Expert Advice About High Blood Pressure and Pregnancy

Among many ways to improve the odds of a healthy pregnancy, one of the most important is keeping blood pressure in check.

High blood pressure, or hypertension, is a major cause of pregnancy problems, including preterm delivery and low birthweight. It also increases risks for heart disease, stroke and death.

“The U.S. still has unacceptably high rates of maternal mortality due to circulation problems,” said Dr. Nisha Parikh, a clinical cardiologist and associate professor of medicine at the University of California, San Francisco. “Empowering women to get healthy before conception is an important tool to prevent and treat high blood pressure.”

A good starting point, she said, is for women to “know their numbers.” These include blood pressure readings, cholesterol and blood sugar levels, and body mass index, which help assess current heart health and signal any medical problems. Sometimes women with no history of high blood pressure will develop it during pregnancy. High blood pressure may have no symptoms so women may not realize they have it. That’s one reason why regular checkups with a health care professional throughout pregnancy are essential.

Parikh said some women can lower their high blood pressure with lifestyle changes such as better nutrition and more physical activity. Others may need to frequently monitor their blood pressure and take medications.

Observing blood pressure should continue even after childbirth. The “fourth trimester” is an important part of pregnancy, but many mothers start to shift their focus to the baby and overlook their own health, Parikh said. “During pregnancy women tend to take really good care of themselves,” she said. “We need to use that energy and motivation to encourage them to focus on their heart health even after delivery of the baby.”

“During pregnancy women tend to take really good care of themselves,” she said. “We need to use that energy and motivation to encourage them to focus on their heart health even after delivery of the baby.”

More about high blood pressure and pregnancy

1. Why is measuring blood pressure important? High blood pressure is called the “silent killer” because often there are no apparent symptoms, so many people may not be aware they have it. Regularly monitoring blood pressure at health care visits throughout pregnancy is essential. Some women may also need to check their blood pressure at home.
   
   
2. What increases a woman’s risk of high blood pressure during pregnancy? Some factors that contribute to pregnancy-related high blood pressure are family history, being age 35 or older, obesity (or too much body fat), preexisting medical conditions such as diabetes, and health problems in previous pregnancies. Structural racism and other health disparities also contribute to high blood pressure problems. Black women are more likely to enter pregnancy with high blood pressure and experience severe complications because of it.
   
   
3. What does blood pressure measure? A blood pressure reading includes two numbers. The first is systolic blood pressure, which indicates the pressure that blood is exerting against artery walls when the heart beats. The second is diastolic blood pressure, which shows the pressure blood is exerting against artery walls while the heart is resting between beats. A reading of less than 120/80 mm Hg is considered normal - and can help prevent maternal morbidity issues.
   
   
4. What are the types of pregnancy-related high blood pressure conditions?
   • Gestational hypertension occurs when high blood pressure happens only during pregnancy. It usually is diagnosed after 20 weeks of pregnancy. The condition often goes away after giving birth. However, it may increase a woman’s future risk of developing chronic hypertension.
   • Preeclampsia is severe high blood pressure that usually develops after 20 weeks of pregnancy, often in the third trimester. It can also develop in the weeks after childbirth and may increase the risk of future health problems. A woman with preeclampsia often has excess protein is in her urine or impaired liver and kidney function.
   • Eclampsia develops in some women with preeclampsia. It is a medical emergency that can cause seizures and coma.
   • Chronic hypertension is high blood pressure that started before pregnancy or before the 20th week of pregnancy.
5. What complications does high blood pressure cause during pregnancy? High blood pressure can lead to preeclampsia, eclampsia, stroke and other serious health problems for pregnant women. High blood pressure also makes it more difficult for a developing child to get enough oxygen and nutrients to grow. This may lead to preterm delivery and low birth weight.
   
   
6. Are medications for high blood pressure safe to take while pregnant? Some blood pressure drugs are safe during pregnancy. However, ACE inhibitors and ARBs (angiotensin II receptor blockers) have been shown to be dangerous to both mother and child during pregnancy because they can cause low blood pressure, kidney failure and high potassium levels. It’s important to talk with a health care professional before stopping or changing any medications or supplements.
   
   
7. In addition to medical treatment, what else can help high blood pressure? Several lifestyle changes can help keep blood pressure under control. These include:
   • Exercising regularly
   • Reducing salt intake
   • Eating a heart-healthy diet
   • Relieving stress
   • Reducing excess weight
   • Quitting smoking and abstaining from alcohol
8. Can blood pressure increase after childbirth even if it wasn’t a problem during pregnancy? High blood pressure may occur after a woman gives birth even if she didn’t have it during her pregnancy. Postpartum preeclampsia is a rare but serious medical condition that is usually diagnosed within 48 hours after delivery but can appear up to six weeks later. Symptoms can include sudden weight gain, headaches, vision changes, swelling, stomach pain and nausea.

Dr. Nisha Parikh is an American Heart Association volunteer medical expert specializing in cardiovascular disease prevention and women’s cardiovascular diseases across the lifespan, including cardiovascular disease in pregnancy and the postpartum period.

To learn more about safeguarding your health during pregnancy, visit goredforwomen.org/pregnancy.