Chronic hypertension in pregnancy can lead to preeclampsia and Severe forms lead to dangerous conditions, such as eclampsia (seizures during preeclampsia) and HELLP syndrome.
Chronic Hypertension in Pregnancy:
During the first 20 weeks of pregnancy.
Diagnosed prior to pregnancy.
Gestational Hypertension:
Hypertension developing in the latter half of pregnancy is called gestational hypertension.

Complications of Hypertension in Pregnancy:

  • kidney disease
  • heart attack
  • stroke
  • Fetal Growth Restriction
  • Placental abruption
  • Pre-term delivery
  • Cesarean birth
  • Preeclampsia
  • Eclampsia
  • Neurological disabilities

Risk Factors for Preeclampsia:

  • Extremes of reproductive age
  • first pregnancy
  • Obesity
  • Family histoy
  • New father increases the risk
  • Multiple Gestations
  • Greater than 10 years or less than two years from prior birth
  • Chronic hypertension
  • Diabetes I &II
  • Kidney disorders
  • Lupus

Symptoms of Preeclampsia:

  • Excess weight gain and edema
  • blurred or loss of vision
  • Persistent headaches
  • Protein in urine at visits
  • Nausea& vomiting
  • upper abdomen, epigastric pain
  • Dehydration

Eclampsia

  • Eclampsia is the onset of seizures in a woman with severe preeclampsia.
  • Maternal morbidity is associated with eclampsia & severe preeclampsia.

Treatment of Preeclampsia:

  • Delivery at 37 weeks
  • Delivery with the onset of severe preeclampsia at any gestation
  • Conservative management in absence of severe preeclampsia or fetal compromise.

HELLP Syndrome

15% of women with preeclampsia will develop HELLP syndrome.

HELLP stands for:

  • Hemolysis – the breaking down of red blood cells
  • Elevated Liver enzymes – indicates damage to the liver
  • Low Platelet count – blood may be unable to clot properly, also called thrombocytopenia

Please monitor your blood pressure and fetal kick counts, attend routine and frequent antepartum visits and emergency room with any concern.

Blood pressure is the pressure of the blood against the blood vessel walls each time the heart contracts (squeezes) to pump the blood through your body (see FAQ123 Managing High Blood Pressure). High blood pressure also is called hypertension.Hypertension can lead to health problems. During pregnancy, severe or uncontrolled hypertension can cause complications for you and your fetus.

Chronic hypertension is high blood pressure that was present before you became pregnant or that occurs in the first half (before 20 weeks) of your pregnancy. The guidelines for blood pressure are the following:

  • Normal: Less than 120/80 mm Hg
  • Elevated: Systolic between 120–129 and diastolic less than 80 mm Hg
  • Stage 1 hypertension: Systolic between 130–139 or diastolic between 80–89 mm Hg
  • Stage 2 hypertension: Systolic at least 140 or diastolic at least 90 mm Hg
Gestational hypertension is high blood pressure that first occurs in the second half (after 20 weeks) of pregnancy. Although gestational hypertension usually goes away after childbirth, it may increase the risk of developing hypertension in the future.

High blood pressure during pregnancy can place extra stress on your heart and kidneys and can increase your risk of heart disease, kidney disease, and stroke. Other possible complications include the following:

  • Fetal growth restriction—High blood pressure can decrease the flow of nutrients to the baby through the placenta. The baby may have growth problems as a result.
  • Preeclampsia—This condition is more likely to occur in women with chronic high blood pressure than in women with normal blood pressure.
  • Preterm delivery—If the placenta is not providing enough nutrients and oxygen to your baby, it may be decided that early delivery is better for your baby than allowing the pregnancy to continue.
  • Placental abruption—This condition, in which the placenta prematurely detaches from the wall of the uterus, is a medical emergency that requires immediate treatment.
  • Cesarean delivery—Women with hypertension are more likely to have a cesarean delivery than women with normal blood pressure. A cesarean delivery carries risks of infection, injury to internal organs, and bleeding.
Your blood pressure will be monitored closely throughout pregnancy. You may need to monitor your blood pressure at home. Ultrasound exams may be done throughout pregnancy to track the growth of your fetus. If growth problems are suspected, you may have additional tests that monitor the fetus's health. This testing usually begins in the third trimester of pregnancy. If your hypertension is mild, your blood pressure may stay that way or even return to normal during pregnancy, and your medication may be stopped or your dosage decreased. If you have severe hypertension or have health problems related to your hypertension, you may need to start or continue taking blood pressure medication during pregnancy.
Preeclampsia is a serious blood pressure disorder that can affect all of the organs in a woman’s body. A woman has preeclampsia when she has high blood pressure and other signs that her organ systems are not working normally. One of these signs is proteinuria (an abnormal amount of protein in the urine). A woman with preeclampsia whose condition is worsening will develop other signs and symptoms known as “severe features.” These include a low number of platelets in the blood, abnormal kidney or liver function, pain over the upper abdomen, changes in vision, fluid in the lungs, or a severe headache. A very high blood pressure reading also is considered a severe feature.
It usually occurs after 20 weeks of pregnancy, typically in the third trimester. When it occurs before 32 weeks of pregnancy, it is called early-onset preeclampsia. It also can occur in the postpartum period.

It is not clear why some women develop preeclampsia, but the risk of developing preeclampsia is increased in women who

  • are pregnant for the first time
  • have had preeclampsia in a previous pregnancy or have a family history of preeclampsia
  • have a history of chronic hypertension, kidney disease, or both
  • are 40 years or older
  • are carrying more than one fetus
  • have certain medical conditions such as diabetes mellitus, thrombophilia, or lupus
  • are obese
  • had in vitro fertilization
If preeclampsia occurs during pregnancy, your baby may need to be delivered right away, even if he or she is not fully grown. Preterm babies have an increased risk of serious complications. Some preterm complications last a lifetime and require ongoing medical care. Babies born very early also may die.
Women who have had preeclampsia—especially those whose babies were born preterm—have an increased risk later in life of cardiovascular disease and kidney disease, including heart attack, stroke, and high blood pressure. Having preeclampsia once increases the risk of having it again in a future pregnancy. Preeclampsia also can lead to seizures, a condition called eclampsia. It also can lead to HELLP syndrome.
HELLP stands for hemolysis, elevated liver enzymes, and low platelet count. In this condition, red blood cells are damaged or destroyed, blood clotting is impaired, and the liver can bleed internally, causing chest or abdominal pain. HELLP syndrome is a medical emergency. Women can die from HELLP syndrome or have lifelong health problems as a result.
  • Swelling of face or hands
  • A headache that will not go away
  • Seeing spots or changes in eyesight
  • Pain in the upper abdomen or shoulder
  • Nausea and vomiting (in the second half of pregnancy)
  • Sudden weight gain
  • Difficulty breathing
Management of mild gestational hypertension or preeclampsia without severe features may take place either in a hospital or on an outpatient basis (you can stay at home with close monitoring by your health care professional). You may be asked to keep track of your baby’s movements by doing a daily kick count and to measure your blood pressure at home. You will need to see your health care professional at least weekly and sometimes twice weekly. Once you reach 37 weeks of pregnancy, it may be recommended that you have your baby. If test results show that the baby is not doing well, you may need to have the baby earlier.
Preeclampsia with severe features usually is treated in the hospital. If you are at least 34 weeks pregnant, it often is recommended that you have your baby as soon as your condition is stable. If you are less than 34 weeks pregnant and your condition is stable, it may be possible to wait to deliver your baby. Corticosteroids may be given to help the baby’s lungs mature, and you most likely will be given medications to help reduce your blood pressure and to help prevent seizures. If your condition or the baby’s condition worsens, prompt delivery will be needed.
Prevention involves identifying whether you have risk factors for preeclampsia and taking steps to address these factors. If you have hypertension and are planning a pregnancy, see your health care professional for a prepregnancy check-up to find out whether your hypertension is under control and whether it has affected your health. If you are overweight, weight loss usually is advised before pregnancy. If you have a medical condition, such as diabetes, it usually is recommended that your condition be well controlled before you become pregnant.