What are the AHA/ASA guidelines on stroke prevention in women with preeclampsia?

Updated: Jan 10, 2016
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Answer

Answer

The AHA/ASA recommendations (class I) for interventions for prevention of preeclampsia are as follows [12] :

  • Women with chronic primary or secondary hypertension or previous pregnancy-related hypertension should take low-dose aspirin from the 12th week of gestation until delivery
  • Consider calcium supplementation (≥1 g/d orally) for women with low dietary intake of calcium (</ul>

    The AHA/ASA recommendations for interventions formanagement of preeclampsia are as follows [12] :

    • Severe hypertension should be treated with safe and effective antihypertensive medications, such as methyldopa, labetalol, and nifedipine, with consideration of maternal and fetal side effects (class I)
    • Consider treatment of moderate hypertension, although maternal-fetal risk-benefit ratios have not been established (class IIa)
    • Atenolol, angiotensin receptor blockers, and direct renin inhibitors are contraindicated in pregnancy and should not be used (class III)

    The AHA/ASA recommends that postpartum, women with chronic hypertension should be continued on their antihypertensive regimen, with dosage adjustments to reflect the decrease in volume of distribution and glomerular filtration rate that occurs after delivery. They should also be monitored carefully for the development of postpartum preeclampsia (class IIa).

    Because of the increased risk of stroke 1 to 30 years after delivery in women with a history of preeclampsia, evaluate all women starting 6 months to 1 year postpartum, as well as those who are past childbearing age, for a history of preeclampsia/eclampsia and document their history of preeclampsia/eclampsia as a risk factor; evaluate and treat for cardiovascular risk factors including hypertension, obesity, smoking, and dyslipidemia (class IIa).

    The ACCP guidelines for venous thromboembolism (VTE), thrombophilia, and antithrombotic therapy during pregnancy offer the following recommendations for the prevention and management of preeclampsia [13] :

    • For women at risk: Low-dose aspirin throughout pregnancy, starting in the second trimester
    • For women with ≥2 miscarriages but without antiphospholipid antibody (APLA) or thrombophilia, antithrombotic prophylaxis is recommended against

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