Objective: This systematic review updates a 2020 analysis of clinical practice guidelines regarding hypertensive disorders of pregnancy, aiming to both support evidence-based practice and inform future research.
Data sources: Searches were conducted in Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials. The search strategy used combinations of keywords and Medical Subject Headings terms relating to "pregnancy," "hypertension," "hypertensive disorders of pregnancy," and "guidelines," alongside Boolean operators to refine 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 guidelines published between 2015 and 2025, in English, Dutch, French, German, Norwegian, or Spanish.
Study appraisal and synthesis methods: A comprehensive search of bibliographic databases and gray literature identified 23 clinical practice guidelines, including 15 updates and 8 newly identified guidelines. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool was used to assess guideline characteristics. Data abstraction was by 2 independent reviewers, with disagreement resolved by consensus, with a third reviewer resolving outstanding difference of opinion. The results are presented descriptively.
Results: Half of clinical practice guidelines were scored as being 'clinically useful', while the other half were scored as useful with modifications, using the AGREE II score. Notable evolution since 2020 includes greater consistency in recommending antihypertensive treatment for nonsevere hypertension in women with chronic hypertension (endorsed by 9 clinical practice guidelines; advice remains more discordant for women with either gestational hypertension or preeclampsia) and improved guidance regarding maternal and fetal monitoring for women either at an increased risk of or with (endorsed by 9 clinical practice guidelines) preeclampsia, although the former remains underaddressed. Aspirin dosage (for preeclampsia prevention) recommendations, while still varied, now fall within a more consistent range of 75 to 162 mg/d. Persistent inconsistencies remain in the definition of 'severe' preeclampsia, timing of birth for preterm preeclampsia, and specific aspirin dosages and timing for commencement.
Conclusion: While several areas of consensus exist between clinical practice guidelines, variability persists in key recommendations, and establishing auditable standards is essential for effective implementation. Where discrepancies reflect insufficient or inconclusive evidence, further research is paramount to support robust guideline development to optimize pregnancy outcomes.
Keywords: clinical practice guideline; definitions; management; prediction; pregnancy hypertension; prevention.
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