What Is Hypertension In Pregnancy

Medication For High Blood Pressure In Pregnancy

High Blood Pressure (Hypertension) During Pregnancy With Dr. Sean Daneshmand | San Diego Health

There are several issues to keep in mind when considering medications for lowering your blood pressure while you are pregnant.

First, your blood pressure will probably be less than it would be if you werent pregnant.

Second, your blood pressure will be dropping rapidly if you are having a baby.

So, if your goal is to minimize the risk of having a baby living in your house or at risk of getting seriously ill, a medication that lowers your blood pressure during pregnancy may not be the best option for you. so its important to discuss them with your doctor before installing

Terms Used In This Guideline

Chronic hypertension

Hypertension that is present at the booking visit, or before 20 weeks, or if the woman is already taking antihypertensive medication when referred to maternity services. It can be primary or secondary in aetiology.


A convulsive condition associated with pre-eclampsia.

Gestational hypertension

New hypertension presenting after 20 weeks of pregnancy without significant proteinuria.

HELLP syndrome

Haemolysis, elevated liver enzymes and low platelet count.


Blood pressure of 140 mmHg systolic or higher, or 90 mmHg diastolic or higher.

Multi-fetal pregnancy

A pregnancy with more than 1 baby .


New onset of hypertension after 20 weeks of pregnancy and the coexistence of 1 or more of the following new-onset conditions:

  • other maternal organ dysfunction:

renal insufficiency

liver involvement (elevated transaminases [alanine aminotransferase or aspartate

aminotransferase over 40 IU/litre] with or without right upper quadrant or epigastric abdominal pain)

neurological complications such as eclampsia, altered mental status, blindness, stroke, clonus, severe headaches or persistent visual scotomata

haematological complications such as thrombocytopenia , disseminated intravascular coagulation or haemolysis

  • uteroplacental dysfunction such as fetal growth restriction, abnormal umbilical artery doppler waveform analysis, or stillbirth.
  • Severe hypertension

    Blood pressure over 160 mmHg systolic or over 110 mmHg diastolic.

    What Are The Symptoms Of Preeclampsia

    Possible symptoms of preeclampsia include:

    • High blood pressure
    • Too much protein in your urine
    • Swelling in your face and hands. Your feet may also swell, but many women have swollen feet during pregnancy. So swollen feet by themselves may not be a sign of a problem.
    • Headache that does not go away
    • Vision problems, including blurred vision or seeing spots
    • Pain in your upper right abdomen
    • Trouble breathing

    Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output. If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.

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    What Is High Blood Pressure During Pregnancy

    A small percentage of pregnant women in the U.S. have high blood pressure at some point during their pregnancy. Some cases are mild other cases are severe. Treatment varies depending on the type you have and how far along you are in your pregnancy.

    There are three main types of high blood pressure during pregnancy:

    In some cases, high blood pressure during pregnancy can cause harm to you and your baby.

    • You may develop gestational diabetes.
    • You may experience problems with your heart or kidneys. Youre also at greater risk for a stroke.
    • High blood pressure may prevent the placenta from getting enough blood. If the placenta doesnt get enough blood, your baby doesnt get enough oxygen and food. This can cause low birth weight and premature birth.
    • High blood pressure can lead to placental abruption. This is when the placenta becomes unattached to the uterus. This can be a life threatening situation to both you and your baby.

    What Are The Different Types Of High Blood Pressure In Pregnancy

    Gestational Hypertension (pregnancy induced hypertension)

    There are 3 types of high blood pressure in pregnancy.

  • Pre-existing hypertension or chronic hypertension this is when you already have high blood pressure before pregnancy or in the first 20 weeks. High blood pressure before 20 weeks of pregnancy is not caused by pregnancy because the placenta is not fully developed. Read more about pre-existing hypertension or chronic hypertension.
  • Pregnancy-induced hypertension or gestational hypertension this is high blood pressure that you develop after 20 weeks of pregnancy. Some women just develop high blood pressure and no other problems, but some develop a condition called pre-eclampsia, where other organs in your body are affected.
  • Pre-eclampsia this is a serious condition that only happens in pregnant women and develops after 20 weeks. The main feature is high blood pressure, but for a diagnosis of pre-eclampsia there must also be evidence that other organs are affected, such as protein in your urine. Your kidneys, liver, brain, placenta and blood clotting system are the organs most commonly involved. Women with pre-existing hypertension can also develop pre-eclampsia. Once you develop pre-eclampsia, you need to be watched closely, as pre-eclampsia doesnt go away until your baby is born and it can lead to eclampsia . Read more about pre-eclampsia.
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    Types Of High Blood Pressure In Pregnancy

    Even if you have not had high blood pressure before pregnancy, you can develop high blood pressure during pregnancy, called gestational hypertension. A blood pressure during pregnancy of 140/90 is considered high during pregnancy and a diagnosis of gestational hypertension is given. Severe high blood pressure in pregnancy is 160/110.

    Types of hypertension in pregnancy include:

    • Gestational Hypertension: High blood pressure that occurs during pregnancy, where high blood pressure was not chronic before the pregnancy began. This type of high blood pressure usually returns to normal soon after the baby is delivered.
    • Chronic Hypertension: If you have had high blood pressure before pregnancy, or before 20 weeks into your pregnancy, you most likely have chronic hypertension.
    • Chronic Hypertension with Superimposed Preeclampsia: High blood pressure that occurs during pregnancy can lead to preeclampsia however, if high blood pressure was present before pregnancy and preeclampsia happens during pregnancy, the diagnosis is chronic hypertension with superimposed preeclampsia.
    • Preeclampsia: If high blood pressure occurs after 20 weeks of pregnancy when no past chronic high blood pressure diagnosis has been given, and there is protein in urine and/or organs start to work improperly, preeclampsia is diagnosed.

    What Is Gestational Hypertension

    Gestational hypertension is a form of high blood pressure in pregnancy. It occurs in about 6 percent of all pregnancies. Another type of high blood pressure is chronic hypertension–high blood pressure that is present before pregnancy begins.

    Gestational hypertension can develop into preeclampsia. This condition occurs often in young women with a first pregnancy. It is more common in twin pregnancies, in women over the age of 35, in women with chronic hypertension or who had hypertension in a previous pregnancy, in African-American women, and in women with diabetes.

    Gestational hypertension is diagnosed when blood pressure readings are higher than 140/90 mm Hg in a woman who had normal blood pressure prior to 20 weeks and has no proteinuria .

    Preeclampsia is diagnosed when a woman with gestational hypertension also has increased protein in her urine.

    Eclampsia is a severe form of preeclampsia. Women with eclampsia have seizures resulting from the condition. Eclampsia occurs in about one in 1,600 pregnancies and develops near the end of pregnancy, in most cases.

    HELLP syndrome is a complication of severe preeclampsia or eclampsia. HELLP syndrome is a group of physical changes including the breakdown of red blood cells, changes in the liver, and low platelets .

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    Can High Blood Pressure During Pregnancy Be Prevented

    Since the cause of high blood pressure during pregnancy is not known, it is not a condition that can usually be prevented. In some women at high risk for developing high blood pressure, healthcare providers often recommend daily baby aspirin for prevention. High blood pressure during pregnancy can sometimes be managed and controlled with the help of a healthcare provider. However, this may often require delivery of the baby. Your blood pressure will be checked regularly during prenatal appointments. If you have any concerns about your blood pressure, speak with your healthcare provider.

    Meanings Of Study And Implications For Physicians And Health Providers

    Blood Pressure During Pregnancy

    The most recent UK Confidential Enquiry into Maternal and Child Health identified chronic disease as an underlying factor in preventable maternal deaths. Consequently, the first recommendation stated that Pre-pregnancy counselling services, . . . for women with pre-existing medical illnesses . . . are a key part of maternity services, supported by the National Institute for Health and Care Excellences guidelines for the management of hypertension in pregnancy. Furthermore, the American Congress of Obstetricians and Gynecologists recent practice bulletin recommends that women with chronic hypertension should be evaluated before conception to ascertain possible end-organ involvement. Systematic reviews and meta-analyses can provide data more readily inferable to the individual, but no large aggregate analysis of pregnancy outcome in women with chronic hypertension has previously been reported. This meta-analysis of outcomes can be used before pregnancy and antenatally by healthcare professionals advising women with chronic hypertension regarding possible adverse pregnancy events.

    Accessibility to healthcare professionals and facilitation of early referral will allow drug treatment to be optimised on an individual basis or enable reassurance regarding continuation of drugs that are safe in pregnancy, to reduce the risk of complications including cerebrovascular events.

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    How To Lower Elevated Blood Pressure

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    How Do They Treat Preeclampsia In Pregnancy

    Preeclampsia is dangerous and can develop gradually or come on quite suddenly. There are mild and severe forms of preeclampsia, depending on the severity of the signs and symptoms. The only cure for preeclampsia is delivery of the baby, and specifically the placenta. Women with severe preeclampsia are at higher risk for developing seizures known as eclampsia. These women usually receive magnesium sulfate during labor as well as 24 hours after delivery to decrease the chance of seizures.

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    What Are High Blood Pressure Complications During Pregnancy

    Complications from high blood pressure for the mother and infant can include the following:

    • For the mother:preeclampsiaexternal icon, eclampsiaexternal icon, stroke, the need for labor induction , and placental abruption .1,4,5
    • For the baby:preterm delivery and low birth weight .1,6 The mothers high blood pressure makes it more difficult for the baby to get enough oxygen and nutrients to grow, so the mother may have to deliver the baby early.

    Discuss blood pressure problems with your health care team before, during, and after pregnancy.

    Learn what to do if you have high blood pressure before, during, or after pregnancy.

    If You Are Already Taking Medicine For High Blood Pressure

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    If you’re already taking medicine to lower your blood pressure and want to try for a baby, talk to your GP or specialist first. They may want to switch you to a different medicine before you get pregnant.

    If you find out you’re already pregnant, tell your doctor immediately. They may need to change your medicine as soon as possible.

    This is because some medicines that treat high blood pressure may not be safe to take when you’re pregnant. They can reduce the blood flow to the placenta and your baby, or affect your baby in other ways.

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    How To Make Your Blood Pressure Go Down Fast

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    Tracking Blood Pressure During Pregnancy

    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 arteries when the heart is beating or squeezing blood forward through your body.

    The diastolic pressure, or the lower number, is a measurement of the blood pressure in your arteries when the heart is at rest.

    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 anything less than 120/80 mm Hg.

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    Why Is High Blood Pressure During Pregnancy A Problem

    The main risk of having high blood pressure during pregnancy is developing pre-eclampsia. Pre-eclampsia is a serious condition and it can affect both you and your baby. Read more about pre-eclampsia.

    If your blood pressure remains mildly to moderately raised and you dont develop pre-eclampsia, the risk of pregnancy complications is low. However, it is important that your blood pressure and urine are checked regularly throughout your pregnancy to check for signs of pre-eclampsia.

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    Treatments For High Blood Pressure

    Your doctor or midwife will check your blood pressure regularly. If you have high blood pressure, it is important to:

    If high blood pressure is caused by a medical condition such as kidney disease, its important to talk to your doctor about what medications are safe to take during pregnancy.

    Pre-eclampsia can be managed with medication and close monitoring of both you and the baby. However, it can become worse very quickly. If this happens, you may need to go to hospital or have the baby delivered early.

    Why Is Gestational Hypertension A Concern

    With high blood pressure, there is an increase in the resistance of blood vessels. This may hinder blood flow in many different organ systems in the expectant mother including the liver, kidneys, brain, uterus, and placenta.

    There are other problems that may develop as a result of severe gestational hypertension . Placental abruption may occur in some pregnancies. Gestational hypertension can also lead to fetal problems including intrauterine growth restriction and stillbirth.

    If untreated, severe gestational hypertension may cause dangerous seizures and even death in the mother and fetus. Because of these risks, it may be necessary for the baby to be delivered early, before 37 weeks gestation.

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