Quality standard

Quality statement 8: Communicating information about future risks

Quality statement 8: Communicating information about future risks

Quality statement

Women who have had gestational hypertension or pre-eclampsia discuss future pregnancy and lifetime cardiovascular risks during a medical review at their 6- to 8-week postnatal medical check.

Rationale

The long-term risks for women who have had hypertension in pregnancy include developing high blood pressure and an increased lifetime cardiovascular risk. Increased awareness and surveillance may lead to earlier intervention, such as antihypertensive treatment, with likely benefits for the woman. Women should be made aware of risks in future pregnancies resulting from hypertension in a previous pregnancy.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements for all women who have had gestational hypertension or pre-eclampsia to have a discussion about future related risks during the medical review at their 6 to 8 week postnatal medical check.

Data source: Local data collection.

Process

The proportion of women who have had gestational hypertension or pre-eclampsia who have a discussion about future related risks during the medical review at their 6 to 8 week postnatal medical check.

Numerator – the number of women in the denominator who have a discussion about future related risks.

Denominator – the number of women who have had gestational hypertension or pre-eclampsia who have a medical review at their 6 to 8 week postnatal check.

Data source: Local data collection.

Source guidance

Hypertension in pregnancy: diagnosis and management. NICE guideline NG133 (2019), recommendations 1.4.16, 1.5.22, 1.10.1 and 1.10.2

What the quality statement means for different audiences

Service providers ensure that local arrangements are in place for all women who have had gestational hypertension or pre-eclampsia to have a discussion about future related risks during the medical review at their 6 to 8 week postnatal medical check.

Healthcare professionals discuss future related risks with all women who have had gestational hypertension or pre-eclampsia during the medical review at their 6 to 8 week postnatal medical check.

Commissioners ensure that they commission services that discuss future related risks with all women who have had gestational hypertension or pre-eclampsia during the medical review at their 6 to 8 week postnatal medical check.

Women who have had gestational hypertension (new high blood pressure starting after 20 weeks of pregnancy) or pre-eclampsia (a pregnancy-related rise in blood pressure with protein in the urine that happens in some pregnancies) have an appointment with their GP or specialist 6 to 8 weeks after they have had their baby, at which they discuss their risk of having problems with their blood pressure or pregnancies in the future.

Definitions of terms used in this quality statement

Gestational hypertension

New hypertension presenting after 20 weeks of pregnancy without significant proteinuria. [NICE's guideline on hypertension in pregnancy, terms used in this guideline]

Pre-eclampsia

New hypertension (over 140 mmHg systolic or over 90 mmHg diastolic) presenting after 20 weeks of pregnancy and the coexistence of 1 or more of the following new-onset conditions:

  • proteinuria (urine protein:creatinine ratio 30 mg/mmol or more, or albumin:creatinine ratio of 8 mg/mmol or more, or at least 1 g/litre [2+] on dipstick testing) or

  • other maternal organ dysfunction:

    • renal insufficiency (creatinine 90 micromol/litre or more, 1.02 mg/100 ml or more)

    • liver involvement (elevated transaminases [alanine aminotransferase or aspartate aminotransferase over 40 IU/litre] with or without right upper quadrant or epigastric abdominal pain)

    • neurological complications such as eclampsia, altered mental status, blindness, stroke, clonus, severe headaches or persistent visual scotomata

    • haematological complications such as thrombocytopenia (platelet count below 150,000/microlitre), disseminated intravascular coagulation or haemolysis

  • uteroplacental dysfunction such as fetal growth restriction, abnormal umbilical artery doppler waveform analysis, or stillbirth.

[NICE's guideline on hypertension in pregnancy, terms used in this guideline]

Future pregnancy and lifetime cardiovascular risk

Women who have had gestational hypertension or pre-eclampsia should be told that these conditions are associated with an increased risk of developing high blood pressure and its complications in later life.

Women who have had gestational hypertension should be told that the risk of developing:

  • gestational hypertension in a future pregnancy is approximately 1 in 7 (between 11% and 15%)

  • pre-eclampsia in a future pregnancy is approximately 1 in 14 (7%).

Women who have had pre-eclampsia should be told that the risk of developing:

  • gestational hypertension in a future pregnancy is up to 1 in 8 (between 6% and 12%)

  • pre-eclampsia in a future pregnancy is up to about 1 in 6 (16%)

  • pre-eclampsia in a future pregnancy is about 1 in 3 (33%) if their pre-eclampsia led to birth between 28 and 34 weeks.

[NICE's guideline on hypertension in pregnancy, recommendation 1.10.1 (table 5)]

Medical review

Women who have had gestational hypertension or pre-eclampsia should be offered a medical review by a GP or specialist at their postnatal check, which takes place 6 to 8 weeks after birth. [NICE's guideline on hypertension in pregnancy, recommendation 1.5.22]

Equality and diversity considerations

Where information is provided, there must be equal access to it for all women, including those with additional needs, such as physical or learning disabilities, and those who do not speak or read English. Women receiving information should have access to an interpreter or advocate if needed.

For women with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.