Pregnancy and High Blood Pressure: When to Call Your Doctor

During pregnancy, blood pressure is considered high when a reading reaches 140/90 mm Hg or higher, according to the American College of Obstetricians and Gynecologists (ACOG).

Call your OB-GYN or labor and delivery unit right away if:

• Your systolic blood pressure is 140 mm Hg or higher, or your diastolic pressure is 90 mm Hg or higher
• Your reading is above the range established by your care team
• You have a persistent or worsening headache
• You have blurred vision, see spots or notice other vision changes
• You have severe upper abdominal pain, especially on the right side
• Your face or hands become unusually swollen
• You experience sudden weight gain
• You develop persistent nausea or vomiting later in pregnancy
• You have shortness of breath

A systolic reading of 160 mm Hg or higher or a diastolic reading of 110 mm Hg or higher is considered severe and can be a medical emergency, according to ACOG. Seek immediate care if either number reaches this level.

Call 911 if you have:

• Chest pain
• Severe difficulty breathing
• Confusion
• A seizure
• Fainting
• Sudden vision loss
• Sudden, extremely severe headache

One high reading may not confirm a diagnosis, but do not ignore it. If your blood pressure is in the severe range or you have serious symptoms, seek emergency care immediately. Do not wait to take another reading.

Chronic hypertension is high blood pressure that was present before pregnancy, diagnosed before 20 weeks or continuing more than 12 weeks after delivery.

Some blood pressure medications may not be safe during pregnancy. Talk with your doctor before pregnancy or as soon as you learn you are pregnant. Never stop prescribed medication without medical guidance.

Gestational hypertension develops after 20 weeks in someone whose blood pressure was previously normal. Unlike preeclampsia, it is not initially accompanied by protein in the urine or other signs of organ damage. However, it can progress to preeclampsia and requires close monitoring.

Preeclampsia is a serious high blood pressure disorder that usually develops after 20 weeks of pregnancy or after delivery.

It may be diagnosed when high blood pressure occurs with protein in the urine or signs of problems with the liver, kidneys, blood, brain or lungs. Protein in the urine is not required for a diagnosis if other signs of organ problems are present.

“Preeclampsia can be difficult to detect because some women feel well even as their blood pressure rises or their organs are affected," Dr. Daneshmand says. "Regular prenatal visits and blood pressure checks help us identify changes early and reduce the risk of complications."

Without treatment, preeclampsia can lead to eclampsia, which can cause seizures, as well as stroke, organ damage, placental abruption and preterm delivery.

Your risk may be higher if you:

• Had preeclampsia in a previous pregnancy
• Have chronic high blood pressure, type 1 or type 2 diabetes, kidney disease or certain autoimmune disorders
• Are carrying twins, triplets or other multiples
• Became pregnant through in vitro fertilization
• Have obesity
• Are pregnant for the first time
• Are 35 or older

Having one or more risk factors does not mean you will develop preeclampsia. Your care team can assess your risk and recommend appropriate monitoring.

Preeclampsia cannot always be prevented. However, low-dose aspirin may reduce the risk in patients with at least one high-risk factor or two or more moderate-risk factors.

When prescribed, 81 milligrams of aspirin is generally started between 12 weeks and 28 weeks, ideally before 16 weeks, and continued through delivery. Do not take aspirin during pregnancy without first talking with your OB-GYN.

Your care team may repeat blood pressure measurements, test your urine for protein and order blood tests to check your liver, kidneys and platelet count. Your baby's growth and well-being may be monitored.

Treatment depends on the severity of the condition, how far along you are and your health and your baby's health.

Care may include:

• Medication to lower blood pressure
• Magnesium sulfate to prevent seizures in patients with severe features
• Corticosteroids to help the baby's lungs mature if preterm delivery is likely
• Close outpatient monitoring for some patients without severe features
• Hospital care for patients with severe features

Delivery is generally recommended at 37 weeks for gestational hypertension or preeclampsia without severe features or at diagnosis if the pregnancy is beyond 37 weeks.

For preeclampsia with severe features, delivery is generally recommended at or 34 weeks once the patient is stable. Earlier delivery may be needed if the condition worsens or the health of the mother or baby is at risk.

High blood pressure can reduce blood flow through the placenta, limiting the oxygen and nutrients the baby receives. Complications may include fetal growth restriction, low birth weight, preterm delivery and placental abruption.

Placental abruption occurs when the placenta separates from the uterine wall too soon. It can cause abdominal or back pain, contractions or vaginal bleeding and requires immediate medical care.

Yes. Postpartum preeclampsia can develop even if your blood pressure was normal during pregnancy. It often occurs within 48 hours but can occur as late as six weeks later.

Seek immediate care if you develop:

• Severe or persistent headache
• Vision changes
• Upper abdominal pain, especially on the right side
• Nausea or vomiting
• Swelling of the face or hands
• Shortness of breath
• A blood pressure reading of 140/90 mm Hg or higher

Call 911 if you have a seizure, chest pain, severe difficulty breathing, confusion or fainting.

If you have gestational hypertension or preeclampsia, follow your care team's instructions for checking your blood pressure and taking medications after delivery.

Women who have had preeclampsia or gestational hypertension face a higher risk of chronic high blood pressure, stroke and heart disease later in life.

Be sure to tell your primary care doctor about any history of high blood pressure during pregnancy. Regular blood pressure, cholesterol and blood sugar checks can detect health problems early and protect your heart health.

Pregnant women with chronic hypertension, pregnancy-related high blood pressure or other high-risk conditions may benefit from a maternal-fetal medicine specialist.

Scripps OB-GYNs and maternal-fetal specialists provide specialized monitoring and treatment before, during and after pregnancy.