Recommendations for Treatment of Hypertension in Pregnancy References that support recommendations are summarized in Online Data Supplement 53. COR LOE Recommendations I C-LD 1. Women with hypertension who become pregnant, or are planning to become pregnant, should be transitioned to methyldopa, nifedipine, and/or labetalolS10.2.2-1 III: Harm C-LD 2. Women with hypertension who become pregnant should not be treated with ACE inhibitors, ARBs, or direct renin Synopsis BP usually declines during the first trimester of pregnancy and then slowly rises. Hypertension management during pregnancy includes 4 general areas: 1) the newly pregnant mother with existing hypertension; 2) incident hyperten- sion; 3) preeclampsia (a dangerous form of hypertension with proteinuria that has the potential to result in serious adverse consequences for the mother [stroke, HF] and fetus [small for gestational age, premature birth]); and 4) severe hypertension, often in the setting of preeclampsia, requir- ing urgent treatment to prevent HF, stroke, and adverse fetal outcomes. Hypertension during pregnancy and preeclamp- sia are recognized as risk factors for future hypertension BP management during pregnancy is complicated by the fact that many commonly used antihy- pertensive agents, including ACE inhibitors and ARBs, are contraindicated during pregnancy because of potential harm to the fetus.S10.2.2-2,S10.2.2-3 The goal of antihypertensive treat- ment during pregnancy includes prevention of severe hyper- tension and the possibility of prolonging gestation to allow the fetus more time to mature before delivery. There are 3 Cochrane database reviews of treatment for mild-to-moderate hypertension during pregnancy.S10.2.2-10 S10.2.2-12 With regard to the treatment of mild-to-moderate hyperten- sion (SBP of 140 169 or DBP of 90 109 mm Hg), anti- hypertensive treatment reduces the risk of progression to severe hypertension by 50% compared with placebo but has not been shown to prevent preeclampsia, preterm birth, small for gestational age, or infant mortality. 