High Blood Pressure During Pregnancy Pregnancy or Gestational Hypertension

Pregnancy hypertension is the most common complication during pregnancy. It is responsible for 30 percent of infant mortality during birth and 20 percent of maternal mortality.

Pregnancy hypertension primarily occurs in first-time mothers after the 20th week of pregnancy. However, the risk of pregnancy high blood pressure is also significant in very young expectant mothers and in multiple pregnancies. The blood pressure usually remains elevated for about six weeks after delivery. In practice, blood pressure values measured at 140/90 mmHg or higher are considered the threshold for diagnosis, which must be confirmed by two consecutive resting measurements. Either the upper or lower value can be elevated.

Pregnancy or gestational hypertension (high blood pressure)

Different forms are distinguished:

Pregnancy or gestational hypertension without proteinuria (protein in urine) and pregnancy or gestational hypertension with proteinuria and possible edema formation, which is then referred to as preeclampsia.

Distinguished from these two forms is hypertension that existed before pregnancy, which is now causing problems. If proteinuria additionally occurs with the pre-existing hypertension, it is referred to as graft preeclampsia.

To prevent this, blood pressure measurement is part of every examination during pregnancy. Because this form of high blood pressure also causes few complaints. Affected women occasionally notice slight dizziness, feel tired, or have headaches.

The exact cause of preeclampsia is unclear. However, there are some risk factors such as pre-existing hypertension, diabetes, kidney problems, or cases of preeclampsia in the biological family that favor its development. Scientifically, problems with the implantation of the embryo are suspected, as the process of widening the arteries in a part of the uterus to connect with the tissue of the child to form the placenta is disturbed in preeclampsia. This also involves processes between the mother's immune system and the developing tissue, as well as deviations in prostaglandin balance. The resulting damage to the inner walls of the vessels leads to reduced blood flow to the placenta and elevated blood pressure values in the expectant mother.

Preeclampsia can develop into eclampsia or HELLP syndrome. Both are serious conditions during pregnancy. Therefore, blood pressure control is an important part of every prenatal examination.

Even after delivery, women who suffered from severe preeclampsia during pregnancy should keep an eye on their blood pressure. Dutch researchers observed women in the first year after pregnancy and found that 41 percent of those who had preeclampsia had elevated blood pressure during that year. The form of masked hypertension was particularly evident, which shows normal blood pressure values in the practice while the values outside the practice are high.

In the 2023 guidelines of the ESH (European Society of Hypertension), complications during pregnancy such as hypertension, preeclampsia, as well as diabetes during pregnancy, and several experienced early or miscarriages are classified as risk factors for developing high blood pressure later in life. Blood pressure should be regularly monitored in affected women even after pregnancy, and not just starting at an older age of 60 or 65 years.

In 2024, the German, Austrian, and Swiss Society for Gynecology and Obstetrics jointly published a new guideline. This guideline also addresses pregnancy hypertension. This can be dangerous not only during pregnancy but also poses an increased risk of cardiovascular diseases for the mother for the rest of her life. Therefore, the guideline aims to improve the detection and treatment of pregnancy high blood pressure and also highlight the importance of follow-up care after delivery. To better organize follow-up care, a follow-up pass for affected women has been created.

Sources:

By Sabine Croci. This article is medically reviewed. Last updated (07/2024).
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High Blood Pressure During Pregnancy Pregnancy or Gestational Hypertension

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