Hypertension affects 25% of the population, and approximately 10% of pregnant women have high blood pressure. There are two types of hypertension in pregnancy: preexisting hypertension (essential hypertension), and Gestational Hypertension. Gestational hypertension includes preeclampsia, HELLP syndrome, and rarely eeclampsia (seizures).

Gestational Hypertension/Preeclampsia:

This may affect up to 5-7% of pregnant women especially those with risk factors (long standing high blood pressure, diabetes, extremes of age, twins and triplets). Gestational Hypertension/Preeclampsia usually affects women in the third trimester and in rare cases it can occur earlier. Early preeclampsia is a serious condition which needs expert Maternal Fetal Management. Severe cases may result in serious maternal and fetal complications including stroke, heart and kidney failure, poor fetal growth, premature birth, and stillbirth. Severe cases may also require early delivery to avoid maternal and fetal complications.

Mild cases of gestational hypertension can be followed closely with frequent ultrasound evaluation for fetal growth and weekly or twice weekly fetal well-being testing such as Non-stress tests and Biophysical Profiles.

Preexisting Hypertension:

Pregnancy outcome in women with preexisting hypertension is directly related to the severity of the disease before pregnancy. Medication to control blood pressure before pregnancy will likely need to continue during pregnancy. Medications may need to be changed during pregnancy for fetal safety. Women with preexisting hypertension are at increased risk to develop superimposed gestational hypertension/preeclampsia, poor fetal growth, and preterm delivery and will need close monitoring.

Severe cases, especially if superimposed preeclampsia develops are at increased risk for serious maternal and fetal complications.

Management of hypertension during pregnancy includes early laboratory evaluation and blood pressure assessment, adjustment of medications, frequent evaluation for superimposed preeclampsia. Fetal surveillance is important and includes frequent ultrasound evaluation for fetal growth and weekly or twice weekly fetal well-being testing such as Non-stress tests and Biophysical Profiles.

We would strongly suggest that women with pre-existing Hypertension have a complete physical examination prior to a planned pregnancy and preconception counseling with a Maternal Fetal Medicine specialist.