High Blood Pressure In Pregnancy (gestational Hypertension)

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1. Pregnancy /
2. Pregnancy health

High blood pressure in pregnancy (gestational hypertension)Medically reviewed by Joseph Aquilina, Consultant obstetrician and gynaecologistWritten by Chess ThomasPhoto credit: Centers for Disease Control and Prevention (CDC) IN THIS ARTICLE

• What is gestational hypertension?
• Am I at risk of developing gestational hypertension?
• How will I know if I’ve got high blood pressure?
• Is gestational hypertension serious?
• How is gestational hypertension treated?
• Will gestational hypertension affect my baby’s birth?
• What will happen after my baby is born?
• Will I have gestational hypertension in my next pregnancy?

What is gestational hypertension?

Gestational hypertension is high blood pressure that occurs after you’re 20 weeks pregnant (Melvin and Funai 2019, NICE 2019a). If you had high blood pressure before 20 weeks, it’s likely that you had it before you were pregnant and that you’ll continue to have it after you’ve given birth (NICE 2019a). Your midwife will describe this kind of high blood pressure as chronic hypertension.

Am I at risk of developing gestational hypertension?

High blood pressure in pregnancy is fairly common, affecting around four mums-to-be in every 100 (NHS Digital 2019, NICE 2019b, Roberts et al 2011). Advertisement | page continues belowYou’re more likely to have high blood pressure when you’re pregnant if:

• This is your first pregnancy.
• You’re expecting twins or more.
• You’re of black ethnic origin.
• You were obese at the start of your pregnancy. 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.
• You had type 1 diabetes before you were pregnant.(NICE 2019b)

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

Your midwife will use a small monitor to take your blood pressure measurements at every antenatal appointment. The reading will consist of two figures that look like a fraction: for example, 110/70. The first, or top, number (110) records your blood pressure as your heart beats and pushes blood round your body. This is your systolic blood pressure. The second, or bottom, number (70) is your blood pressure when your heart relaxes between beats. This is your diastolic blood pressure. Your midwife will diagnose high blood pressure if your top figure (systolic) is 140 or higher, or your bottom figure (diastolic) is 90 or more (NICE 2019a).

Is gestational hypertension serious?

If you have gestational hypertension, you do have an increased chance of developing pre-eclampsia later on. This increases further if you have certain other risk factors, for example, if this is your first baby (NICE 2019a). You're also more likely to develop pre-eclampsia if your gestational hypertension started before 35 weeks (NICE 2019b).Pre-eclampsia is thought to happen when the placenta isn’t working properly. It reduces the flow of blood through the placenta, so it could affect how your baby grows.Advertisement | page continues below Just because your blood pressure is high, that doesn’t mean you have pre-eclampsia. Your doctor or midwife will diagnose pre-eclampsia if you have high blood pressure and at least one other symptom, such as protein in your urine (August 2020, NICE 2019a).The key thing with pre-eclampsia is to catch it early so that you and your baby can be monitored and treated if necessary. You may have very high blood pressure and feel absolutely fine. That’s why it’s important to go to all your antenatal appointments so your midwife can check your blood pressure each time (NHS 2018a). VIDEO

How is gestational hypertension treated?

Your midwife will offer you extra checks, depending on how high your blood pressure is and whether you have one or more of the following risk factors:

• it’s your first pregnancy
• you’re aged 40 or more
• it’s been 10 years since your last pregnancy
• you have a family history of pre-eclampsia, or you’ve had pre-eclampsia or high blood pressure in pregnancy before
• you’re carrying twins or more
• your BMI is 35 or more
• you already have vascular disease or kidney disease (NICE 2019a)

Your midwife will want to check your blood pressure once or twice a week from now on. She’ll also test your urine for protein at each visit. If your blood pressure remains above 140/90, you’ll be given medication to bring it down. You’ll also have a weekly blood test to check your blood count, liver and kidney function. She may also do a blood test to check whether hormones that help your placenta work are at healthy levels. Some women may have extra ultrasound scans too (NICE 2019a).Advertisement | page continues belowIf your high blood pressure is classed as severe, your doctor will admit you to hospital so it can be safely brought down with medication (NICE 2019a). Nurses will check your blood pressure at least four times a day. They’ll also give you urine and blood tests when you arrive.As well as extra ultrasound scans, you may also be offered fetal monitoring, to check that your baby is well (NICE 2019a). Once your blood pressure has fallen and you’re able to go home, your midwife will check your blood pressure and urine twice a week, and you’ll have a weekly blood test.It’s usually safe to carry on with most normal activities, but take care with strenuous or aerobic exercise, as this may increase your blood pressure (Melvin and Funai 2019). If your blood pressure goes up when you’re at work, it may be best to take time off (Melvin and Funai 2019). Talk to your midwife or doctor if you’re at all worried.

Will gestational hypertension affect my baby’s birth?

It’s possible to have gestational hypertension and have a straightforward birth. However, it can sometimes be a reason for having your baby sooner (NICE 2019a). This depends on how severe your hypertension is and whether your high blood pressure is affecting your baby (NICE 2019a). If your doctor thinks it’s safest for your baby to be born sooner, she may recommend that you have an induction or a caesarean section. Your specialist team will discuss your options for labour and birth with you, including: Advertisement | page continues below

• how gestational hypertension may affect your care
• how labour and birth may affect your blood pressure and any other medical conditions
• how gestational hypertension and its treatment may affect your baby(NICE 2019c)

High blood pressure needs frequent monitoring during labour. If your high blood pressure is mild or moderate, you could have it measured hourly (NHS 2018b). If it’s severe, it may need to be continuously monitored and you may need to be looked after in a high dependency unit (NHS 2018b). You may also have frequent blood tests.If you’re taking medication, you’ll need to carry on taking it during labour (NHS 2018b). Even so, it’s perfectly possible to aim for a straightforward birth, as long as your high blood pressure is well controlled during labour (NHS 2018b). If you develop severe high blood pressure during labour, your doctor may recommend that your baby is born as quickly as possible. So you may be offered an assisted birth, using ventouse or forceps, which attach to your baby's head (NICE 2019a). This can help to speed up the second stage of labour.

What will happen after my baby is born?

Your blood pressure will be monitored at least daily for the first two days after your baby’s birth (NICE 2019a). It will then be checked once between days three and five after the birth (NICE 2019a). It’s possible to develop pre-eclampsia or eclampsia after the birth, so these follow-up checks are really important (Bramshaw et al 2013).You may need to carry on taking medication to control your blood pressure (NICE 2019a). Or you may need to start taking medication after your baby’s born, even if you weren't taking medication during pregnancy (NICE 2019a). Advertisement | page continues belowYou can still breastfeed while taking medication for high blood pressure (NHS 2018b, NICE 2019a). However, if your baby was born before 37 weeks, he may be more likely to be affected by the medication. Let your doctor or midwife know if you want to breastfeed, so she can make sure your baby is monitored (Bramham et al 2013, NICE 2018a). If your blood pressure was normal before you became pregnant, it will most likely return to normal after your baby’s birth. How long it takes to return to normal, is usually similar to how long you were on medication during your pregnancy (Melvin and Funai 2019, NICE 2019a). Unfortunately, you’re more likely to develop high blood pressure in a future pregnancy, and later in life (Melvin and Funai 2019, NICE 2019a). This means that you have a higher risk of future cardiovascular problems (Bramshaw et al 2013, NICE 2019a). Although this may sound alarming, it will help you to know this, as you can make healthier lifestyle and diet choices now, that may make a difference later on. If your blood pressure carries on being high after your baby is born, it’s unlikely you had gestational hypertension. What you have is pre-existing chronic hypertension (Bramshaw et al 2013, Melvin and Funai 2019). If that’s the case, your doctor will probably advise you to keep taking medication to ensure your blood pressure stays at a healthy level. In most cases, your midwife will advise you about when you need to make an appointment with your GP to review your medication (NICE 2019a). If you need to carry on taking blood pressure medication after you've given birth, you should have a review with your GP or specialist two weeks after you go home with your baby, and again six to eight weeks after the birth (NICE 2019a). If you still need to take medication for high blood pressure six to eight weeks after the birth, your GP should refer you to a specialist for assessment (Bramham et al 2013, NICE 2019a).Advertisement | page continues belowEven if you don’t need to carry on taking blood pressure medication, you should have an appointment with your GP or specialist to review your condition, six to eight weeks after the birth (NICE 2019a).

Will I have gestational hypertension in my next pregnancy?

You are more likely to have gestational hypertension in future pregnancies, compared to women who haven't had high blood pressure in pregnancy (Melvin and Funai 2019, NICE 2019a). Up to one in seven women who've had it before will develop it again (NICE 2019a).Find out more about blood pressure in pregnancy.Was this article helpful?YesNo

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BabyCentre's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organisations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

August P. 2020. Management of hypertension in pregnant and postpartum women. UpToDate. www.uptodate.comOpens a new window [Accessed February 2020] Bramham K, Nelson-Piercy C, Brown MJ et al. 2013. Postpartum management of hypertension. BMJ 346: f894. www.bmj.comOpens a new window [Accessed February 2020] Melvin LM, Funai EF. 2019. Gestational hypertension. UpToDate. www.uptodate.comOpens a new window [Accessed February 2020] NHS Digital. 2019. NHS maternity statistics 2018-19: HES maternity statistics tables. NHS Maternity Statistics, England 2018-19. digital.nhs.ukOpens a new window [Accessed February 2020] NHS. 2018a. Pre-eclampsia. NHS, Health A-Z, Pregnancy and baby. www.nhs.ukOpens a new window [Accessed February 2020] NHS. 2018b. High blood pressure (hypertension) and pregnancy. NHS, Health A-Z, Pregnancy and baby. www.nhs.ukOpens a new window [Accessed February 2020] NICE. 2019a. Hypertension in pregnancy: diagnosis and management. National Institute for Health and Care Excellence, Guideline 133. www.nice.org.ukOpens a new window [Accessed February 2020] NICE. 2019b. Hypertension in pregnancy. National Institute for Health and Care Excellence, Clinical Knowledge Summaries. cks.nice.org.ukOpens a new window [Accessed February 2020] NICE. 2019c. Intrapartum care for women with existing medical conditions or obstetric complications and their babies. National Institute for Health and Care Excellence, Guideline 121. www.nice.org.ukOpens a new window [Accessed February 2020] Roberts CL, Ford JB, Algert CS, et al. 2011. Population-based trends in pregnancy hypertension and pre-eclampsia: an international comparative study. BMJ Open 1: e000101. bmjopen.bmj.comOpens a new window [Accessed February 2020] Chess Thomas

Chess Thomas is a freelance health writer and former research editor at BabyCentre.

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