Most women expect their pregnancy to come with morning sickness, strange food cravings and plenty of prenatal appointments. High blood pressure, or hypertension, is often not included on that list.
One reason why a diagnosis of high blood pressure during pregnancy can feel so concerning is that it doesn't always cause obvious symptoms. You may feel completely fine and still hear your OBGYN express concern after a routine blood pressure check. Suddenly, terms like hypertension, gestational hypertension or preeclampsia are being mentioned and you’re wondering what they mean for you and your baby.
High blood pressure during pregnancy is more common than you may think. According to the Centers for Disease Control and Prevention (CDC), hypertensive disorders of pregnancy affect roughly 1 in every 12 to 17 pregnancies among women ages 20 to 44 in the United States.
Let’s walk through what high blood pressure during pregnancy means, the warning signs to take seriously, how gestational hypertension can affect your baby and what you can do right now to support a healthy pregnancy.
Blood pressure is the force your blood puts on the walls of your arteries as it moves through your body. During pregnancy, your body is doing an enormous amount of extra work. It’s pumping more blood, building new tissue and supporting a growing baby.
For most women, your blood pressure can dip a little in the first and second trimesters before returning to its normal range by the third trimester. In some cases, when it does the opposite and climbs too high, your care team pays close attention. Unmanaged high blood pressure can increase your risk of stroke, organ damage and other serious complications if it progresses to severe preeclampsia or eclampsia.
There are a few different forms that pregnancy hypertension can take:
Chronic hypertension refers to high blood pressure that existed before you became pregnant or that is diagnosed before your 20th week of pregnancy. This isn't caused by pregnancy itself, though it does require careful management during it.
Gestational hypertension develops after the 20th week of pregnancy in women who had normal blood pressure before. It typically resolves after delivery, but it still requires monitoring because it can develop into a more serious form.
Preeclampsia is a more serious form of hypertension in pregnancy, typically occurring after 20 weeks. It involves elevated blood pressure along with signs that other organs, such as the kidneys or liver, are being affected. Preeclampsia requires prompt attention and close management by your medical team. Left untreated, preeclampsia can become dangerous for both you and your baby.
Related: Eclampsia vs. preeclampsia: What you need to know for your pregnancy journey
Your blood pressure is recorded as two numbers, systolic and diastolic. The top number (systolic) measures the pressure when your heart beats. The bottom number (diastolic) measures the pressure when your heart rests between beats. A reading of 120/80 mm Hg or below is considered normal.
Here is a simple breakdown of what the numbers mean during pregnancy:
A reading at or above 140/90 mm Hg is the threshold that meets the clinical definition of high blood pressure in pregnancy, according to the American College of Obstetricians and Gynecologists (ACOG). If your home blood pressure readings are repeatedly elevated or you record a reading of 140/90 mm Hg or higher, contact your OBGYN for guidance. Do not wait until your next scheduled visit.
One of the first concerns you may have after learning you have high blood pressure during pregnancy is whether it could affect your baby's health. If left unmanaged, it can.
High blood pressure can affect how well the placenta delivers oxygen and nutrients to your growing baby. When blood flow through the placenta is reduced, your baby may not grow as expected during pregnancy.
Depending on the severity, high blood pressure can also increase the risk of preterm birth. In some instances, delivery may be recommended earlier than planned if continuing the pregnancy becomes riskier for you or your baby than delivering.
More serious complications, such as placental abruption, can also occur. This happens when the placenta partially or completely separates from the wall of the uterus before delivery, which can be dangerous for both you and your baby.
While these risks sound concerning, it's important to remember that most women with well-managed high blood pressure go on to have healthy pregnancies and healthy babies.
Related: A letter to every new mom about your heart—from the Baylor Scott & White cardio-obstetrics team
There are certain factors that increase your likelihood of developing high blood pressure during pregnancy. Having one or more risk factors doesn't mean you'll develop high blood pressure during pregnancy, but it does help your provider determine whether closer monitoring may be necessary. Risk factors to be aware of include:
If several of these apply to you, be open about your history at the start of your prenatal care. Your OBGYN can put additional screenings in place early, connect you with a cardio-obstetrics team and continue to monitor you as your pregnancy progresses.
Pregnancy is a natural stress test on a woman's body and these conditions during pregnancy can impact your long-term cardiovascular health. Women who have gestational hypertension or preeclampsia are more likely to develop chronic hypertension and are at an increased risk for heart disease, making it even more important to identify and treat women at risk.
Most pregnancy symptoms are normal and expected. However, certain symptoms deserve prompt medical attention, especially during the second half of your pregnancy.
Contact your provider right away if you experience any of the following, which can be signs of high blood pressure during pregnancy:
Trust your instincts. If something feels off, make the call. Your care team would always rather hear from you than have you wait.
While you can't control every risk factor of high blood pressure during your pregnancy, there are things you can do to improve your chances of keeping your blood pressure in a healthy range.
Routine prenatal visits do more than check your baby's growth. Every blood pressure reading builds a picture over time, which gives your OBGYN a full view to catch any upward trends early. Even if you feel completely fine, don't skip or postpone visits.
Exercise during pregnancy has been shown to reduce the risk of gestational hypertension and preeclampsia by approximately 30%, according to the American Heart Association. You don't need intense workouts. A 30-minute walk five days a week, prenatal yoga or swimming are all good exercise options. The goal is steady movement, not performance.
There is no single pregnancy diet that works for everyone, but what you eat during pregnancy can support healthy blood pressure. Consuming plenty of fruits, vegetables, whole grains and lean proteins while limiting heavily processed and high-sodium foods gives your cardiovascular system less to work against. Be sure to keep an eye on your sodium (salt) intake. For some people, excess salt can cause your body to retain fluid and raise your blood pressure.
Home blood pressure monitoring is an easy thing you can do between prenatal visits, especially if you are at higher risk. Invest in a validated upper-arm cuff (wrist monitors can be less accurate), take readings at the same time each day, and log them. Bring that log to each appointment to share with your OBGYN.
Stress doesn't directly cause preeclampsia, but chronic stress does affect your cardiovascular system over time. When stress gets to be too much or you’re feeling overwhelmed, find something that helps lower your stress level. That could be meditation, a phone call with a friend, a slow walk or an afternoon nap. Make sleep a priority and don't hesitate to ask for help at home when you need it.
Manage each trimester of your pregnancy with our virtual pregnancy program through MyBSWHealth.
Finding out your blood pressure is elevated during pregnancy can be unsettling, but rest assured that millions of women manage high blood pressure while pregnant every year and deliver healthy babies.
Consistent care is one of the most powerful things you can do throughout your pregnancy. Regular prenatal visits allow your care team to identify changes, such as high blood pressure, early and intervene when needed.
Stay in control of your prenatal health today with our maternity care.
Anandita Kulkarni, MD, is a cardiologist on the medical staff of Baylor Scott and White The Heart Group - Frisco. Her clinical expertise lies in the management of complex lipid disorders, women’s cardiovascular health, South Asian cardiovascular health and cardiac imaging.
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