What is Gestational Hypertension? Risks, Symptoms and Management

Gestational hypertension is when your blood pressure is 140/90 mmHg or higher in pregnancy. High blood pressure might not cause noticeable symptoms, but untreated, it can decrease blood flow to the placenta and affect your baby’s growth. It can also lead to severe health complications for you.

We spoke with maternal-fetal-medicine specialist Dr. Malavika Prabhu about why gestational hypertension can be so dangerous in pregnancy. She also explains why your blood pressure needs to be monitored closely to keep you and your baby healthy.

What is Gestational Hypertension?

Several types of high blood pressure conditions can affect your pregnancy. Gestational hypertension means you have high blood pressure only while pregnant. It usually occurs without protein in the urine, and it happens after week 20 of pregnancy.

Other types of blood pressure issues include:

• Chronic hypertension: High blood pressure before pregnancy or before week 20 of pregnancy.
• Preeclampsia: Involves high blood pressure and tests reveal protein in the urine. Gestational hypertension can lead to preeclampsia. Preeclampsia can develop into eclampsia which means you can have seizures. It’s a life-threatening condition that can affect both you and your baby.

You may have also heard of HELLP syndrome, which is also a serious pregnancy complication. While preeclampsia involves elevated blood pressure and protein in the urine, people with HELLP syndrome rarely have these signs. The Preeclampsia Foundation refers to HELLP syndrome as a variant of preeclampsia.

Who Is At Risk of Gestational Hypertension?

Healthcare providers aren’t sure why some people can have gestational hypertension. But some factors put people at an increased risk for it including:

• Being under age 20 or over age 40
• High blood pressure or preeclampsia in a previous pregnancy
• Having a family member who had gestational hypertension
• Having diabetes or gestational diabetes
• History of an immune condition such as lupus
• Having kidney disease
• Being pregnant with multiples
• Being Black

What Complications Can Happen with Gestational Hypertension?

“Gestational hypertension increases risks of adverse maternal outcomes, such as seizure, stroke or other organ injury, and can also compromise the health of the developing fetus,” says Dr. Alexander.

You can have complications from gestational hypertension including:

• Preeclampsia: This is a serious condition that can develop from gestational hypertension and involve other organ problems.
• Placental abruption: High blood pressure can increase the risk of the placenta detaching prematurely.
• An increased risk of stroke: Gestational hypertension can raise the risk of some pregnancy-related complications that can affect the brain, but the direct risk of stroke is lower.
• Eclampsia (seizures): This is a rare but serious complication of preeclampsia, not gestational hypertension itself. However, gestational hypertension can increase your risk of developing preeclampsia, which then carries the risk of eclampsia.

High blood pressure during pregnancy affects your body differently than if you weren’t pregnant. The increased blood pressure causes stress on the body. High blood pressure can cause concerns with the placenta and your baby might not get the nutrients they need to grow.

Some things that can happen to your baby when you have gestational hypertension include:

• Low birth weight, which means your baby weighs 5 pounds, 8 oz or less when they’re born
• Being born before 37 weeks
• Stillbirth
• Being induced before 39 weeks

Most people diagnosed early and treated appropriately will have a healthy baby. Gestational hypertension usually goes away after you deliver the baby, but some people are at risk of future blood pressure problems.

What Are the Symptoms of Gestational Hypertension?

The main sign of gestational hypertension is elevated blood pressure. This is a blood pressure of 140/90 or higher. Severe gestational hypertension is blood pressure over 160/110. This can increase your chances of life-threatening complications.

But many people may not have any symptoms. High blood pressure can lead to other concerns, such as preeclampsia, and it’s important to watch out for symptoms such as:

• A headache that doesn’t go away with pain relievers
• Swelling
• Weight gain
• Changes in vision such as blurry vision
• Nausea or vomiting
• Pain in the upper right side of your abdomen or around the stomach
• Decreased urine

These symptoms need to be reported to your healthcare provider immediately.

How Is Gestational Hypertension Diagnosed and Treated?

Healthcare providers diagnose gestational hypertension based on new elevated blood pressure readings that are consistently over 140/90 after week 20 of pregnancy, say Dr. Prabhu.

If you’re diagnosed with gestational hypertension, your healthcare provider will want to carefully monitor your blood pressure. They will also have you check your blood pressure at home and may start you on blood pressure medications.

“Starting blood pressure medications in pregnancy is an individualized decision. There’s not a one-size-fits-all approach. The most commonly used blood pressure medications in pregnancy are nifedipine and labetalol,” says Dr. Prabhu.

You might have additional tests through the rest of your pregnancy including:

• Ultrasounds
• Nonstress tests (NSTs)
• Biophysical profile
• Doppler ultrasound
• Tracking fetal movements, known as kick counting

What Complications Can Happen During Labour and Delivery?

According to Dr. Prabhu, it’s usually recommended that you deliver at 37 weeks of pregnancy. That could mean inducing labour or planning a C-section if there are other reasons for a C-section, says Dr. Prabhu.

“Gestational hypertension can progress in the course of pregnancy or labour into preeclampsia. If preeclampsia with severe features develops, an IV infusion of magnesium is recommended to prevent a seizure from occurring,” says Dr. Prabhu.

The main treatment for preeclampsia is magnesium sulfate given intravenously (IV). This prevents eclampsia, which can lead to seizures. You might also be given IV blood pressure medications to quickly reduce your blood pressure.

Can you have high blood pressure postpartum?

Gestational hypertension can sometimes get worse before it gets better after childbirth. “Some people who never needed blood pressure medications before the birth of the baby may need them for a few days or a few weeks postpartum,” says Dr. Prabhu.

If your high blood pressure doesn’t improve by 12 weeks postpartum, you may be diagnosed with chronic, or long-term, high blood pressure. It’s important to stay in touch with your healthcare provider after you have your baby and keep track of your blood pressure readings.

Eating nutritious foods, maintaining a healthy weight and getting regular exercise can lower the chances of developing high blood pressure.

Experts

• Malavika Prabhu, MD, Associate Medical Director of Maternal Fetal Medicine at Massachusetts General Hospital