Pregnancy and chronic hypertension
Chronic hypertension occurs in approximately 2% of pregnancies in the United States and remains a major cause of maternal and perinatal morbidity and mortality. While there is a consensus supporting the treatment of severe chronic hypertension in pregnancy to mitigate risks, significant variation in guidelines exists regarding the treatment of mild chronic hypertension which is defined as a systolic blood pressure (BP) of ≥ 140 mmHg and < 160 mmHg or a diastolic BP ≥ 90 mmHg and < 110 mmHg or both.
A study titled “Chronic Hypertension and Pregnancy (CHAP)” is a randomized controlled trial that was recently published in the New England Journal of Medicine. This multi-center randomized trial included singleton gestations with mild chronic hypertension who were randomized to receive antihypertensive therapy versus no treatment until severe hypertension developed. The study found a reduced risk of the primary composite outcome (preeclampsia with severe features, medically indicated preterm birth < 35 weeks of gestation, placental abruption or fetal/neonatal death) (30.2% versus 37.0%, RR 0.82) with no significant difference in neonatal birthweight/small for gestational age and serious maternal and neonatal complications between the groups.
Based on these findings, ACOG recommends utilizing 140/90 mmHg as the threshold for initiation or titration of medical therapy for chronic hypertension in pregnancy.
Does COVID-19 cause miscarriage or congenital anomalies?
The risk of miscarriage has been detailed in case reports and a case-control study comparing incident SARS-CoV-2 infection in first trimester miscarriages with ongoing pregnancies. These studies have not demonstrated that COVID-19 infection is associated with a greater chance of miscarriage.
At this time, no data describing the risk of structural anomalies associated with infection in the first and second trimesters exist. There are mixed data regarding the risk of congenital malformations in the setting of maternal fever in general. Overall, at this time, data are insufficient to suggest an increased risk of congenital anomalies associated with SARS-CoV-2 infection early in pregnancy.
Vaccination is the best method to reduce maternal and fetal complications of SARS-CoV-2 infection. SMFM, ACOG and the CDC continue to recommend that pregnant, postpartum and lactating people and those considering pregnancy receive the COVID-19 vaccination and well as a booster when eligible. As with the primary vaccine series, the booster can be given at any stage during pregnancy and postpartum.
Updated COVID-19 Vaccine Boosters
The CDC recently updated vaccination guidance recommending that everyone 12 years and older receive an updated bivalent booster, as long as it has been at least two months since their last vaccine dose. Updated COVID-19 boosters can both help restore protection that has decreased since previous vaccination, and provide broader protection against newer variants. The bivalent boosters target the most recent Omicron subvariants, BA.5 and BA.5, which are more contagious and more resistant than earlier strains of Omicron. The Society for Maternal Fetal Medicine endorses current CDC recommendations with particular emphasis that all pregnant, recently pregnant, or lactating people receive a bivalent booster, to mitigate increased risk of adverse maternal, fetal, and obstetric outcomes of COVID-19 disease. Additionally, the bivalent booster should be given at any point in pregnancy. COVID-19 booster doses, along with the original series of vaccine doses, can be administered along with other vaccines.
At this time, people are considered up-to-date on their coronavirus vaccinations if they have received the original primary series – two doses of Pfizer, two doses of Moderna or one dose of Johnson & Johnson – plus the updated bivalent booster.
We welcome a new perinatologist to NJPA…
Stacey Gold, MD
Dr. Stacey Gold is one of our Maternal-Fetal Medicine Specialists at NJ Perinatal Associates. Dr. Gold received her B.S. from Northeastern University and graduated from Tufts University School of Medicine. She then completed residency training at Einstein Medical Center in Philadelphia and fellowship training in Maternal-Fetal Medicine at Medstar Washington Hospital Center in Washington, D.C. She is board-certified in Obstetrics & Gynecology.
Dr. Gold’s research interests include labor management, fetal impact of diabetes, hypertensive disorders in pregnancy, as well as obesity and nutrition. She also has an interest in resident education and simulation training. Her academic record includes peer-reviewed publications and presentations at national meetings.
In her free time, Dr. Gold enjoys baking, trying new restaurants, hiking and running.