ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy

Obstet Gynecol. 2019 Jan;133(1):e26-e50. doi: 10.1097/AOG.0000000000003020.


Chronic hypertension is present in 0.9-1.5% of pregnant women () and may result in significant maternal, fetal, and neonatal morbidity and mortality. The rate of maternal chronic hypertension increased by 67% from 2000 to 2009, with the largest increase (87%) among African American women. This increase is largely secondary to the obesity epidemic and increasing maternal age (). The trend is expected to continue.The purpose of this document is to clarify the criteria used to define and diagnose chronic hypertension before or during pregnancy, to review the effects of chronic hypertension on pregnancy and vice versa, and to appraise the available evidence for management options. The purpose of these revised best practice recommendations is to provide a rational approach to chronic hypertension in pregnancy based on new research data and relevant pathophysiologic and pharmacologic considerations.

Publication types

  • Practice Guideline

MeSH terms

  • Female
  • Humans
  • Hypertension / diagnosis
  • Hypertension / drug therapy
  • Hypertension / prevention & control*
  • Obstetrics
  • Perinatal Care*
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / chemically induced
  • Pregnancy Complications, Cardiovascular / prevention & control*
  • Pregnancy Complications, Cardiovascular / therapy
  • Prenatal Diagnosis*
  • Societies, Medical
  • United States