Current Hypertension Reports (2020) 22:64

https://doi.org/10.1007/s11906-020-01070-0

GUIDELINES/CLINICAL TRIALS/META-ANALYSIS (WJ KOSTIS, SECTION EDITOR)

Hypertension During Pregnancy

Akanksha Agrawal 1 & Nanette K. Wenger 1

# Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
Purpose of Review Hypertensive disorders of pregnancy affect about 5–10% of pregnancies impacting maternal, fetal, and
neonatal outcomes. We review the recent studies in this field and discuss the pathophysiology, diagnosis, and management
of hypertension during pregnancy, as well as the short- and long-term consequences on the cardiovascular health of
women.
Recent Findings Although the American College of Cardiology/American Heart Association revised their guidelines for
hypertension in the general population in 2017, hypertension during pregnancy continues to be defined as a systolic
blood pressure (SBP) ≥ 140 mmHg and/or a diastolic blood pressure (DBP) ≥ 90 mmHg, measured on two separate
occasions. The addition of stage 1 hypertension will increase the prevalence of hypertension during pregnancy, identi-
fying more women at risk of preeclampsia; however, more research is needed before changing the BP goal because a
lower target BP has a risk of poor placental perfusion. Women with chronic hypertension have a higher incidence of
superimposed preeclampsia, cesarean section, preterm delivery before 37 weeks’ gestation, birth weight less than
2500 g, neonatal unit admission, and perinatal death. They also have a higher risk of developing cardiovascular disease
later in life. The guidelines recommend low-dose aspirin for women with moderate and high risk of preeclampsia. While
treating pregnant women with hypertension, the effectiveness of the antihypertensive agent must be balanced with risks
to the fetus.
Summary Hypertensive disorders of pregnancy should be appropriately and promptly recognized and treated during pregnancy.
They should further be co-managed by the obstetrician and cardiologist to decrease the long-term negative impact on the
cardiovascular health of women.

Keywords Chronic hypertension . Pregnancy . Gestational hypertension . Women . Cardiovascular . Fetal

Introduction normal pregnancy, the BP decreases gradually in the first tri-

Hypertensive disorders of pregnancy complicate about 5–
10% of pregnancies causing maternal, fetal, and neonatal mor-
bidity and mortality [1]. Hypertension during pregnancy is
defined as a systolic blood pressure (SBP) ≥ 140 mmHg
and/or a diastolic blood pressure (DBP) ≥ 90 mmHg, mea-
sured on two separate occasions. During the course of a
This article is part of the Topical Collection on Guidelines/Clinical Trials/
Meta-Analysis
* Akanksha Agrawal
aagra30@emory.edu; Akanksha21agr@gmail.com
1
Division of Cardiology, Emory University School of Medicine, 101
Woodruff Circle, Suite 319, Atlanta, GA 30322, USA
mester due to a decrease in systemic vascular resistance. It
reaches a nadir at about 22–24 weeks, rising again from
28 weeks to reach preconception levels by 36 weeks of ges-
tation [2]. There are multiple hormonal, vascular, and meta-
bolic factors postulated to explain hypertensive diseases dur-
ing pregnancy.
Hypertension during pregnancy has negative implications
for a woman’s cardiovascular health later in life. As per a large
population study, the prevalence of chronic hypertension in
pregnancy has increased over 13-fold during the last 4 decades
(1970–2010) [3•]. In this review, we discuss the categoriza-
tion of hypertensive disorders in pregnancy and discuss the
pathophysiology, associated maternal and offspring risks,
management, and long-term consequences of hypertension
during pregnancy, but do not address preeclampsia/eclampsia.
A detailed review of literature and latest guidelines have been
included in the review and reflected in the included citations.
 64 Page 2 of 9
Categorization
As per the American College of Obstetricians and
Gynecologists (ACOG) guidelines, hypertension in pregnan-
cy is divided in the following four categories [4].
Chronic/Pre-existing Hypertension Hypertension discovered
preconception or prior to 20 weeks’ gestation, persisting for
more than 42 days postpartum.
Gestational Hypertension (GH) Hypertension developing after
20 weeks of gestation and usually resolving within 42 days
postpartum.
Preeclampsia/Eclampsia Gestational hypertension accompa-
nied by one of the following:
& Proteinuria
& Maternal organ dysfunction includes the following:
& Acute kidney injury,
& Liver involvement (transaminitis) with or without right
upper quadrant or epigastric abdominal pain
& Neurological complications (eclampsia, altered mental
status, blindness, stroke, clonus, severe headache, persis-
tent visual scotomata)
& Hematological complications (decreased platelet count <
150,000/uL, disseminated intravascular coagulation,
hemolysis)
& Uteroplacental dysfunction (fetal growth restriction, ab-
normal umbilical artery Doppler wave form analysis, or
stillbirth)
Chronic/Pre-existing Hypertension with Superimposed
Preeclampsia-Eclampsia Chronic hypertension that develops
signs and symptoms of preeclampsia or eclampsia after
20 weeks’ gestation.
In addition to above, the European Society of Cardiology
(ESC) has an additional category, antenatally unclassifiable
hypertension, which is used when BP is first recorded after
20 weeks of gestation; and reassessment is necessary after
42 days postpartum [1].
Depending on the severity of BP elevation, hypertension
during pregnancy is categorized as mild or severe.
Mild Hypertension SBP 140–159 mmHg and DBP 90–
109 mmHg
Sometimes, it is further broken down into mild (140–
149/90–99 mmHg) and moderate (150–159/100–
109 mmHg)
Curr Hypertens Rep (2020) 22:64
Severe Hypertension SBP ≥ 160 mmHg and/or DBP ≥
110 mmHg
The threshold for severe hypertension is lower in pregnant
women compared with non-pregnant women due to higher
risk of hypertensive encephalopathy.
In the last several years, though the definition of hyperten-
sion in general population has been revised (BP 130–139/80–
89 mmHg termed as stage 1 hypertension), the guidelines for
diagnosing hypertension in pregnancy have remained un-
changed so far [5]. As per a retrospective study from China
including 16,345 women, adopting 2017 ACC/AHA guide-
lines would result in a substantial increase in prevalence of
gestational hypertension (25.1% vs 4.2%) [6•]. Another study
from the USA including 1020 women demonstrated an in-
creased risk of preeclampsia in the high-risk population in
the presence of stage 1 hypertension (as per ACC/AHA guide-
lines) when compared with high-risk normotensive women
[7]. Elevated blood pressure and stage 1 hypertension have
been shown to be associated with higher risk of preeclampsia,
severe preeclampsia, preterm delivery, and perinatal death [8].
More prospective data are needed to establish the risk and
cardiovascular consequences of stage 1 hypertension during
pregnancy. Detecting and treating women with stage 1 hyper-
tension during pregnancy might reduce maternal and neonatal
risks.
Epidemiology
In women of reproductive age (20–44 years old), the estimat-
ed prevalence of hypertension is about 7.7% as per the
National Health and Nutrition Examination Survey
(NHANES) [9]. The prevalence of gestational hypertension
is estimated at about 6–7% [4] and that of chronic hyperten-
sion during pregnancy varies between 0.9 and 1.5% [10].
During the last 4 decades, the prevalence of chronic hyperten-
sion has increased by almost 6% per year [3•].
The rate of chronic hypertension in pregnancy increases
steadily with increasing maternal age [3•]. As per a study
including 150 million women from the National Hospital
Discharge Survey from 1970 to 2010, the prevalence of
chronic hypertension has a 2-fold higher rate among black
women (1.24%) than white women (0.53%) [3•].
Additionally, black women tend to have earlier disease onset
and poorer control of hypertension [11]. The pregnancy-
related mortality data from 2006 to 2010 also echo a similar
racial disparity, with a higher rate of death in non-Hispanic
black women when compared with non-Hispanic white wom-
en [12]. The 2014–2015 national birth cohort data showed
substantial ethnic differences in the prevalence of maternal
hypertension among other races, varying from 2.2% for
Chinese and 2.9% for Vietnamese women to 8.9% for
Curr Hypertens Rep (2020) 22:64
American Indians/Alaska Natives (AIANs) and 9.8% for non-
Hispanic blacks [13]. In another smaller study (n = 3244),
Hispanic women demonstrated a significantly decreased inci-
dence of gestational hypertension (1.6% versus 8.5%;
P < 0.01) but a similar incidence of preeclampsia (3.8% versus
3.7%; P = 0.9) when compared with non-Hispanic Caucasian
women [14].
Pathophysiology and Risk Factors
The risk factors for gestational hypertension (GH) include
obesity, parity, and history of prior preeclamptic pregnancies
[15]. The last variable poses a challenge in that preeclampsia
is the most common in the first pregnancy. In addition, as
mentioned above, African-American women are at higher risk
of having hypertension. About 42% of women with pre-
eclampsia and 39% of women with GH progress to hyperten-
sion after a mean follow-up of 2.5 years as compared with
women with normotensive pregnancy where the rate is as
low as 1% [16].
Multiple mechanisms including placental vascular insuffi-
ciency, endothelial dysfunction, arterial stiffness, and system-
ic inflammation play a role in the development of preeclamp-
sia [17–20]. However, it is not entirely clear if the same path-
ophysiological changes are also responsible for gestational
hypertension. Additionally, there is limited research on mech-
anisms that link hypertensive disorders of pregnancy with
maternal cardiovascular disease. A large cohort study demon-
strated a strong association between hypertensive diseases of
pregnancy and several cardiovascular risk factors including
hypertension, type 2 diabetes mellitus, hyperlipidemia, and
increased body mass index (BMI) [21].
Immediate Maternal and Fetal Risks
Women with chronic hypertension have a higher incidence of
superimposed preeclampsia, cesarean section, preterm deliv-
ery before 37 weeks’ gestation, birth weight less than 2500 g,
neonatal unit admission, and perinatal death [22]. Fetal growth
restriction, defined as absolute or estimated weight less than
the 10th percentile for gestational age-based population
norms, has been observed in 10–20% of pregnancies in wom-
en with chronic hypertension [23].
Placental abruption, i.e., premature separation of the pla-
centa from underlying myometrium resulting in pain, bleed-
ing, and potentially clinically significant interruption of fetal
gas and nutrient exchange, is more common in women with
chronic hypertension. According to a study using National
Center for Health Statistics data from 1995 to 2002, the rate
of placental abruption was about 1.56% in comparison with
0.58% in normotensive women [24].
Page 3 of 9 64
As a result of the above-mentioned complications such as
placental abruption and preeclampsia, patients with chronic
hypertension have a significantly higher rate of preterm deliv-
ery and cesarean section. Preterm delivery rates range from 12
to 34% among women with chronic hypertension and be-
tween 62 and 70% in women with severe hypertension [25].
Women with preeclampsia also have a greater risk for car-
diovascular disease in the postpartum period even after
adjusting for demographic, socioeconomic, and other CVD
risk factors [26]. The impact on the outcome of pregnancy
and future risk highlights the need for antenatal surveillance
and aggressive control of modifiable cardiovascular risk fac-
tors such as obesity, smoking, and diabetes control.
Long-Term Maternal Cardiovascular Risk
It is well known from several studies that in comparison with
normotensive pregnancies, women with a history of hyperten-
sive diseases of pregnancy have a higher risk of developing
cardiovascular disease later in life [27]. Wu et al. demonstrat-
ed that women with a history of preeclampsia have a 71%
increased risk of CV mortality, a 2.5-fold increase in risk of
coronary artery disease (CAD), and a 4-fold increase in the
development of heart failure when compared with normal co-
horts [28].
The same association has been less aggressively studied for
gestational hypertension; a few studies show an increased risk
for CVD in comparison with preeclampsia; the others show an
increase in the risk but comparatively lower than preeclamp-
sia. A study by Lykke et al. suggested an increase in the risk of
subsequent cardiovascular events as the severity, parity, and
recurrence of hypertensive pregnancy disorders rise. The risk
of subsequent hypertension after gestational hypertension was
5.31-fold in comparison with mild preeclampsia (3.61-fold)
and severe preeclampsia (6.07-fold) [29].
On the contrary, a study of a Finnish cohort with 39 years
of follow-up found that GH was associated with modestly
higher CVD risk than preeclampsia (HR: 1.45 versus 1.40)
[30].
A study including more than 600,000 women in Norway
showed that GH was associated with an increased risk of sub-
sequent CVD (1.8-fold) in comparison with normotensive
pregnancy and the highest risk was observed when GH was
combined with small-for-gestational-age infants and/or pre-
term delivery [31]. Also, women who were hypertensive dur-
ing their first pregnancy had a 70% increased risk of type 2
diabetes and 30% increased prevalence of hypercholesterol-
emia later in life [32•]. All these long-term cardiovascular ef-
fects highlight the need for long-term follow-up of women
who develop hypertensive disorders of pregnancy and routine
surveillance for cardiovascular diseases. The majority of these
studies are from Europe, not reflecting the ethnic heterogeneity
 64 Page 4 of 9
seen in the United States (US) population, and hence its trans-
lation to real world practice becomes challenging.
Diagnosis
Measurement of BP should be done in either the sitting posi-
tion or the left lateral recumbent (during labor) with an appro-
priately sized arm cuff at heart level, and using Korotkoff V
for diastolic BP (DBP) [33]. The United States Preventive
Services Task Force (USPSTF) recommends screening for
preeclampsia by BP measurement at each pregnancy visit
[34]. In a small study of 100 nulliparous women with a BP
more than 140 or 90 mmHg, measuring automated BP mea-
surement for 24 h at home in comparison with conventional
sphygmomanometry in the antenatal clinic showed improve-
ment in the identification of women at high risk of poor ob-
stetric outcome such as proteinuria, preterm delivery, birth
weight below 10th percentile, admission to a special care neo-
natal unit, and cesarean delivery [35]. This suggests the use of
ABPM (ambulatory blood pressure monitoring) in high-risk
women to plan for early intervention and better blood pressure
control.
Identifying women with chronic hypertension is important
during the first antenatal visit, and if possible preconception,
so that safe medications can be discussed. When indicated,
evaluation for secondary causes of hypertension should be
performed prior to pregnancy in an ideal scenario to avoid
radiation exposure and enable surgical intervention if re-
quired. Hypertension of secondary cause is common in ado-
lescent and young adult years [36].
Laboratory Tests
Basic laboratory evaluation including urinalysis, blood count,
hematocrit, liver enzymes, serum creatinine, and serum uric
acid is recommended in all pregnant women [1]. Screening
for proteinuria is essential in early pregnancy to detect pre-
existing kidney disease and also in the second half of pregnan-
cy to check for preeclampsia. Pre-pregnancy proteinuria has
been associated with an increased risk for fetal growth restric-
tion [37]. During pregnancy, a value of < 30 mg/mmol rules out
proteinuria, and anything above that is labeled as significant
proteinuria requiring close monitoring [1]. A relatively new
marker called sFlt1 to placental growth factor (sFlt1:PIGF)
ratio ≤ 38 can be used to exclude the development of pre-
eclampsia in the next week when suspected clinically [38].
In addition to laboratory investigations, doppler ultrasound
of the uterine arteries (performed after 20 weeks of gestation)
can be useful to detect women at higher risk of gestational
hypertension, preeclampsia, and intrauterine growth retarda-
tion [39].
Curr Hypertens Rep (2020) 22:64
Prevention
The ESC has categorized pregnant women into high and mod-
erate risk of women (Table 1) and recommends 100–150 mg
of aspirin daily from week 12 to weeks 36–37 for both high-
and moderate-risk women. This recommendation is supported
by a study by Rolnik et al. where 1776 high-risk women were
randomized to aspirin 150 mg per day or placebo and preterm
preeclampsia occurred in 1.6% in the aspirin group vs 4.3% in
the placebo group [40].
As discussed above, on application of 2017 ACC/AHA
guidelines to current categorization, patients with stage 1 hy-
pertension in a high-risk cohort have been shown to have an
increased risk of preeclampsia compared with normotensive
women (39% versus 15%). Randomization of this cohort to
low-dose aspirin (60 mg) showed a decline in the risk of
preeclampsia (24% versus 39%) in a study of about 1000
patients [7].
The ACOG recommends daily low-dose aspirin beginning
in the late first trimester for women with a history of early-
onset preeclampsia and preterm delivery at less than 34 weeks
of gestation or for women with more than one prior pregnancy
complicated by preeclampsia [41]. The USPSTF recommends
the use of low-dose aspirin (81 mg/day) as preventive medi-
cation after 12 weeks of gestation in women who are at high
risk for preeclampsia [42].
Calcium supplementation has also been studied to evaluate
its effect on maternal and child outcomes in patients with hy-
pertensive disorders of pregnancy. As per a Cochrane review,
calcium supplementation (≥ 1 g/day) is associated with a sig-
nificant reduction in the risk of preeclampsia, particularly for
women with low calcium diets [43]. The ESC guidelines rec-
ommend calcium supplementation (1.5–2 g/day, orally) in
pregnant women with low dietary intake of calcium (<
600 mg/day) starting at the first antenatal clinic for the preven-
tion of preeclampsia [1]. The ACOG guidelines mention cal-
cium to be useful in reducing severity of preeclampsia in pop-
ulations with low calcium intake; however, there are no task
force recommendations for US population with adequate cal-
cium intake [4]. The ACOG also recommends against vitamin
C or vitamin E supplementation to prevent preeclampsia [4].
Management
Goal Blood Pressure
The primary aim of BP control during pregnancy is to limit the
episodes of severe hypertension, thereby reducing maternal
morbidity. A study by von Dadelszen et al. in 2000 suggested
that aggressive maternal BP control might adversely affect
fetal growth, causing small-for-gestational-age (SGA) infants
and fetal growth restriction [44]. Another relatively recent
Curr Hypertens Rep (2020) 22:64
Table 1 Categorization of
pregnant women to high risk and High risk of preeclampsia (includes any of the following)
moderate risk for preeclampsia
Hypertensive disease during a previous pregnancy
Chronic kidney disease
Autoimmune disease such as systemic lupus erythematosus
or antiphospholipid syndrome
Type 1 or type 2 diabetes
Chronic hypertension
study on about 1000 women with gestational or pre-existing
hypertension showed no significant difference in the compos-
ite primary outcome with less-tight-control (target DBP <
100 mmHg) or tight-control (target DBP < 85 mmHg) [45].
The composite primary outcome included pregnancy loss or
high-level neonatal care for more than 48 h during the first 28
postnatal days. However, severe hypertension (≥ 160/
110 mmHg) was developed in 40.6% of the women in the
less-tight-control group and 27.5% of the women in the
tight-control group (P < 0.001).
The ACOG recommends maintaining BP between 120/80
and 160/105 mmHg in women with uncomplicated hyperten-
sion [4]. ACOG further recommends initiating antihyperten-
sive treatment for women with chronic hypertension when the
BP is persistently elevated to > 160 mmHg systolic and/or >
105 mmHg diastolic. The European guidelines have a slightly
different BP goal, recommending initiation of drug treatment
in all women with persistent elevation of BP ≥ 150/95 mmHg,
and at values > 140/90 mmHg in women with gestational
hypertension, pre-existing hypertension with superimposed
gestational hypertension, and hypertension with subclinical
organ damage or symptoms at any time during pregnancy
[1]. As discussed above, these guidelines antedate the 2017
ACC/AHA guidelines for non-pregnant adults, and more pro-
spective studies are needed to establish if there should be a
change in the BP goal. The Chronic Hypertension and
Pregnancy (CHAP) project is one such large, multicentric,
randomized controlled trial including pregnant patients with
blood pressures ranging between 140 and 159/90–104 mmHg.
Patients are randomized to the “antihypertensive therapy” arm
to control their blood pressure to < 140/90 mmHg, or the “no
antihypertensive or low-dose therapy” arm, with the goal of
maintaining a blood pressure < 160/105 mmHg; antihyperten-
sive drugs are only given in small enough doses to maintain
pressures just below this threshold. Primary outcomes will be
composite adverse perinatal outcomes up to 2 weeks postpar-
tum (fetal and neonatal death, preeclampsia with severe fea-
tures, placental abruption, and preterm labor < 35 weeks’ ges-
tation) and SGA (< 10th percentile birth weight). This study is
estimated to be completed in June 2021 [46].
Page 5 of 9 64
Moderate risk of preeclampsia (includes more
than one of the following)
First pregnancy
Age 40 years or older
Pregnancy interval of more than 10 years
BMI of ≥ 35 kg/m2 at first visit
Family history of preeclampsia
Multiple pregnancy
Non-pharmacological Management
There exists a linear correlation between body mass index
(BMI) and hypertensive disorders of pregnancy, with the risk
for preeclampsia becoming 2-fold with each increase in BMI
of 5 to 7 kg/m2 [47, 48]. Hence, regular exercise should be
continued with caution during pregnancy. A randomized trial,
LIMIT, compared comprehensive dietary and lifestyle inter-
vention with standard care in overweight women (BMI ≥
25 kg/m2) between 10 and 20 weeks of gestation [49]. The
antenatal lifestyle advice used in this study did not reduce the
risk of delivering a baby weighing above the 90th percentile
for gestational age and sex or improve maternal pregnancy
and birth outcomes. More studies are needed to examine the
effect of lifestyle interventions during pregnancy. As per
guidelines, obese women (BMI ≥ 30 kg/m2) are advised
against gaining more than 6.8 kg during their pregnancy [50].
Pharmacological Management
While treating pregnant women, the effectiveness of the anti-
hypertensive agent has to be balanced with risks to the fetus.
Most women with mild chronic hypertension are able to stop
their antihypertensive medications during the first and second
trimester secondary to a physiologic fall in blood pressure.
Earlier medications during pregnancy were classified under
five letter risk categories (A, B, C, D, or X). As per the US
Food and Drug Administration (FDA), this categorization is
no longer used, and specific drug information should be
checked at the US FDA website under pregnancy and lacta-
tion registries (https://www.fda.gov/drugs/labeling-
information-drug-products/pregnancy-and-lactation-labeling-
drugs-final-rule). The drugs of choice for treatment of
hypertension during pregnancy include methyldopa, beta-
blockers, and calcium antagonists. Specific drug information
is discussed in Table 2. angiotensin-converting enzyme
(ACE) inhibitors, angiotensin receptor blockers (ARBs), and
direct renin inhibitors are strictly contraindicated during preg-
nancy and lactation due to adverse fetal and neonatal
outcomes.
 64
Page 6 of 9

Table 2 Antihypertensive medications used to treat hypertension during pregnancy

Drug Class Intravenous dose Oral dose Former Placenta Transfer to breast milk
FDA permeable
category

Methyldopa Central α-agonist Not commonly used first line 500–3000 mg/day, divided into two to four doses B Yes Yes*
Hydralazine Vasodilator 5 mg, then 5–10 mg every 20–40 min, maximum 20 mg Not commonly used first line C Yes Yes (1%)*
OR 0.5–10 mg/h infusion
Labetalol α-/β-blocker 10–20 mg, then 20–80 mg every 10–30 min, maximum 200–2400 mg/day, divided into two to three doses C Yes Yes*
300 mg OR 1–2 mg/min infusion
Nifedipine Calcium channel Not used in intravenous form Immediate Release—10–20 mg every 2–6 h, maximum C Yes Yes* (maximum of
blocker 180 mg/day (may repeat initial dose after 20 min if 1.8%)
needed)
Extended release—30–120 mg/day
Verapamil Calcium channel Intravenous use not recommended. Associated with Immediate release—80 mg three times a day C Yes Yes*
blocker greater risk of hypotension and subsequent fetal Extended release—180 mg once a day (total maximum
hypoperfusion dose not to exceed 480 mg/day)
Furosemide Diuretic (loop) Individual dose not to exceed > 200 mg/dose 20–80 mg q12/daily (not to exceed 600 mg/day) C Yes Well tolerated (milk
production can be
reduced)
Nitroprusside Vasodilator 0.3 mcg/kg/min infusion, titrated every 5 min to a Not available C Yes Unknown
maximum dose of 10 mcg/kg/min (animal
studies)

*Breastfeeding is possible if the mother is treated with the drug

Adapted from the 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy [1] and Drug Treatment of Hypertension in Pregnancy [52]
Curr Hypertens Rep
(2020) 22:64
Curr Hypertens Rep (2020) 22:64
For the treatment of severe hypertension, the selection of an
antihypertensive drug and its route of administration depend
on the expected time of delivery [1]. Treatment with intrave-
nous labetalol, oral methyldopa, or nifedipine should be initi-
ated, and sodium nitroprusside should be used only as drug of
last choice due to risk of fetal cyanide poisoning [51].
Conclusion
Hypertensive disorders of pregnancy affect about 5–10% of
pregnancies with adverse fetal, neonatal, and maternal out-
comes. They also have a negative impact on the long-term
cardiovascular health of women. Antenatal and postnatal sur-
veillance for hypertensive disorders must be performed in the
high-risk women. The racial/ethnic differences in the long-
term cardiovascular consequences should be studied. More
research is needed to identify the target blood pressure during
pregnancy, especially subsequent to the revised AHA/ACC
guidelines.
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
interest.
Human and Animal Rights and Informed Consent This article does not
contain any studies with human or animal subjects performed by any of
the authors.
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