Preeclampsia & high blood pressure in pregnancy overview

Women can develop high blood pressure during pregnancy, called gestational hypertension. It is also called pregnancy-induced hypertension.

High blood pressure in pregnancy can lead to preeclampsia, a condition that could damage other organs. Preeclampsia occurs in roughly 3 to 4 percent of pregnancies in the United States.

Symptoms include a persistent headache, blurry vision, severe nausea and vomiting and severe pain in the upper abdomen.

While there is no way to entirely prevent preeclampsia or high blood pressure during pregnancy, some methods for decreasing the risk include managing blood pressure before pregnancy or taking low-dose aspirin.

If left untreated, complications from high blood pressure can harm the mother’s and baby’s health during and after pregnancy. Our are carefully attuned to blood pressure during pregnancy, partly due to the steady increase of high blood pressure complications in pregnancies in recent years.

High blood pressure and resulting complications are common and treatable. Most women with preeclampsia or other high blood pressure issues have safe deliveries and healthy babies.

High blood pressure during pregnancy

Blood pressure is the force of blood against the blood vessel walls each time the heart pumps. High blood pressure, or hypertension, occurs when that pressure is higher than normal. High blood pressure, if left untreated, can result in long-term health problems, which is why it is carefully monitored once diagnosed.

High blood pressure that is brought on by pregnancy is called gestational hypertension, or pregnancy-induced hypertension. This can lead to a pregnancy complication called preeclampsia and other problems that could affect the mother and her baby.

For this reason, we help our patients prepare for pregnancy and work with them to create a prevention plan, especially for mothers who are at a higher risk for developing gestational hypertension.

Having a normal pregnancy with high blood pressure

Most mothers with high blood pressure during pregnancy have normal deliveries and healthy babies. Throughout the pregnancy, a physician will actively monitor the condition and discuss management options with the mother.

Other complications from high blood pressure during pregnancy

• High blood pressure causes significant force on the blood vessels, which can impair the flow of blood throughout the body. This can negatively impact the mother’s health as it could compromise blood flow to the mother’s organs such as the liver, kidneys and brain, leading to a higher risk of developing kidney disease, stroke and heart disease.
• High blood pressure in pregnancy can also cause harm to the placenta. If blood flow to the placenta is impaired, the baby’s growth could be compromised.
• The obstetrician may recommend delivery prior to the due date to protect the mother’s and her child’s health if high blood pressure during pregnancy threatens to cause severe health problems.

Preeclampsia & gestational hypertension

The terms “preeclampsia” and “gestational hypertension” are often used interchangeably, but preeclampsia is an additional complication brought on by high blood pressure in pregnancy. It occurs when a mother has high blood pressure and also displays signs that her organ systems might be affected by this.

What is preeclampsia?

Preeclampsia is a form of ongoing high blood pressure that starts in pregnancy or in the postpartum period (after the baby’s birth). This condition affects the organs of the mother, including the kidneys, liver and brain. The organ injury typically resolves within days to weeks after delivery.

Pregnancy complications from preeclampsia

There isn’t a cure for preeclampsia, except for the delivery of the baby and placenta. For the mother’s and baby’s safety, as soon as we diagnose this condition we discuss options with the mother (or parents) to determine how quickly the baby needs to be delivered before the due date. Preeclampsia is the cause of roughly 15 percent of premature births in the U.S. Preeclampsia can also progress to a condition called eclampsia. Eclampsia occurs when a woman with preeclampsia develops such high blood pressure that she has a seizure.

Preeclampsia can also very rarely lead to the HELLP syndrome. HELLP stands for hemolysis, elevated liver enzymes and low platelet count, and HELLP syndrome damages red blood cells, which can result in a number of problems for both mother and baby.

While these are serious conditions, both preeclampsia and gestational hypertension are treatable. Because these conditions are relatively common, obstetricians are well-equipped in working with mothers to manage these conditions.

Gestational hypertension & preeclampsia symptoms

High blood pressure conditions may develop slowly over a woman’s pregnancy without symptoms. However, each mother is unique, and hypertension can develop quickly for some women. Gestational hypertension is categorized as blood pressure higher than 140/90, documented on two occasions at least four hours apart. During routine prenatal care, blood pressure is regularly checked to assess for any changes or trends.

Symptoms of preeclampsia

When a mother has preeclampsia, she can often show signs that her internal organs are not working normally, in addition to high blood pressure. One of the main signs of the condition, but not the only one, is an abnormal amount of protein in the urine; this is known as proteinuria. As part of routine prenatal care, patients are asked to provide a urine sample at every appointment. This sample is then checked for protein levels. Preeclampsia can present with mild or severe features.

Mild features include:

• Elevated blood pressure
• Water retention

Severe features include:

• Severe, persistent headache
• Pain in the upper abdomen
• Visual changes, like blurred vision
• Severe difficulty breathing

We monitor all potential symptoms and adjust our care accordingly. If you experience any of the symptoms above, call your physician.

Gestational hypertension & preeclampsia diagnosis

The main goal of evaluating the mother’s high blood pressure is to distinguish gestational hypertension from preeclampsia, which has a different treatment plan. Gestational hypertension and preeclampsia diagnosis begin the same and diverge based on the severity. Physicians will measure the levels of protein in a mother’s urine.

Diagnosing preeclampsia

When diagnosing preeclampsia, a physician will check for several other factors, monitoring the mother’s organs and blood platelet levels for any signs of trouble. We may suspect preeclampsia if we see:

• High levels of protein in the urine
• Signs of kidney or liver trouble
• Fluid in the lungs
• A decrease in blood platelets

Risks of developing high blood pressure & preeclampsia in pregnancy

While the exact cause of gestational hypertension (high blood pressure that only develops during pregnancy) is unclear, there are some well-defined risk factors that indicate when high blood pressure may occur.

Gestational hypertension and preeclampsia develop in mothers after the 20th week of pregnancy. These conditions are more common for:

• First-time mothers
• Women under the age of 20 and over 40
• Mothers who are carrying twins, triplets or more are more likely to develop the conditions

Preeclampsia develops in 3 percent to 4 percent of pregnancies in the U.S., most of which occur after 34 weeks of pregnancy, often closer to 37 weeks (when the pregnancy is considered at term).

Risks for developing preeclampsia include:

• First pregnancy (excluding miscarriages and abortions).
• Gestational diabetes.
• Multiple gestation (e.g., twins or triplets).
• Women who have a family history of gestational hypertension or preeclampsia.
• Mothers who experienced preeclampsia in a previous pregnancy.
• Age under 20 years or 40 years and older.
• Obesity.
• African-American mothers may also be at a higher risk of developing these conditions.

Mothers who developed either condition during a previous birth are more likely to develop them again in their next pregnancy. Women who have medical conditions before becoming pregnant such as diabetes, chronic hypertension or kidney disease are also at a higher risk of developing pregnancy-induced hypertension and preeclampsia.

High blood pressure prevention during pregnancy

As with most medical concerns, prevention is better than treatment if it is an option. We can assist a woman in taking steps to help prevent high blood pressure during pregnancy and preeclampsia. For women who want to get pregnant and already have hypertension, managing that condition is a great first step.

Managing other pre-existing conditions is another important step in successful pregnancy planning. If the woman is overweight, we will likely recommend weight loss. Medical conditions such as diabetes should also be properly managed before pregnancy. Speaking with one of our doctors at a preconception counseling appointment is an opportunity to learn how to manage these risk factors.

For some mothers, we may recommend a low-dose aspirin regimen to help prevent preeclampsia. This treatment is not effective for all women and should be discussed with a doctor before adopting.

Treatment for pregnancy complications due to blood pressure

Managing high blood pressure during pregnancy

Most mothers with gestational hypertension can continue with their normal physical activities and can be safely monitored during scheduled office visits. It may be useful for some women to monitor and track their blood pressure at home to determine the average and peak blood pressure during usual activity.

Treatment for mild preeclampsia

Mothers with mild features of preeclampsia may seek treatment at a hospital, by visiting her OB-GYN or through close health monitoring at home. Monitoring and treatment include:

• Monitoring the baby: Our obstetrician may recommend keeping track of the baby’s movements. This includes keeping a kick count to identify any changes in the baby’s activity. It may also be recommended to perform monitoring of the baby through fetal heart rate monitoring and/or ultrasounds to assess fetal growth and amniotic fluid levels.
• Monitoring the mother: Frequently measuring mom’s blood pressure can help spot an unhealthy trend before it gets severe. Doctors will also do urine analyses regularly to monitor for any increase in protein, as well as monitor the kidneys, liver and lungs for any changes. There will likely be weekly, or sometimes twice weekly, appointments with a health care professional.
• Preterm birth: Based on the ongoing tests and monitoring, scheduling an early birth could be the best option for the baby and mother to limit the impact of preeclampsia.

Treatment for severe preeclampsia

For women with more serious preeclampsia symptoms, also known as preeclampsia with severe features, the treatment typically takes place in the hospital. This allows the obstetrician the opportunity to monitor the mother’s and baby’s health and adjust the treatment plan should the condition worsen.

Ultimately, the treatment for preeclampsia with severe features is to have the baby as soon as possible.

If the pregnancy is at least 34 weeks along, our physicians will often recommend proceeding with preterm delivery (or induced labor) as soon as it’s deemed safe for the baby’s health and development. If the pregnancy is less than 34 weeks and stable, the obstetrician may prescribe corticosteroids, which help the baby’s lungs mature faster in preparation for a possible early birth after 34 weeks. The mother may also receive medication to help prevent seizures and lower blood pressure.

Labor & delivery with gestational hypertension or preeclampsia

While giving birth, mothers with severe preeclampsia may be treated with intravenous (IV) magnesium, which is safe for the baby. This medication is a potent muscle relaxer that decreases the likelihood of the mother having a seizure, or eclampsia. This treatment typically continues for 24 hours after delivery. It usually takes two weeks for the mother’s blood pressure to return to normal levels after giving birth.

Gestational hypertension and complications resulting from high blood pressure are both common and manageable. At CU Anschutz Women's Health, we work closely with parents to understand the risks and options, should the mother develop high blood pressure in pregnancy or preeclampsia.