Management of Hypertension in the Obese Pregnant Patient

To evaluate recent developments in the management of hypertension in obese pregnant women.

The mainstay of management targets prevention of hypertension with preconception counselling, entering pregnancy with a lower BMI, limiting weight gain, and taking low-dose aspirin to prevent pre-eclampsia from before 16 weeks' gestation. There are conflicting results regarding the use of metformin in reducing hypertensive disease, but there is a high probability that it has a role to play. Clinical trials are in progress examining the use of statins in preventing pre-eclampsia, with promising results from pre-clinical trials. Home blood pressure monitoring may be helpful in diagnosing and monitoring the control of hypertension. The most protective interventions against hypertensive disease in obese pregnant women are entering pregnancy at a lower BMI, avoiding inter-pregnancy weight gain, and taking low-dose aspirin during pregnancy. Further research is needed around the use of metformin, statins, and home blood pressure monitoring.