Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy are a leading cause of maternal mortality and can put both mother and baby at risk for problems during pregnancy.1 High blood pressure can also cause problems during and after delivery. Importantly, hypertensive disorders of pregnancy are often preventable and treatable. In the U.S., high blood pressure is noted in one in every 12 to 17 pregnancies among women aged 20 to 44.2 Hypertensive disorders of pregnancy have become more common, affecting approximately 15% of women during their reproductive years, in part as a result of advanced age at first pregnancy, as well as increasing prevalence of obesity and other cardiometabolic risk factors.1,3 There are racial/ethnic disparities in both the burden and outcomes of hypertensive disorders of pregnancy.1

Hypertensive Disorders of Pregnancy
Condition Description
Chronic Hypertension Chronic hypertension is high blood pressure present before pregnancy or diagnosed before 20 weeks of pregnancy. Women who have chronic hypertension can also develop preeclampsia
Gestational Hypertension Gestational hypertension is high blood pressure that develops at or after 20 weeks of pregnancy without evidence of protein in the urine or other heart or kidney problems. Gestational hypertension usually improves after delivery. However, some women with gestational hypertension have a higher risk of developing chronic hypertension in the future.
Preeclampsia Preeclampsia occurs when a woman with previously normal blood pressure suddenly develops high blood pressure and protein in the urine or other problems (e.g., low platelet count, impaired liver function) after 20 weeks of pregnancy. Women who have chronic hypertension can also develop preeclampsia. Preeclampsia occurs in about 1 in 25 pregnancies in the U.S.
Eclampsia Some women with preeclampsia can develop seizures. This is called eclampsia, which is a medical emergency.
Hemolysis Elevated Liver Enzymes and Low Platelet Count (HELLP) Syndrome HELLP syndrome is life-threatening condition that can occur during pregnancy or soon after delivery. It can cause high blood pressure and seizures, and can lead to a potentially fatal liver disorder or stroke if left untreated.

Prevention of Hypertensive Disorders of Pregnancy

Lifestyle and behavioral interventions, including optimal maternal weight gain and diet, can improve pregnancy outcomes. Exercise may reduce gestational hypertension and preeclampsia risk by 30% to 40%. Low-dose aspirin started between 12 to 16 weeks of pregnancy can reduce the risk of preeclampsia and related adverse outcomes by 10% to 20% in women at increased risk.1 Accurate blood pressure measurement is important for diagnosing, classifying, and treating hypertensive disorders of pregnancy. Several self-measured blood pressure devices are accurate in pregnant women, including those with gestational hypertension and preeclampsia.4

Treatment

Additional evidence is needed to better define optimal treatment targets and the threshold for pharmacotherapy for hypertensive disorders of pregnancy.  Antihypertensive therapy in the setting of hypertensive disorders of pregnancy should focus on the use of safe and effective medications specific to this population.  Treatment of hypertension, prevention of seizures, and timed delivery are currently the primary approaches for women with preeclampsia.1

Importance of Longitudinal Care

Hypertensive disorders of pregnancy can lead to complications during and after delivery as well as life-long risk and early onset of CVD. Therefore, postpartum assessment and control of cardiovascular risk factors is essential in those with hypertensive disorders of pregnancy. A team-based approach and multi-specialty collaboration is needed to ensure appropriate care transition with the goal of optimizing cardiovascular preventive strategies across the life course.1

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Page last reviewed: February 1, 2022