NEW ORLEANS -- Recent guidelines from the American Heart Association on the management of stroke risk in pregnant women differ significantly from guidelines issued by the (ACOG), maternal-fetal specialists said here.
Leaders of the Society for Maternal-Fetal Medicine (SMFM) were reluctant to openly criticize the American Heart Association (AHA), but president , told reporters at the SMFM meeting that the AHA guidelines appeared to be based on data that came out before were issued.
In the SMFM's official statement, leadership danced around the issue that the AHA guidelines could potentially put pregnant women with hypertension at serious risk through outdated methods of management.
The ACOG and AHA guidelines have "different diagnostic criteria for pre-eclampsia, differing recommendations for the use of low-dose aspirin for the prevention of pre-eclampsia and the threshold for initiating antihypertensive medications for pregnant patients with chronic hypertension," according to the statement.
The SMFM statement also noted disparity among guidelines for "treatment of acute-onset versus chronic hypertension during pregnancy."
Mercer confirmed that SMFM experts had not been consulted for the AHA guidelines.
He said SMFM will continue to evaluate the AHA guidelines. In addition, the society will work with other associations to address the discrepancies between the two guidelines.
"In the November ACOG statement, the criteria for diagnosis of pre-eclampsia, and recommendations for treatment of hypertension during pregnancy were established by a large multidisciplinary group. And [the AHA], as stated in their document, were using information published before that time, so they didn't have the benefit from this additional perspective," Mercer said.
"Education is key. When there's confusion in the literature, in research, you often see publications that come up with discrepant results or differing conclusions. We're going to work to help educate our providers and understand the issues so they can provide the best care to their patients," Mercer said.
Both AHA and ACOG guidelines are currently under close review by SMFM leaders, and Mercer commented that "I think we need to move forward and take advantage of both perspectives."
"We [SMFM and AHA] are aligned in the importance of that pre-exists for women coming into pregnancy -- for treating hypertension that occurs during pregnancy -- because untreated hypertension in pregnancy can have significant effects on pregnancy outcomes and long-term health," he added.
Mercer stressed that the management of "broad spectrum" hypertension in pregnancy requires a nuanced approach.
"It's hard to articulate in a guideline that nuanced approach. One issue that's important is to differentiate chronic, stable hypertension from hypertension that is changing acutely and ... hypertension that is severe. One needs to balance the importance of treating the mom and the potential beneficial and negative impacts ... on the unborn child," he said.
"The important aspect of treating with aspirin in pregnancy is to identify those women who have the best potential to benefit, because any treatments that one gives has the potential for side effects. It's important to have a nuanced approach," Mercer told MedPage Today.
As of today, the AHA had not commented on the SMFM statement.