High blood pressure during pregnancy – pregnancy or gestational hypertension
Pregnancy hypertension is the most common complication in pregnancy. It accounts for about 30 percent of fetal deaths during delivery and about 20 percent of maternal deaths.
Pregnancy hypertension mainly occurs in first-time mothers after the 20th week of pregnancy. It is also more likely in very young mothers-to-be and in multiple pregnancies. Blood pressure then usually stays high until about six weeks after delivery. In practice, blood pressure readings of 140/90 mmHg or higher measured at two consecutive resting measurements are used as the cut-off. Either the top (systolic) or bottom (diastolic) value can be elevated.
Pregnancy or gestational hypertension without protein in the urine, and pregnancy or gestational hypertension with protein in the urine and possible swelling the latter is called preeclampsia.
These two forms are different from high blood pressure that already existed before pregnancy and now causes problems. If new protein appears in the urine on top of pre-existing hypertension, this is called superimposed preeclampsia.
To prevent this, measuring blood pressure is part of every prenatal check-up. This form of high blood pressure often causes few symptoms. Occasionally affected women notice mild 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 close relatives that increase the chance of developing it. Scientists suspect problems with the embryo implanting, because in preeclampsia the process by which arteries in part of the uterus widen to connect with the babys tissue and form the placenta is disturbed. There are also interactions between the mothers immune system and the developing tissue, and changes in prostaglandin balance. The resulting damage to the inner walls of blood vessels leads to reduced blood flow to the placenta and higher blood pressure in the mother.
Preeclampsia can progress to eclampsia or HELLP syndrome. Both are serious conditions during pregnancy. That is why blood pressure monitoring is an important part of every prenatal visit.
Even after delivery, women who had severe preeclampsia should keep an eye on their blood pressure. Dutch researchers followed women in the first year after pregnancy and found that 41 percent of those who had preeclampsia had high blood pressure during that year. Masked hypertension was especially common normal readings in the clinic but high values outside the clinic.
The 2023 ESH (European Society of Hypertension) guidelines classify pregnancy complications such as hypertension, preeclampsia, and gestational diabetes, as well as multiple early or miscarriages, as risk factors for developing high blood pressure later in life. Blood pressure in affected women should be checked regularly after pregnancy, and not only starting at older ages like 60 or 65.
In 2024 the German, Austrian and Swiss societies for gynecology and obstetrics issued a new guideline that also addresses pregnancy hypertension. This condition can be dangerous not only during pregnancy but also increases the mother's lifelong risk of cardiovascular disease. The guideline therefore aims to improve detection and treatment of pregnancy high blood pressure and to emphasize the importance of follow-up after delivery. To better organize follow-up care, a postnatal follow-up booklet for affected women was created.
The 2023 ESH (European Society of Hypertension) guidelines classify pregnancy complications such as hypertension, preeclampsia, and gestational diabetes, as well as multiple early or miscarriages, as risk factors for developing high blood pressure later in life. Blood pressure in affected women should be checked regularly after pregnancy, and not only starting at older ages like 60 or 65.
In 2024 the German, Austrian and Swiss societies for gynecology and obstetrics issued a new guideline that also addresses pregnancy hypertension. This condition can be dangerous not only during pregnancy but also increases the mother's lifelong risk of cardiovascular disease. The guideline therefore aims to improve detection and treatment of pregnancy high blood pressure and to emphasize the importance of follow-up after delivery. To better organize follow-up care, a postnatal follow-up booklet for affected women was created.
Sources:
- https://www.hochdruckliga.de/fileadmin/downloads/mediziner/leitlinien/Pocket-Leitlinie_Hypertonie_2018.pdf
- http://flexikon.doccheck.com/de/Schwangerschaftshypertonie
- https://www.aerzteblatt.de/nachrichten/89051/Schwangerschaft-Schwere-Praeeklampsie-fuehrt-haeufig-zu-unbemerktem-Bluthochdruck
- https://idw-online.de/en/news817680
- https://journals.lww.com/jhypertension/Fulltext/9900/2023_ESH_Guidelines_for_the_management_of_arterial.271.aspx
- https://register.awmf.org/assets/guidelines/015-018l_S2k_Hypertensive-Erkrankungen-Schwangerschaft-HES-Diagnostik-Therapie_2024-07.pdf
- https://www.aerzteblatt.de/nachrichten/153008/Neue-Leitlinie-zu-Diagnostik-und-Therapie-von-Bluthochdruck-in-der-Schwangerschaft
This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands monitor their blood pressure every day.
Our content is based on carefully researched, evidence-based data and is continuously updated (as of 11/2025).
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care, and has led BloodPressureDB's specialist editorial team since 2015. Thanks to her extensive additional qualifications as a paramedic, first responder and in various therapy and emergency areas, she provides solid, practical and reliably reviewed information.
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care, and has led BloodPressureDB's specialist editorial team since 2015. Thanks to her extensive additional qualifications as a paramedic, first responder and in various therapy and emergency areas, she provides solid, practical and reliably reviewed information.
