In the U.S., high blood pressure occurs in one out of every 12 to 17 pregnancies among women 20 to 44 years of age. Although the condition can lead to complications, you can still have a healthy pregnancy by keeping your blood pressure levels under control as much as possible. Knowing the different types of high blood pressure that occur during pregnancy will allow you to better understand your risks and treatment options.

What is chronic hypertension during pregnancy?

Chronic hypertension is high blood pressure that starts before pregnancy or during the first 20 weeks of pregnancy. It is the same medical condition that men and women who aren’t pregnant develop when their blood pressure levels are chronically elevated. Roughly 0.9% to 1.5% of pregnant women have chronic hypertension, according to the American College of Obstetricians and Gynecologists.

What causes chronic hypertension?

When chronic hypertension occurs on its own, doctors typically can’t identify a single cause. Genetics, environment and lifestyle usually play a role. You can also develop chronic hypertension due to other medical conditions, such as kidney disease, thyroid disease, diabetes or sleep apnea. Risk factors for chronic hypertension include:

  • Being overweight or obese
  • Lack of physical activity
  • Smoking
  • Diet high in salt
  • Drinking too much alcohol
  • Stress
  • Taking certain medications

What are the symptoms of chronic hypertension?

Normally, chronic hypertension doesn’t cause any symptoms unless blood pressure levels reach dangerously high levels. Pregnant women are usually diagnosed with hypertension after they experience elevated blood pressure readings during multiple prenatal appointments.

What are the risks of chronic hypertension?

When not properly controlled, chronic hypertension increases the risk of:

Additional risks of chronic hypertension during pregnancy include:

  • Preeclampsia
  • Preterm birth
  • Placental abruption, where the placenta separates from the uterus
  • Needing to undergo a C-section
  • Low birth weight because the fetus doesn’t receive enough blood through the placenta

What are the treatments for chronic hypertension?

In some cases, blood pressure levels naturally decrease during the first 20 weeks of pregnancy.

Doctors often wait to see if this occurs before treating the condition. However, if blood pressure levels are above 130/80 mm Hg, they may prescribe blood pressure medication.

In addition, pregnant women with chronic hypertension usually monitor their blood pressure at home daily and receive more ultrasound exams during the third trimester to track fetal growth.

It is important to note that if you were started on a blood pressure medication prior to pregnancy, check with your physician to ensure it is safe to continue using it throughout your pregnancy.

Will chronic hypertension go away after pregnancy?

Chronic hypertension is often a lifelong condition that persists after pregnancy. Normally, women closely monitor their blood pressure levels at home for one to two weeks and then visit their doctors to discuss ongoing treatment options that include healthy lifestyle changes and medication.

What is gestational hypertension?

Gestational hypertension is high blood pressure that develops after the first 20 weeks of pregnancy. Normally, doctors diagnose the condition when women had normal blood pressure before pregnancy and then begin to consistently show:

  • Systolic or top number blood pressure of 130 mm Hg or higher

and/or

  • Diastolic or bottom number blood pressure of 80 mm Hg or higher

Doctors may also use a urinalysis as part of diagnosing gestational hypertension. 

What causes gestational hypertension?

Research hasn’t determined why some women develop gestational hypertension. Risk factors for the condition include:

  • Having high blood pressure during a previous pregnancy
  • Kidney disease
  • Diabetes
  • Being younger than 20 or older than 40
  • Multiple pregnancies, such as being pregnant with twins or triplets

What are the symptoms of gestational hypertension?

Often, gestational hypertension doesn’t cause symptoms unless it worsens and develops into preeclampsia. Most of the time, women find out they have gestational hypertension because of ongoing blood pressure monitoring during doctor’s visits.

What are the risks of gestational hypertension?

Gestational hypertension can increase the risk of the following complications of pregnancy:

  • Placental abruption
  • Low birth weight
  • Stillbirth
  • Preterm delivery
  • Needing to undergo a C-section

If the condition worsens into preeclampsia, risks include seizures and even death of the mother and the baby. Fortunately, these risks greatly diminish when pregnant women receive ongoing care and monitoring.

Women who develop gestational hypertension may also be more likely to develop chronic hypertension and heart disease later in life. 

What are the treatments for gestational hypertension?

Women who have gestational hypertension usually receive enhanced monitoring, including:

  • Nonstress testing to check the heart of the fetus
  • Ultrasounds to check the development of the fetus
  • Doppler flow studies to monitor blood flow to the fetus
  • Urine testing

Doctors also usually ask pregnant women to monitor their blood pressure at home and to keep track of the number of kicks and movements they feel during the day.

Normally, doctors don’t prescribe blood pressure medications for gestational hypertension. If they believe a woman may need to deliver early due to high blood pressure, they may prescribe corticosteroids to help the baby’s lungs develop more quickly.

Will gestational hypertension go away after pregnancy?

Blood pressure often increases in the weeks following pregnancy, so doctors usually have women with gestational hypertension continue to monitor their levels at home. For most women, blood pressure levels gradually return to normal in the weeks and months after.  

Doctors may recommend that women with high blood pressure make changes to their diets and physical activity levels to decrease the risk of chronic hypertension. 

What is preeclampsia?

Preeclampsia is a serious pregnancy complication in which high blood pressure levels begin to damage organs, such as the kidneys. When it occurs between weeks 20 and 34, doctors refer to it as early-onset preeclampsia. The condition can also start after delivery.

What causes preeclampsia?

Research hasn’t determined why some women develop preeclampsia. Factors that put a woman at high risk for the condition include:

  • History of preeclampsia or high blood pressure in a previous pregnancy
  • Multiple pregnancies, such as twins or triplets
  • Chronic hypertension
  • Kidney disease
  • Diabetes
  • Autoimmune disease

More moderate risk factors for the condition include:

  • Being pregnant for the first time
  • Space of 10 years or more between pregnancies
  • Being obese
  • Family history of preeclampsia
  • Being over the age of 35
  • Getting pregnant through in vitro fertilization (IVF)  

What are the symptoms of preeclampsia?

Symptoms of preeclampsia include:

  • Swelling of the face or hands
  • Persistent headache
  • Seeing spots and blurred vision
  • Pain in the shoulder or upper abdomen
  • Nausea and vomiting after the first 20 weeks of pregnancy
  • Unexplained sudden weight gain
  • Trouble breathing

What are the risks of preeclampsia?

Complications of preeclampsia include:

  • Need for emergency induction
  • Needing to undergo a C-section
  • Seizure
  • Stroke
  • Death of the mother and the baby

Having preeclampsia during pregnancy also makes a woman more likely to develop the following conditions in the future:

  • Chronic hypertension
  • Kidney disease
  • Heart attack
  • Stroke

What are the treatments for preeclampsia?

Treatments for preeclampsia depend on how severe the condition is.

Preeclampsia with no severe signs or symptoms

Pregnant women with preeclampsia that aren’t showing any severe signs or symptoms usually monitor their blood pressure and the number of kicks their baby makes every day at home. Normally, they visit their doctors once or twice per week for monitoring.

Around 37 weeks, doctors usually order tests to assess how much the baby has grown and developed. These tests may include:

  • Nonstress testing to check the fetus’ heart
  • Ultrasounds to check the festus’ development
  • Doppler flow studies to monitor blood flow to the fetus

Doctors may also prescribe corticosteroids to help the baby’s lungs develop. Normally, doctors recommend induced labor. Women will usually receive an IV before and after pregnancy to help prevent seizures. If they experience any complications during labor, they may need to undergo a C-section.

Preeclampsia with severe signs or symptoms

Women who have severe signs or symptoms of preeclampsia usually need to be admitted to the hospital to stabilize their condition. If they are at least 34 weeks pregnant, doctors may induce labor as soon as they are stable. Women will receive an IV before and after delivery, and a C-section may be necessary if complications arise during labor.

When severe symptoms happen prior to 34 weeks, doctors may prescribe corticosteroids and closely monitor the woman’s condition. If at any time, they believe her life to be in danger, emergency induction or C-section may be necessary.

Will preeclampsia go away after pregnancy?

In rare cases, preeclampsia develops after pregnancy. This is called postpartum preeclampsia. Normally, it happens within 48 hours of childbirth but it can occur up to 6 weeks after childbirth. Doctors usually treat postpartum preeclampsia with blood pressure and anti-seizure medications.

For most women, preeclampsia resolves within 6 weeks after delivery. Doctors usually have new mothers track their blood pressure levels at home and continue with regular visits until the condition resolves. Once blood pressure levels return to normal, they may discuss lifestyle changes to reduce the risk of chronic hypertension.

How Forward can help you get high blood pressure under control

The U.S. Centers for Disease Control and Prevention (CDC) recommends that women with high blood pressure planning to become pregnant get hypertension under control prior to pregnancy.  Our 12-week, doctor-led Healthy Heart program can get you on the path to accomplishing your goal of lowering your blood pressure. It begins with comprehensive blood work to assess your risk factors and includes diet and exercise optimization. Throughout the program, we act as your primary care provider, giving you ongoing support and biometric monitoring to manage hypertension.

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