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High blood pressure in pregnancy (gestational hypertension)

In this article

What is gestational hypertension?

How will I know if I’ve got high blood pressure?

  • Mild hypertension is when your top figure is 140-9 and your bottom figure is 90-99. You won’t need treatment, but your midwife will want to check your blood pressure once a week from now on. She’ll also test your urine for protein at each visit.

  • Moderate hypertension is when your top figure is 150-9 and your bottom figure is 100-9. You’ll be given medication to bring it down and your midwife will test your blood pressure twice a week. She’ll also test your urine for protein at each visit, and you’ll have a blood test to check kidney function and your levels of minerals and salts.

  • Severe hypertension is when your top figure is 160 or greater and your bottom figure is 110 or greater. Your doctor will admit you to hospital until your blood pressure falls. You’ll be given medication to bring it down and while there, nurses will check your blood pressure at least four times a day. They’ll also give you a urine and blood test when you arrive, followed by daily urine tests and weekly blood tests. (NCCWCH 2010)
  • How common is high blood pressure in pregnancy?

    • You had diabetes before you were pregnant.

  • You had chronic high blood pressure before you were pregnant or problems caused by hypertension in a previous pregnancy.

  • You have chronic kidney disease or an autoimmune disease.

  • You were obese at the start of your pregnancy. (NCCWCH 2010) Your midwife will work out your body mass index (BMI) at your booking appointment. If it’s 35 or more, it increases your chance of developing high blood pressure.

  • This is your first pregnancy, particularly if you’re an older mum.

    Is high blood pressure in pregnancy serious?

    How is high blood pressure in pregnancy treated?

    • It’s your first pregnancy

  • It’s been 10 years since your last pregnancy

  • You’re carrying twins or more

  • Your BMI is 35 or more

  • You already have vascular disease or kidney disease (NCCWCH 2010)
  • You’ll have more frequent blood pressure checks, plus urine and blood tests. Some women with mild to moderate high blood pressure may have extra scans.

    High Blood Pressure During Pregnancy

    High blood pressure, or hypertension, is defined as blood pressure higher than 140/90 mm Hg. The condition is a serious concern for some pregnant women.

    High blood pressure during pregnancy isn’t always dangerous. But it can sometimes cause severe health complications for both mother and developing baby. According to the Centers for Disease Control and Prevention, an increasing number of pregnant women in the United States have this condition.

    According to the National Heart, Lung, and Blood Institute (NHLBI), there are several possible causes of high blood pressure during pregnancy.

    • Being overweight or obese
    • Failing to stay active
    • Smoking
    • Drinking alcohol
    • First-time pregnancy
    • A family history of pregnancy-related hypertension
    • Carrying more than one child
    • Age (over 40)
    • Assistive technology (such as IVF)

    Unhealthy lifestyle choices may lead to high blood pressure during pregnancy. Being overweight or obese, or not staying active, are major risk factors for high blood pressure.

    Women experiencing their first pregnancy are more likely to have high blood pressure. Fortunately, there’s a lower chance of this condition in subsequent pregnancies with the same partner.

    Women carrying multiples are more likely to develop hypertension, as their body is under additional stress.

    Maternal age is also a factor, with pregnant women over the age of 40 being more at risk.

    According to the American Society for Reproductive Medicine, using assistive technologies (such as IVF) during the conception process can increase chances of high blood pressure in a pregnant woman.

    Women who had high blood pressure before pregnancy are at higher risk for related complications during pregnancy than those with normal blood pressure.

    • Chronic hypertension: Sometimes a woman has pre-existing high blood pressure, or hypertension before she gets pregnant. This may be referred to as chronic hypertension, and is usually treated with blood pressure medication. Doctors also consider hypertension that occurs in the first 20 weeks of pregnancy to be chronic hypertension.
    • Gestational hypertension: Gestational hypertension develops after the 20th week of pregnancy. It usually resolves after delivery and the most common complication is induced labor. When diagnosed before 30 weeks, there’s a higher chance it will progress to preeclampsia (see below).
    • Chronic hypertension with superimposed preeclampsia: Another variation of chronic hypertension is when a woman has hypertension before she becomes pregnant, then also experiences protein in her urine or additional complications as her pregnancy progresses.

    A blood pressure reading is a fraction: your systolic blood pressure over your diastolic blood pressure.

    • The top number is your systolic pressure, which is a measurement of the pressure on your heart’s arteries when the heart is beating or squeezing blood forward through your body.
    • The diastolic or lower number is a measurement of the force of blood pressure in your heart when the heart is at rest.

    What is considered normal blood pressure during pregnancy?

    To determine what your “normal” blood pressure is during pregnancy, your doctor will likely take a baseline blood pressure measurement at your first visit. Then they will measure your blood pressure at every visit that follows.

    Normal blood pressure is usually somewhere close to 120/80 mm Hg.

    What is considered high blood pressure during pregnancy?

    A blood pressure that is greater than 140/90 mm Hg, or that is 15 degrees higher on the top number from where you started out before pregnancy, may be cause for concern.

    Early in pregnancy, usually from 5 weeks’ pregnant to the middle of the second trimester, a pregnant woman’s blood pressure may actually decrease. This is because pregnancy hormones can stimulate blood vessels to widen. As a result, the resistance to blood flow isn’t as high.

    What is considered low blood pressure during pregnancy?

    While there isn’t a definitive number that is too low, there are symptoms that are associated with low blood pressure:

    As a woman progresses in her pregnancy, her blood pressure may change or return to prepregnancy levels. Reasons for this may include the following.

    The amount of blood in a woman’s body increases. According to the journal Circulation, a woman’s blood volume increases by as much as 45 percent during pregnancy. This is an extra amount of blood that the heart must pump throughout the body.

    The left ventricle (left side of the heart that does a significant amount of pumping) becomes thicker and larger. This temporary effect allows the heart to work harder to support the increased blood volume.

    The kidneys release increased amounts of vasopressin, a hormone that leads to increased water retention.

    In most cases, high blood pressure during pregnancy will subside almost immediately after the baby is delivered. In cases where blood pressure remains elevated, your doctor may prescribe medication to get it back to normal.

    Tips for tracking blood pressure during pregnancy

    There are many ways that you can track your blood pressure during pregnancy. Try out the following ideas:

  • Purchase a blood pressure monitor from a pharmacy or online medical goods store. Many of these devices will go on your wrist or upper arm. To ensure that the monitor is accurate, take it to your doctor’s office and compare the readings on the monitor to those from your doctor.
  • Visit a grocery store, pharmacy, or other store that has a machine that takes blood pressure readings.
  • For the most accurate readings, take your blood pressure at the same time every day. Take it while seated with your legs uncrossed. Use the same arm each time.
  • Notify your doctor immediately if you have repeated high blood pressure readings that are four hours apart, or symptoms of high blood pressure.
  • If high blood pressure continues after 20 weeks of pregnancy, there can be complications. Preeclampsia can develop.

    What is preeclampsia?

    This condition can cause serious damage to your organs, including your brain and kidneys. Preeclampsia is also known as toxemia or pregnancy-induced hypertension. Preeclampsia with seizures becomes eclampsia. This can be fatal.

    Thorough prenatal care, including regular doctor’s visits, should be able to address preeclampsia symptoms. Symptoms include:

    • Protein in a urine sample
    • Abnormal swelling in hands and feet
    • Persistent headaches

    HELLP syndrome

    HELLP is an acronym that stands for hemolysis, elevated liver enzymes, and low platelet count. This condition is severe and life-threatening, and can be a complication of preeclampsia. Symptoms associated with HELLP include nausea, vomiting, headache, and upper abdominal pain. Because HELLP syndrome can severely damage organ systems vital to life, emergency medical care is aimed at reducing blood pressure for the health of the mother and the baby. In some cases, a premature delivery is required.

    High blood pressure during pregnancy can also have an effect on the baby’s growth rate. This can result in low birth weight. According to the American Congress of Obstetricians and Gynecologists, other complications include:

    • Placental abruption, a medical emergency during which the placenta detaches from the uterus prematurely
    • Preterm delivery, defined as delivery prior to 38 weeks of pregnancy
    • Caesarean delivery

    Common risk factors for high blood pressure, such as obesity and a history of high blood pressure, can be minimized through diet and exercise. Of course, during pregnancy, it is inevitable that you will gain some weight. It’s recommended that pregnant women consult with their doctor to identify a weight gain target that is healthy for them.

    Dietary guidelines for pregnant women vary from person to person. Speak with a nutritionist who will keep your specific height and weight in mind when creating a nutrition plan for you.

    The NHLBI emphasizes that it’s important to take steps to lessen your risk of high blood pressure. You should steer clear of smoking and drinking alcohol, both of which have been known to raise blood pressure.

    Pregnancy causes hormone shifts, as well as psychological and physical changes. This can bring on stress, which can make high blood pressure harder to manage. Try stress reduction techniques such as yoga and meditation.

    Some traditional blood pressure medications can cause problems in pregnant women.

    According to Mayo Clinic, these medications for lowering blood pressure should be avoided when you are pregnant:

    These drugs in particular will be passed through the bloodstream to the developing baby. They can negatively impact the baby’s health. These medications may also cause blood to thin, which can compromise the mother’s ability to carry the baby to term.

    Methyldopa and labetalol are both drugs that have been deemed safe for use to manage blood pressure during pregnancy.

    Talk to your doctor about how to control your blood pressure if you develop hypertension during pregnancy.

    High blood pressure during pregnancy doesn’t usually lead to serious problems. However, if it goes untreated, hypertension can become life-threatening for both mother and baby. Unfortunately, hypertensive disorders resulting from high blood pressure are the second-leading cause of U. S. maternal death during pregnancy.

    Always talk to your doctor about your concerns. Plan to stay on top of your prenatal care to have the healthiest pregnancy outcome possible.

    Take the time to understand the risk factors and possible causes of high blood pressure before you get pregnant — and take preventive measures to keep your blood pressure down during pregnancy.

    High Blood Pressure in Pregnancy

    Patient is a certified member of

    The Information Standard

    Dr Jacqueline Payne, 30 Oct 2017

    In this series

    In this article

    • Arrow-downWhat is high blood pressure?
    • Arrow-downWhat are the different types of high blood pressure in pregnancy?
    • Arrow-downHow common is high blood pressure during pregnancy?
    • Arrow-downWhat are the possible problems with high blood pressure during pregnancy?
    • Arrow-downHow do I know if I have high blood pressure whilst I am pregnant?
    • Arrow-downWhat is the treatment for high blood pressure in pregnancy?

    High Blood Pressure in Pregnancy

    In this article

    What is high blood pressure?

    If you have high blood pressure (hypertension), the pressure of the blood in your blood vessels (arteries) is too high. Blood pressure is recorded as two figures. For example, 140/85 mm Hg. This is said as “140 over 85”. Blood pressure is measured in millimetres of mercury (mm Hg). The first (or top) number is your systolic blood pressure. This is the pressure in your arteries when your heart contracts. The second (or bottom) number is your diastolic blood pressure. This is the pressure in your arteries when your heart rests between each heartbeat.

    Normal blood pressure is below 140/90 mm Hg. During pregnancy:

    • Mildly high blood pressure is blood pressure between 140/90 and 149/99 mm Hg (ie the systolic or upper number is between 140 and 149, and/or the lower or diastolic number is between 90 and 99).
    • Moderately high blood pressure is blood pressure between 150/100 and 159/109 mm Hg. (The systolic is between 150 and 159 and/or the diastolic is between 100 and 109.)
    • Severely high blood pressure is blood pressure of 160/110 mm Hg or higher. (The systolic is 160 or more, and/or the diastolic is 110 or more.)

    Our blood pressure goes up when we are anxious or stressed, such as when we have to rush. Some people find it stressful seeing a doctor or midwife. It is important to give yourself enough time for your antenatal appointments so that you can relax and your blood pressure is not higher than it normally would be. Your employer is obliged to give you adequate time off work to attend antenatal appointments. If your blood pressure is high when you attend the clinic but normal when, for example, your midwife takes your blood pressure at home, this is called “white coat” hypertension. See separate leaflet called Home and Ambulatory Blood Pressure Recording.

    What are the different types of high blood pressure in pregnancy?

    Pre-existing high blood pressure

    Some women already have high blood pressure (hypertension) Before they become pregnant and they may be on treatment for this. Some women are found to have high blood pressure Before they are 20 weeks pregnant. (If high blood pressure is first discovered before you are 20 weeks pregnant, this usually means that you had previously undetected high blood pressure before you were pregnant.)

    So, high blood pressure before 20 weeks of pregnancy is not caused by pregnancy but is pre-existing, or chronic, high blood pressure. There are various causes. See separate leaflet called High Blood Pressure (Hypertension).

    If you have pre-existing high blood pressure, you have an increased risk of developing pre-eclampsia during your pregnancy (see below).

    Note: if you are taking medicines to treat high blood pressure then, ideally, you should have this reviewed Before you become pregnant. Some medicines that are used to treat high blood pressure should not be taken during pregnancy – for example, medicines called:

    • Angiotensin-converting enzyme (ACE) inhibitors.
    • Angiotensin-II receptor antagonists (AIIRAs) – sometimes called angiotensin receptor blockers (ARBs).
    • ‘Water’ tablets (diuretics).

    This is because these medicines may harm a developing baby. If you are taking one of these medicines then it is very likely that your medicine will be changed to another medicine that is not known to harm a developing baby.

    Gestational high blood pressure

    Some women can develop New high blood pressure during their pregnancy. This is called gestational high blood pressure (or hypertension) or pregnancy-induced high blood pressure (or hypertension).

    Gestational high blood pressure is high blood pressure that develops for the first time after the 20th week of pregnancy. Doctors can confirm this type of high blood pressure if you do not go on to develop pre-eclampsia during your pregnancy (see below) And if your blood pressure has returned to normal within six weeks of giving birth. If you have gestational high blood pressure, you do not have protein in your urine when it is tested by your midwife or doctor during your pregnancy.

    Note: some women may be found to have new high blood pressure after 20 weeks of pregnancy. At first, they may not have any protein in their urine on testing. However, they may later develop protein in their urine and so be diagnosed with pre-eclampsia (see below). You are only said to have gestational hypertension if you Do not go on to develop pre-eclampsia during your pregnancy.

    Pre-eclampsia and eclampsia

    Pre-eclampsia is a condition that can affect some women who develop new high blood pressure after the 20th week of their pregnancy. Pre-eclampsia can also sometimes develop in women who have high blood pressure before they are pregnant (pre-existing high blood pressure) or in women who have protein in their urine before they are pregnant (for example, due to kidney problems).

    Pre-eclampsia not only causes high blood pressure; it also affects other parts of your body such as your kidneys, liver, brain and blood clotting system. Pre-eclampsia causes protein to leak from your kidneys into your urine. If you have pre-eclampsia, you will have high blood pressure and protein will be found in your urine when it is tested. Pre-eclampsia gets better within six weeks of you giving birth.

    Eclampsia can be a complication of pre-eclampsia. In eclampsia, a woman with pre-eclampsia has one or more fits (seizures or convulsions). This is a serious condition. The aim is to detect and treat pre-eclampsia successfully to try to prevent eclampsia from developing.

    How common is high blood pressure during pregnancy?

    High blood pressure (hypertension) during pregnancy is quite a common problem.

    • About 1 in 10 pregnant women have problems with high blood pressure.
    • Up to 3 in 100 pregnant women have pre-existing high blood pressure.
    • About 4 to 8 in 100 pregnant women have gestational high blood pressure and do not go on to develop pre-eclampsia.
    • Between 2 and 8 in 100 pregnant women develop pre-eclampsia.
    • For every 100 women who have already developed pre-eclampsia in one pregnancy, 16 will develop it again in a future pregnancy. Up to half of these women will develop gestational hypertension in a future pregnancy.

    Problems with new high blood pressure are more common during your first pregnancy.

    What are the possible problems with high blood pressure during pregnancy?

    As a rule, the higher your blood pressure, the greater the risk for you and your baby.

    Mild-to-moderate high blood pressure

    If your blood pressure remains mildly to moderately raised and you do not develop pre-eclampsia then the risk is low. Most women with high blood pressure (hypertension) during pregnancy just have mildly or moderately raised blood pressure. However, it is important that your blood pressure and urine should be checked regularly throughout your pregnancy and that you look out for any signs of possible pre-eclampsia (see below).

    Severe high blood pressure or pre-eclampsia

    Severe high blood pressure, especially with pre-eclampsia, is serious.

    • The risks to you as the mother include:
      • An increased chance of having a stroke.
      • Damage to your kidneys and liver.
      • An increased risk of blood clotting problems.
      • An increased risk of severe bleeding from your placenta.
      • Having fits (seizures) if you go on to develop eclampsia.
    • The risks to your baby include:
      • An increased chance of poor growth.
      • An increased chance of premature birth.
      • An increased chance of stillbirth.

    How do I know if I have high blood pressure whilst I am pregnant?

    Many women with high blood pressure (hypertension) during their pregnancy do not have any symptoms. This is why your blood pressure is checked regularly by your doctor or midwife during your pregnancy. Your urine is also tested regularly for protein, to look for possible pre-eclampsia.

    However, there are some symptoms that you should look out for that could be signs of pre-eclampsia. If you develop any of these, you should see your doctor or midwife Urgently so that they can check your blood pressure and test your urine for protein. They include:

    • Severe headaches that do not go away.
    • Problems with your vision, such as blurred vision, flashing lights or spots in front of your eyes.
    • Tummy (abdominal) pain. The pain that occurs with pre-eclampsia tends to be mainly in the upper part of the abdomen, just below your ribs, especially on your right side.
    • Vomiting later in your pregnancy (not the morning sickness of early pregnancy).
    • Sudden swelling or puffiness of your hands, face or feet.
    • Feeling out of breath.
    • Not being able to feel your baby move as much.
    • Just not feeling right.

    Note: swelling or puffiness of your feet, face, or hands (oedema) is common in normal pregnancy. Most women with this symptom do not have pre-eclampsia but it can become worse in pre-eclampsia. Therefore, report any sudden worsening of swelling of the hands, face or feet promptly to your doctor or midwife.

    What is the treatment for high blood pressure in pregnancy?

    If your doctor or midwife finds that your blood pressure is high during your pregnancy, they will usually check to see if you have any protein in your urine and ask you if you have any symptoms of pre-eclampsia. If your blood pressure remains high, or if you have any signs of pre-eclampsia, you will usually be seen by a specialist (an obstetrician). In order to advise on treatment, there are various questions that need to be considered by the specialist, such as:

    • How severe is your high blood pressure (hypertension)?
    • Is there pre-eclampsia and, if so, how severe is it?
    • How far on is your pregnancy?
    • What are the risks to you, the mother, and your baby? This will depend on the severity of your high blood pressure and whether or not pre-eclampsia is present.

    If high blood pressure remains mild and pre-eclampsia does not develop

    There is usually little risk. Regular checks of your blood pressure and your urine for protein, as well as checks to see how your pregnancy is progressing, may be all that is needed until the natural time of birth. Checks may include blood tests and an ultrasound scan to look at how your baby is growing and to check the blood flow from the afterbirth (placenta) to the baby. You may be followed up by an obstetrician. You may need medicines to control your blood pressure during your pregnancy.

    If high blood pressure becomes severe, or if pre-eclampsia develops

    There are risks to both you, as the mother, and to your baby if high blood pressure becomes more severe, especially if you develop pre-eclampsia. You will usually be seen urgently by a specialist and you may be admitted to hospital. Blood tests may be suggested to check to see how much your blood pressure or pre-eclampsia is affecting you. The well-being of your baby may also be checked using ultrasound scanning. A recording of your baby’s heart rate may be carried out.

    For severe high blood pressure, especially if pre-eclampsia develops, there is often a dilemma. If the high blood pressure is caused by the pregnancy, the only cure is to deliver your baby. This may be fine if your pregnancy is near to the end. The birth can be induced, or your baby can be born by caesarean section if necessary. However, a difficult decision may have to be made if high blood pressure or pre-eclampsia becomes severe earlier in your pregnancy.

    Medicine to lower the blood pressure may be prescribed for a while. The most commonly used medicine is labetalol. This may allow your pregnancy to progress further before delivering your baby. The best time to induce the birth (or deliver by caesarean section) varies depending on the factors mentioned above.

    If you have severe pre-eclampsia, the medicine magnesium sulfate may be given via a drip around the time that your baby is delivered. This may reduce your chance of developing eclampsia and prevent you having fits (seizures).

    There is some evidence to suggest that regular low-dose aspirin and calcium supplements may help to prevent pre-eclampsia in some women who may be at increased risk of developing it. Your specialist may recommend you take one or both of these. They will be able to discuss this with you in more detail.

    Pre-eclampsia, Eclampsia and HELLP Syndrome

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