High Blood Pressure & Preeclampsia

High blood pressure during pregnancy can mean different things depending on when it develops and whether there are other signs of preeclampsia. Some patients enter pregnancy with chronic hypertension, while others develop gestational hypertension or preeclampsia later in pregnancy.

Most patients with high blood pressure have healthy pregnancies, but additional monitoring is often recommended to watch your blood pressure, your health, and your baby's growth and well-being.

Chronic Hypertension & Pregnancy

Chronic hypertension means that high blood pressure was present before pregnancy or developed early in pregnancy. Because chronic hypertension increases the risk of preeclampsia and certain pregnancy complications, we typically recommend some additional monitoring throughout pregnancy.

Your care may include:

Baseline blood and urine testing, including checking the amount of protein in your urine. This gives us a baseline for comparison if your blood pressure increases later in pregnancy.
Low-dose aspirin during pregnancy to help reduce the risk of developing preeclampsia, when appropriate.
Additional ultrasounds to monitor your baby's growth.
Antenatal testing later in pregnancy, often beginning around 32 weeks depending on your blood pressure, medications, and other pregnancy factors. Antenatal testing helps us monitor your baby's well-being and typically includes nonstress tests (NSTs), which monitor your baby's heart rate, and ultrasounds to check the amount of amniotic fluid around your baby.
Home blood pressure monitoring, particularly if your blood pressure requires medication or begins to increase.

If you and your baby are doing well, delivery is often recommended before your due date, commonly around 38–39 weeks. Your individual delivery timing may be earlier depending on your blood pressure, medications, development of preeclampsia, baby's growth, or other pregnancy concerns.

Preventing Preeclampsia

For patients with certain risk factors, we may recommend low-dose aspirin during pregnancy to reduce the risk of developing preeclampsia. Whether aspirin is recommended depends on your medical and pregnancy history. If we recommend aspirin for you, we will discuss when to start it and how long to continue it.

Taking Aspirin for Prevention of Preeclampsia (Preeclampsia Foundation)

Gestational Hypertension & Preeclampsia

Gestational hypertension is high blood pressure that develops after 20 weeks of pregnancy without other findings of preeclampsia. Preeclampsia occurs when high blood pressure is accompanied by other concerning findings involving the urine, blood work, or other organ systems.

These conditions can change over time, which is why close monitoring is important. Depending on the severity and how far along you are, monitoring may include frequent blood pressure checks, blood and urine testing, ultrasounds to monitor your baby's growth, and antenatal testing to monitor your baby's well-being. Some patients can be monitored closely as an outpatient, while others may need to be admitted to the hospital.

Delivery is ultimately the treatment for preeclampsia. When gestational hypertension or preeclampsia develops without severe features, we generally recommend delivery by 37 weeks. Severe blood pressure elevations, concerning symptoms or laboratory changes, or concerns about your baby may make earlier delivery safer.

Symptoms of Preeclampsia

Preeclampsia does not always cause noticeable symptoms, which is why checking your blood pressure and keeping your prenatal appointments are important. Please contact us if you develop:

A severe or persistent headache, particularly one that does not improve with usual measures
Vision changes, including blurry vision, flashing lights, spots, or temporary loss of vision
Pain in the upper abdomen, especially under the ribs on the right side
New or worsening shortness of breath
Sudden or significant swelling, particularly of the face or hands
Significant nausea or vomiting later in pregnancy when this is new or unusual
A blood pressure that reaches the thresholds we have asked you to report

Monitoring Your Blood Pressure At Home

If we ask you to monitor your blood pressure at home, using the correct technique helps make your readings more reliable. Sit quietly for several minutes before checking your blood pressure, keep your feet flat on the floor, support your arm at heart level, and use an appropriately sized upper-arm cuff whenever possible.

Keep a record of your readings and bring them with you to your appointments. If you receive an unexpectedly high or low reading, sit quietly for several minutes and repeat your blood pressure.

Your individual monitoring parameters matter. We will let you know how often to check your blood pressure and what readings we would like you to report. Some patients may be asked to call for blood pressures persistently 140/90 or higher, while patients with known hypertension may be given different parameters.

Unless we have given you different instructions, please call promptly if your blood pressure is persistently 160/110 or higher. This means either the upper or lower number is in the severe range.

Preeclampsia After Delivery

Preeclampsia can develop or worsen after your baby is born, even if your blood pressure was normal during pregnancy. Continue to pay attention to concerning symptoms and follow any instructions you receive about checking your blood pressure after delivery. Postpartum hypertension sometimes requires medication and additional follow-up.

Postpartum Preeclampsia & Breastfeeding (SMFM)

When Should I Call?

Please call us if:

Your blood pressure is persistently at or above the threshold your care team has asked you to report.
Your blood pressure is persistently 160/110 or higher, unless you have been given different instructions. This means either the upper or lower number is in the severe range.
You develop a severe or persistent headache, especially one that does not improve with usual measures.
You have vision changes, including blurry vision, flashing lights, or spots in your vision.
You develop pain in the upper abdomen, particularly under the ribs on the right side.
You have new or worsening shortness of breath or chest pain.
You experience significant dizziness, weakness, or fainting, particularly with a low blood pressure reading.
You have other new or worsening symptoms that concern you.

If you are pregnant and have not been diagnosed with high blood pressure, repeated readings of 140/90 or highermay be abnormal in pregnancy. Please contact us for guidance if you are seeing readings in this range.

If you're unsure whether something you're experiencing is normal, please don't hesitate to reach out. For severe or urgent symptoms, please seek prompt medical evaluation rather than waiting for a MyChart response.

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