Hypertensive Disorders of Pregnancy

Different types of hypertension during pregnancy include: 

• Chronic hypertension: High blood pressure that happens before you became pregnant and continues during the pregnancy. Hypertension that develops before the 20th week of pregnancy and continues during the pregnancy is also called chronic hypertension. If you have chronic hypertension, it will not go away after you have your baby. You will need follow-up visits with your health care provider and your doctor may want you to keep taking medicine to lower your blood pressure. Gestational hypertension: High blood pressure that develops after the 20th week of pregnancy.
• Gestational hypertension: usually goes away after you have your baby, but your health care provider will need to monitor your blood pressure to make sure that it is getting better.
• Preeclampsia: High blood pressure that develops after the 20th week of pregnancy and is usually paired with protein in your urine. This disorder can cause serious complications for you and your baby during pregnancy and can also cause complications for you after delivery.
• Postpartum hypertension: Blood pressure that remains higher than normal after childbirth. You may not know that you have postpartum hypertension unless your blood pressure is checked regularly. In most cases, postpartum hypertension occurs within 48 hours after childbirth and will go away on its own, but this can take up to twelve weeks after delivery and may require treatment. Women with postpartum hypertension are at risk for a stroke or seizure so treatment and follow up are important to prevent serious complications.

How does this affect me? 

Women with hypertension during or after pregnancy are at risk for a stroke or seizure so treatment and follow up are important to prevent serious complications. Women who have hypertension during pregnancy have a greater chance of developing hypertension later in life or during future pregnancies. In some cases, hypertension during pregnancy can cause serious complications, such as:

• Stroke
• Heart attack 
• Injury to other organs, such as kidneys, lungs, or liver 
• Preeclampsia
• Convulsions or seizures
• Placental abruption

How does this affect my baby?

Hypertension during pregnancy can affect your baby. Your baby may: 

• Be born early (prematurely)
• Not weigh as much as he or she should at birth (low birth weight)
• Not tolerate labor well, leading to an unplanned cesarean delivery

What are the risks? 

There are certain factors that make it more likely for you to develop hypertension during pregnancy. These include:

• Having hypertension that existed before pregnancy or during a previous pregnancy, such as chronic hypertension, gestational hypertension, or preeclampsia/eclampsia.
• Being overweight
• Being age 35 or older 
• Being pregnant for the first time 
• Being pregnant with more than one baby 
• Becoming pregnant using fertilization methods, such as IVF (in vitro fertilization) 
• Having other medical problems, such as diabetes, kidney disease, hyperthyroidism, or lupus
• Having a family history of hypertension

What can I do to lower my risk?

The exact cause of hypertension during pregnancy is not known. You may be able to lower your risk by:

• Maintaining a healthy weight
• Eating a healthy and balanced diet
• Following your health care provider's instructions about treating any long-term conditions that you had before becoming pregnant

It is very important to keep all your prenatal care appointments. Your health care provider will check your blood pressure and make sure that your pregnancy is progressing as expected. If a problem is found, early treatment can prevent complications.

Signs and symptoms: 

With any type of hypertension, you may or may not have symptoms. Depending on how high your blood pressure is, you may experience:

• Headaches: This is the most common symptom. May be mild, moderate, or severe. May be steady, constant, or sudden in onset (thunderclap headache). Generally, do not go away with medication
• Elevated blood pressure/BP higher than 160/110 (It is helpful to have a working blood pressure cuff at home to check your blood pressure from time to time or when symptoms present)
• Changes in your ability to see (visual changes)
• Right upper abdominal pain or pain where your liver is
• Dizziness or lightheadedness • Shortness of breath or difficulty breathing when lying down
• Heart palpitations or a racing heartbeat
• Chest pain
• Swelling of your hands, feet, lower legs, and/or face
• Decrease in the amount of urine that you pass
• Seizures

How is hypertension diagnosed?

Hypertension, including type of hypertension, may be diagnosed based on the results of a physical exam, blood pressure measurements, and blood and urine tests.

How is hypertension treated?

Treatment for hypertension during or after pregnancy varies depending on the type of hypertension you have and how serious it is.

• If you were taking medicine for high blood pressure before you became pregnant, talk with your health care provider. You may need to change medicine during pregnancy because some medicines may not be considered safe for your baby or when breastfeeding. 
• If you have hypertension during or after pregnancy, your health care provider may order medicine to reduce your blood pressure (antihypertensives). 
• If you are at risk for preeclampsia, your health care provider may recommend that you take a low-dose aspirin during your pregnancy. 
• If you have severe hypertension, you may need to be hospitalized so you and your baby can be monitored closely. You may also need to be given medicine to lower your blood pressure. This medicine may be given by mouth or through an IV. 
• In some cases, if your condition gets worse, you may need to deliver your baby early.
• Hypertension caused by other medical conditions may require that condition to be treated.
• Complications of hypertension, such as seizures, stroke, or kidney problems, may also require treatment.

Your health care provider will also continue to monitor your blood pressure closely until it stays within a safe range for you.

Follow these general instructions at home:

• Avoid caffeine
• Drink enough fluid to keep your urine pale yellow
• Do not use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and/or chewing tobacco; if you need help quitting, ask your health care provider
• Do not use alcohol or drugs
• Avoid stress as much as possible
• Rest and get plenty of sleep
• Regular exercise can help to reduce your blood pressure; ask your health care provider what kinds of exercise are best for you and when you can return to your normal activities
• Take over-the-counter and prescription medicines only as told by your health care provider. Many patients are sent home on one or more blood pressure medications to help treat hypertension. Take your medication as prescribed until directed by your provider to change the dose. The plan to wean these medications will be discussed when you meet with your health care provider.
• Keep all prenatal and follow-up visits as told by your health care provider. Most patients will need to see their provider 1-2 weeks after discharge from the hospital for a blood pressure check. Please call to set up an appointment once you return home.

When to get help:

Contact a health care provider if you have: 

• Worsening symptoms
• Blood pressures at home that are greater than 160/110 despite taking prescribed medications (antihypertensives)
• A severe headache that does not get better with rest and/or medication
• Blurred or double vision (visual changes)
• Severe pain in your abdomen
• Vomiting that does not get better
• Sudden, rapid weight gain
• Sudden swelling in your hands, ankles, or face 
• Dizziness or light-headedness
• Vaginal bleeding
• Blood in your urine
• If you are pregnant and your baby is not moving as much as usual

 If unable to contact your physician go to the nearest hospital for evaluation.

Call Emergency Services (911) right away if you have:

• The worst headache of your life
• Difficulty breathing or severe chest pain
• Seizure(s)
• Weakness on one side of your body
• Difficulty speaking 
• Heart palpitations or a racing heartbeat

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms go away. Get medical help right away. Do not drive yourself to the hospital.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your physician.