those identified by Scott et al,4
(no more than N=3) regardless of HDP monitoring was emphasized, but vari- continuing the increasing alignment of
(Table 6). DGGG stated that monitoring able recommendations were made, for CPGs. General consensus included:
should be more frequent than usual each antenatal visit (N=3), once or definitions of hypertension, chronic and
care, but “no evidence-based recom- twice/week for outpatients and daily gestational hypertension, proteinuria,
mendation can be made regarding the during an inpatient stay (N=2), or low-dose aspirin use for preeclampsia
examination intervals and necessary “between appointments” (N=2). For prevention in high-risk women, anti-
monitoring measures”. Monitoring was women with preeclampsia, 3 CPGs hypertensives for severe hypertension,
described as: self-monitoring of symp- emphasized ongoing monitoring of MgSO4 for eclampsia prevention and
toms (ie, headache, dyspnea, abdominal proteinuria only if not previously treatment, and the nonmandatory na-
pain, or vaginal bleeding), monitoring detected, whereas NICE continued to ture of proteinuria for preeclampsia
of BP (in office or at home) or protein- advise dipstick proteinuria testing at diagnosis (other than CNGOF, MSH,
uria, pulse oximetry, and laboratory least twice per week. ISSHP and SOGC Société Française d’Anesthésie et de
testing (most often [N=3], as platelet advised overall assessment at least twice Réanimation and Collège national des

AUGUST 2026 American Journal of Obstetrics & Gynecology 299

gynécologues et obstétriciens français, recommended device for measuring BP; Human Development Maternal-Fetal
and WHO). While all included CPGs however, more recent CPGs typically Medicine Network [NICHD] [81 mg vs
reviewed a similar body of evidence, recommend a “machine that is validated 182 mg], Pregnancy Early Assessment
there was heterogeneity in how some of for use in pregnancy.” Notably, no CPG and Rapid Linkage to Services
the data were interpreted by each com- recommended an aneroid device as a (PEARLS) [75 mg vs 150 mg]), angio-
mittee. There was no clear rationale for gold standard. genic marker-based aspirin cessation in
these differing interpretations, in terms Nineteen CPGs provide the definition mid-pregnancy (Fetal Medicine Foun-
of the quality of either the evidence of proteinuria, while AIPE & SIMP, dation), and use in multiple pregnancies
assessed or national resources. ISUOG, SMFM, and SFSR & CNGOF (ASPRE-T).
In contrast to Scott et al,4 improve- do not. Testing for clinically significant There is very little guidance on place
ments in consistency were noted in the (eg, >2+ proteinuria, protein:creatinine of care or home BP monitoring; these
recommendation of antihypertensive ratio >30 mg/mmol) proteinuria is are critical gaps in guidance, as new
treatment for nonsevere hypertension, essential when pregnancy hypertension models of care are implemented. Rec-
which has become more widely is present. While screening for protein- ommendations seem to reflect more
endorsed. Additionally, more CPGs uria at all antenatal contacts is an confidence in office measurements than
now include information on the nature essential element of WHO guidance,39 home/out of office based on the number
and frequency of maternal and fetal whether or not routine testing for pro- of recommendations.
monitoring for women with pre- teinuria beyond the booking visit is That preeclampsia is a moderate risk
eclampsia, and some address women at actually useful is uncertain,40 and is an factor for postpartum hemorrhage is
an ‘increased risk.’ However, this re- important research gap. under-recognized,46 and only 4/23
mains an area in need of further It is important to emphasize that the CPGs mention active management of
research. In particular, while the ma- complications ACOG categorizes as third stage.
jority of CPGs all recommended the “severe features” correspond to the The effective management of pre-
same methods of checking for fetal maternal end-organ manifestations eclampsia requires teamwork. It is
growth restriction (ultrasound scans, other societies use to define the disease important that CPGs emphasize the vital
umbilical artery Doppler, and amniotic itself. This discrepancy highlights a gap role of communication between mid‑
fluid volume assessment), there were in international standardization, sug- wifery (where established), nursing ob-
several variations in the frequency at gesting the need for greater harmoni- stetrics, obstetric medicine, anesthesia,
which these should be performed. The zation of diagnostic criteria. Broadening neonatology, and critical care (when
dosage of aspirin, while still inconsistent the definition of from proteinuric hy- required) to optimize outcomes.
as found in Scott et al,4 has shown some pertension, through maternal, maternal Standardizing the diagnosis, initial
improvement, with all CPGs recom- and fetoplacental, to maternal, fetopla- assessment, ongoing surveillance, and
mending doses within the range of 75 cental, and angiogenic imbalance, therapeutic interventions for women with
mg/d to 162 mg/d. Areas of inconsis- incrementally improves the capacity of a preeclampsia optimizes outcomes.47—49
tency identified by Gillon et al3 and definition to identify women and fetuses However, many CPGs make no mention
Scott et al,4 and also observed in this at risk of adverse events.41,42 Objective of maternal-fetal surveillance protocols.
review, include the definition of ‘severe’ risk stratification using likelihood ratios This is a gap that should be addressed in
preeclampsia, timing of birth for women for adverse event risks provides future CPG updates.
with preterm preeclampsia at a viable evidence-based criteria for maternally
gestational age, specific aspirin dosage defined disease severity.43 Strengths and limitations
for preventative therapy, and optimal Clinical risk factor screening to This systematic review followed the
timing for initiating aspirin prophylaxis. identify preeclampsia risk remains the methodology established by Gillon et al3
norm despite compelling evidence that and Scott et al4 to ensure consistency of
Comparison with existing literature included risk factors perform poorly approach and to enable longitudinal
The measurement of BP is an area where and that the Fetal Medicine Foundation comparisons. Eligibility criteria were
consistency across CPGs was observed, multivariable competing risk models are broad, including multidisciplinary CPGs
in line with Scott et al.4 Ten CPGs superior, to aid in the prevention of both from authoritative sources to ensure high
(ACOG, AIPE & SIMP, ESC, ISSHP, preterm and term preeclampsia.44,45 quality and relevance. Multiple biblio-
NICE, NVOG, NPMS, CEMDSA, The WHO is isolated in advocating for graphic databases and gray literature were
SOMANZ, and USPSTF) specified that initiating low-dose aspirin to prevent searched, supplemented by targeted ef-
the woman should be seated during preeclampsia beyond 16 weeks’ gesta- forts to identify updates via organizational
measurement. Most CPGs did not tion. There are ongoing trials regarding websites and personal communication.
address use of an appropriately sized the optimal dose of aspirin to prevent Data abstraction was standardized using
cuff. In Scott et al,4 the mercury sphyg- preeclampsia (Eunice Kennedy Shriver predefined tables to ensure consistency
momanometer was the most commonly National Institute of Child Health and and facilitate comparative analysis.

300 American Journal of Obstetrics & Gynecology AUGUST 2026

However, several limitations warrant in certain aspects of CPG content, ultrasound in screening for and follow-up of pre-
mention. Excluding local or regional indicating that the strength of recom- eclampsia. Ultrasound Obstet Gynecol
2019;53:7–22.
guidelines when national versions existed mendations and the quality of support- 9. SMFM, Lauder J, Sciscione A, Biggio J,
may have overlooked context-specific ing evidence are robust. To ensure Osmundson S. Society for Maternal-Fetal
adaptations; however, CPGs from effective implementation, auditable Medicine Consult Series #50: the role of activ-
Malaysia, Tunisia, and South Africa standards should be established. How- ity restriction in obstetric management: (re-
recognize the relative constraints experi- ever, inconsistencies persist, which may places consult number 33, August 2014). Am J
Obstet Gynecol 2020;223:B2–10.
enced by colleagues in low- and middle- arise from factors such as the adaptation 10. SOMANZ. SOMANZ Hypertension in
income countries. CPG appraisal was of recommendations to local contexts. Pregnancy Guideline 2023. Sydney: Society of
conducted by 2 reviewers using the Crucially, when discrepancies stem Obstetric Medicine of Australia and New Zea-
AGREE II tool, the minimum recom- from inconclusive or weak evidence, land; 2023.
mended by the AGREE II trust, potentially further research is essential to establish 11. WHO. WHO recommendation on calcium
supplementation before pregnancy for the
limiting robustness.50 Despite consensus definitive recommendations. We intend prevention of pre-eclampsia and its complica-
discussions, AGREE II’s inherent subjec- for this systematic review to serve as a tions. Geneva: World Health Organization;
tivity can introduce scoring variability. valuable, up-to-date resource for clini- 2020.
Furthermore, selection bias may stem cians seeking confirmation of guideline 12. WHO. WHO recommendation: calcium
from relying on the top 100 Google recommendations and for guideline- supplementation during pregnancy for the
prevention of pre-eclampsia and its complica-
Scholar results. Abstracting only key authorizing bodies to identify areas for tions. Geneva: World Health Organization;
content from lengthy CPGs may have improvement and compare key CPGs. 2018.
omitted nuanced recommendations, The overarching objective is to promote 13. WHO. WHO recommendations on drug
although full texts were reviewed when evidence-based medicine where appli- treatment for non-severe hypertension in
critical information appeared lacking. cable, ultimately enhancing patient care pregnancy. Geneva: World Health Organiza-
tion; 2020.
Furthermore, most available guidelines and optimized outcomes. ■
14. WHO. WHO recommendations: drug
originate from high-income settings, treatment for severe hypertension in pregnancy.
whereas low- and middle-income coun- Geneva: World Health Organization; 2018.
tries, which bear the greatest burden of REFERENCES 15. WHO. WHO recommendations on anti-
preeclampsia and its associated mortality, 1. Magee LA, Nicolaides KH, von Dadelszen P. platelet agents for the prevention of pre-
Preeclampsia. N Engl J Med 2022;386: eclampsia. Geneva: World Health Organization;
are under-represented. In addition, 2021.
1817–32.
restricting inclusion to documents defined 2. Sun S, Li W, Zhang X, et al. Trends in global 16. ACOG. ACOG committee opinion no. 743:
as “evidence-based” and issued by and regional incidence and prevalence of hy- low-dose aspirin use during pregnancy. Obstet
governmental agencies may have pertensive disordersin pregnancy (1990-2021): Gynecol 2018;132:e44–52.
excluded influential national guidelines an age-period-cohort analysis. Sci Rep 17. ACOG. Gestational hypertension and pre-
2025;15:1513. eclampsia: ACOG practice bulletin, number
with substantial clinical impact. An 222. Obstet Gynecol 2020;135:e237–60.
3. Gillon TE, Pels A, von Dadelszen P, et al.
example is Brazil that has a strong national Hypertensive disorders of pregnancy: a sys- 18. Yanque-Robles O, Becerra-Chauca N,
obstetrics and gynecology society playing tematic review of international clinical practice Nieto-Gutierrez W, et al. Clinical practice
a leading role in guideline development guidelines. PLoS One 2014;9:e113715. guideline for the prevention and management of
but was not captured by this selection 4. Scott G, Gillon TE, Pels A, et al. Guidelines - hypertensive disorders of pregnancy. Rev
similarities/dissimilarities: a systematic review of Colomb Obstet Ginecol 2022;73:48–141.
criterion (an updated Brazilian guideline
international clinical practice guidelines for 19. Bernstein PS, Martin JN Jr, Barton JR, et al.
has since been published51). Similarly, pregnancy hypertension. Am J Obstet Gynecol National partnership for maternal safety:
some recent or forthcoming CPG updates 2020;226:S1222–36. consensus bundle on severe hypertension
may not have been captured despite 5. Page MJ, McKenzie JE, Bossuyt PM, et al. during pregnancy and the postpartum period.
extensive search efforts. The PRISMA 2020 statement: an updated Obstet Gynecol 2017;130:347–57.
guideline for reporting systematic reviews. BMJ 20. Magee LA, Smith GN, Bloch C, et al. Hy-
2021;372:n71. pertensive disorders of pregnancy: diagnosis,
Conclusion and implications 6. Cifkova R, Johnson MR, Kahan T, et al. prediction, prevention, and management.
Since the publication of the systematic Peripartum management of hypertension: a J Obstet Gynaecol Can 2022;44(5):547–71.
review by Scott et al,4 there has been an position paper of the ESC Council on Hyper- 21. Davidson KW, Barry MJ,
increase in updated CPGs on HDPs, tension and the European Society of Hyper- Mangione CM, et al. Aspirin use to prevent
tension. Eur Heart J Cardiovasc Pharmacother preeclampsia and related morbidity and
developed by various organizations with
2020;6:384–93. mortality: US Preventive Services Task
varying standards. While the overall 7. Magee LA, Brown MA, Hall DR, et al. The Force Recommendation Statement. JAMA
AGREE II scores of many updated hypertensive disorders of pregnancy: the 2021 2021;326:1186–91.
guidelines have improved, there re- International Society for the Study of Hyper- 22. Barry MJ, Nicholson WK, Silverstein M,
mains room for further enhancement. tension in Pregnancy classification, diagnosis et al. Screening for hypertensive disorders of
and management recommendations for interpregnancy: US Preventive Services Task Force
Strengthening the rigor and standardi-
national practice. Pregnancy Hypertens Final Recommendation Statement. JAMA
zation of CPG quality would enhance 2022;27:148–69. 2023;330:1074–82.
their utility for clinicians. Despite some 8. Sotiriadis A, Hernandez-Andrade E, da Silva 23. Vasapollo B, Zullino S, Novelli GP, et al.
variations, there is notable consistency Costa F, et al. ISUOG practice guidelines: role of Maternal hemodynamics from preconception to

AUGUST 2026 American Journal of Obstetrics & Gynecology 301

delivery: research and potential diagnostic and 32. HNZ. Diagnosis and Treatment of Hyper- 42. Lai J, Syngelaki A, Nicolaides KH, et al.
therapeutic implications: position statement by tension and Pre-eclampsia in Pregnancy in Using ultrasound and angiogenic markers from
Italian Association of Preeclampsia and Italian Aotearoa New Zealand. Wellington: Health New a 19-23 week assessment to inform the sub-
Society of Perinatal Medicine. Am J Perinatol Zealand/Te Whatu Ora; 2022. sequent diagnosis of preeclampsia. Am J
2024;41:1999–2013. 33. Moodley J, Soma-Pillay P, Buchmann E, Obstet Gynecol 2022;227:294.e1.
24. Sentilhes L, Schmitz T, Arthuis C, et al. et al. Hypertensive disorders in pregnancy: 43. Montgomery-Csoban T, Kavanagh K,
[Preeclampsia: Guidelines for clinical practice 2019 national guideline. S Afr Med J 2019;109: Murray P, et al. Machine learning-enabled
from the French College of Obstetricians and 12723. maternal risk assessment for women with
Gynecologists]. Gynecol Obstet Fertil Senol 34. Ben Temime R, Boudaya F, Ouerdiane N, pre-eclampsia (the PIERS-ML model): a
2024;52:3–44. et al. Recommandations STGO: Troubles modelling study. Lancet Digit Health 2024;6:
25. Pecks U, Baumann M, Binder J, et al. Hy- Hypertensifs de la Grossesse. Tunis: Société e238–50.
pertensive disorders in pregnancy (HDP): di- Tunisienne de Gynécologie Obstétrique; 2016. 44. Rolnik DL, Wright D, Poon LC, et al. Aspirin
agnostics and therapy. Guideline of the DGGG, 35. MSH, MOHM, AMM. Clinical Practice versus placebo in pregnancies at high risk for
OEGGG and SGGG (S2k-Level, AWMF registry Guidelines Management for Hypertension preterm preeclampsia. N Engl J Med 2017;377:
no. 015/018, June 2024). Geburtshilfe Frauen- (MOH). Kuala Lumpur: Malaysian Ministry of 613–22.
heilkd 2025;85:810–50. Health; 2018. 45. Goadsby J, Syngelaki A, Magee LA, et al.
26. HSE, RCPI. Clinical Practice Guideline: The 36. Borghi C, Ferri C, Sechi L, et al. Clinical Scheduled birth at term for the prevention of
diagnsosi and management of severe pre- management of hypertension in pregnancy. pre-eclampsia (PREVENT-PE): an open-label
eclampsia and eclampsia - 2016 update. Dub- Practical recommendations from the Italian randomised controlled trial. Lancet 2026;407:
lin: Health Service Executive and Royal Society of Hypertension (SIIA). High Blood 67–77.
College of Physicians and Surgeons of Ireland; Press Cardiovasc Prev 2013;20:123–7. 46. Yunas I, Islam MA, Sindhu KN, et al. Causes
2016. 37. von Dadelszen P, Payne B, Li J, et al. Pre- of and risk factors for postpartum haemor-
27. HSE, RCPI. Clinical Practice Guideline: The diction of adverse maternal outcomes in pre- rhage: a systematic review and meta-analysis.
management of hypertension in pregnancy - eclampsia: development and validation of the Lancet 2025;405:1468–80.
2019 update. Dublin: Health Service Executive fullPIERS model. Lancet 2011;377:219–27. 47. Bailit JL, Grobman WA, McGee P, et al.
and Royal College of Physicians and Surgeons 38. Ukah UV, Payne B, Karjalainen H, et al. Does the presence of a condition-specific ob-
of Ireland; 2019. Temporal and external validation of the fullP- stetric protocol lead to detectable improve-
28. NGF. Hypertensive svangerskapskompli- IERS model for the prediction of adverse ments in pregnancy outcomes? Am J Obstet
kasjoner og eklampsi 2020. Bergen: Norsk maternal outcomes in women with pre- Gynecol 2015;213:86.e1.
gynekologisk Forening; 2020. eclampsia. Pregnancy Hypertens 2019;15: 48. Menzies J, Magee LA, Li J, et al. Instituting
29. NICE. Hypertension in pregnancy: diag- 42–50. surveillance guidelines and adverse outcomes in
nosis and management [NG133] - update. 39. WHO. WHO Recommendations on Ante- preeclampsia. Obstet Gynecol 2007;110:121–7.
NICE guideline. London: National Institute for natal Care for a Positive Pregnancy Experience. 49. von Dadelszen P, Sawchuck D,
Health and Care Excellence; 2023. Geneva: World Health Organization; 2016. McMaster R, et al. The active implementation of
30. NVOG. Hypertensieve aandoeningen in de 40. Magee LA, Sharma S, Sevene E, et al. pregnancy hypertension guidelines in British
zwangerschap. Utrecht: Nederlandse Verenig- Population-level data on antenatal screening for Columbia. Obstet Gynecol 2010;116:659–66.
ing voor Obstetrie en Gynaecologie; 2023. proteinuria; India, Mozambique, Nigeria, 50. Brouwers MC, Kho ME, Browman GP, et al.
31. Bonnet MP, Garnier M, Keita H, et al. Pakistan. Bull World Health Organ 2020;98: Agree II: advancing guideline development,
[Reprint of: severe pre-eclampsia: guidelines for 661–70. reporting and evaluation in health care. CMAJ
clinical practice from the French Society of 41. Lai J, Syngelaki A, Nicolaides KH, et al. 2010;182:E839–42.
Anesthesiology and Intensive care (SFAR) and Impact of new definitions of preeclampsia at 51. Korkes HA, Ramos JGL, de Oliveira LG,
the French College of Gynaecologists and Ob- term on identification of adverse maternal and et al. Pre-eclampsia: protocolo 2025. Botucatu:
stetricians (CNGOF)]. Gynecol Obstet Fertil perinatal outcomes. Am J Obstet Gynecol Reda Brasileira de Estudos sobre Hipertensao
Senol 2022;50:2–25. 2020;224:518.e1. na Gravidez; 2025.

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