What is a gestational hypertension diagnosis?
Hypertension refers to elevated blood pressure, and gestational hypertension is high blood pressure that develops during pregnancy after 20 weeks’ gestation. (To learn more about blood pressure stages and guidelines, which changed in 2017, click here.) Your blood pressure often fluctuates during pregnancy as your body adjusts to the changing demands on your circulatory system, and it is typical for your numbers to drop during the first few months of pregnancy. Your blood pressure will be checked at every prenatal appointment, and if your numbers start to creep up above normal levels (generally 120/80) in the latter half of your pregnancy, you might receive a gestational hypertension diagnosis. One elevated blood pressure reading is not automatically a major concern (lots of things can affect your blood pressure, like activity, stress, or pain), but if your numbers start to be consistently elevated, there may be cause for concern.
Often the only sign that you have developed gestational hypertension will be an elevated blood pressure reading.
A gestational hypertension diagnosis alone is not necessarily a problem—but you will likely need to be monitored more closely. The bigger problems arise when gestational hypertension can lead to other complications, such as preeclampsia, placental complications, postpartum hemorrhage, blood-clotting issues, and others, outlined below.
There are also other hypertensive disorders of pregnancy beyond basic gestational hypertension, including chronic hypertension (when you have high blood pressure before you get pregnant), preeclampsia (where hypertension develops after 20 weeks’ gestation and other signs of organ damage are present), and chronic hypertension with superimposed preeclampsia (where you had elevated blood pressure prior to pregnancy and then develop preeclampsia). Around 8 percent of women will experience some type of elevated blood pressure during pregnancy.
Risk factors for a gestational hypertension diagnosis
There are a number of factors that affect your risk of receiving a gestational hypertension diagnosis. As with many pregnancy complications, age (being under 20 or over 40), family history, being overweight, and carrying multiple babies puts you at higher risk.
In addition, you may have increased risk if you:
- Have a history of chronic hypertension
- Have had gestational hypertension or preeclampsia during past pregnancies
- Have diabetes or gestational diabetes
- Have an immune system disorder (e.g., lupus)
- Have kidney disease
- Have in vitro fertilization
- Are African American
Signs and symptoms of gestational hypertension
Often the only sign that you have developed gestational hypertension will be an elevated blood pressure reading, and you may feel completely fine even if your blood pressure is high, so it’s important to attend all of your prenatal appointments.
Is there anything to do to prevent a gestational hypertension diagnosis?
If you’ve had any issues with hypertension in the past, check in with your provider before you get pregnant. Starting a pregnancy with a healthy blood pressure, as well as eating healthy foods, getting exercise, maintaining a healthy weight, and reducing your sodium intake can all have an impact on your blood pressure during pregnancy. In addition, avoiding smoking and alcohol and drug use is important.
The good news is that with monitoring and interventions, it is often possible to have a safe and successful pregnancy even with a gestational hypertension diagnosis.
If you’ve had gestational hypertension or preeclampsia during a previous pregnancy, you might consider picking up a home blood pressure monitor so that you can track your blood pressure readings between appointments. On a personal note: I developed preeclampsia with my first two pregnancies and gestational hypertension with my third. With my latter two pregnancies, I caught my elevated blood pressure with home monitoring between appointments. I was then able to let my provider know ahead of my next checkup and started monitoring myself more frequently at home.
Complications
While some cases of gestational hypertension only require monitoring, it can be a serious condition. Some complications that can develop with gestational hypertension include:
- Development of preeclampsia (read more about preeclampsia)
- Reduced blood flow from the placenta to the baby (which can result in intrauterine growth restriction and low birth weight)
- Kidney issues and kidney failure
- Blood-clotting issues
- Placental abruption (when the placenta separates from the wall of the uterus too early)
- Postpartum hemorrhage
- Pulmonary edema (fluid in the lungs)
- Heart attack
- Stroke
- Early delivery of the baby
- C-section delivery
- Maternal, fetal, or neonatal death
I have received a gestational hypertension diagnosis—now what?
The good news is that with monitoring and interventions, it is often possible to have a safe and successful pregnancy even with a gestational hypertension diagnosis. First, be sure to attend all of your prenatal checkups and follow any instructions from your provider regarding activity, diet, and medications (including over the counter).
How your provider proceeds with your monitoring and treatment will depend on a lot of factors, like how many weeks along you are, if your baby is experiencing any complications or distress, how severe or mild your blood pressure elevation is, and if you are experiencing any other complications, including the development of preeclampsia.
Even if you are feeling great, it can’t hurt to monitor your blood pressure at home during the first couple weeks postpartum if you have had any issues with hypertension during your pregnancy.
Your provider may want to schedule your appointments more frequently and may also schedule you for additional monitoring like a non-stress test (which checks on the health of your baby by recording your baby’s movements, heartbeat, and any contractions you’re having) and a biophysical profile, which examines your baby’s heart rate, movement, breathing, and muscle tone, as well as the amount of amniotic fluid around your baby. You may also need to take medication to help control your blood pressure.
Depending on your specific situation, it’s possible that your provider will want to deliver your baby early, either by inducing labor (when labor is started with a medication) or a C-section, which might need to happen quickly if an emergency arises with you or your baby.
Labor, delivery, and postpartum
During labor and after your baby has arrived, your providers will continue to monitor your blood pressure. In some cases, gestational hypertension will resolve quickly and your blood pressure will return to normal levels within a couple days. Other times, high blood pressure can linger for a few weeks and up to a couple months. You may need to temporarily take medication to keep your blood pressure at a safe level (especially if your gestational hypertension diagnosis was severe or you developed preeclampsia). If your blood pressure remains elevated for more than three months postpartum, it’s likely you have underlying chronic hypertension or something else is causing your elevated blood pressure.
Even if you are feeling great, it can’t hurt to monitor your blood pressure at home during the first couple weeks postpartum if you have had any issues with hypertension during your pregnancy. In my third pregnancy, when I received a gestational hypertension diagnosis, I was so relieved to have not developed preeclampsia, and thought I was in the clear when I was discharged from the hospital on a low dose of medication. When I took my blood pressure six days postpartum, my numbers were suddenly very high. I ended up being sent to the hospital for evaluation, and by the time I arrived, I was in a hypertensive crisis, even though I still felt fine. An increase in my blood pressure medication dose did the trick, and I was able to wean off the medication successfully by my six-week checkup, but it was a scary incident that might have taken a turn for the worse if I hadn’t been monitoring my blood pressure at home.
Developing gestational hypertension does put you at higher risk for some postpartum complications like postpartum hemorrhage, postpartum preeclampsia, and stroke. It is important to follow all instructions, take all medications as prescribed, and check in with your provider if anything seems off. Gestational hypertension and other hypertensive disorders of pregnancy also put you at greater risk for cardiovascular disease later in life, which is important to be aware of.
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