Pregnancy and High Blood Pressure: When to Call the Doctor

Preeclampsia is a disease marked by elevated blood pressure and proteinuria (protein excretion in the urine). Women may develop it during pregnancy or up to six weeks after delivery.

A woman’s risk of developing preeclampsia may be higher than average if she:

• Had preeclampsia in a previous pregnancy
• Has not been pregnant before
• Is older than 40 or younger than 18 years of age
• Had high blood pressure prior to becoming pregnant
• Is obese and/or has diabetes
• Is pregnant with twins or triplets

“The two main signs of preeclampsia are elevated blood pressure and abnormally high protein levels in the mother’s urine,” says Sean Daneshmand, MD, an OB-GYN, and director of maternal and fetal medicine at Scripps Clinic. “It is important to review the signs and symptoms associated with preeclampsia with all patients.”

Symptoms include:

• Swelling in the hands or face
• Rapid weight gain within a few days
• Moderate to severe headaches
• Pain in the upper right side of the abdomen
• Severe shortness of breath
• Changes in vision
• Continuous nausea or vomiting

The severity of preeclampsia depends on the mother’s blood pressure levels, symptoms and/or laboratory values. 

Diagnosis of preeclampsia is made when the blood pressure is above or equal to 140/90 taken 4 hours apart, plus, protein in the urine.

In preeclampsia with severe features, blood pressure is typically above 160/110 with protein in the urine.

Laboratory abnormalities, such as elevated liver enzymes, poor renal function, or low platelets, and neurological symptoms, such as a severe headache not responsive to pain medication, are also associated with severe preeclampsia. 

Treatment of preeclampsia is delivery, Dr. Daneshmand says.

“Supportive treatment that includes mainly medications to maintain blood pressure at a safe level may be used to allow the baby to get to a higher gestational age,” he says.

“Typically, patients with preeclampsia without severe features are delivered by 37 weeks and those with preeclampsia with severe features are delivered at 34 weeks or earlier if indicated.”

High blood pressure during pregnancy can also be harmful for the baby. One complication is fetal growth restriction, which means the baby is smaller than they should be and may need specialized care during or after delivery.

Another possible complication is a life-threatening condition called placental abruption, where the placenta separates from the uterine wall.

Gestational hypertension occurs when a pregnant woman has high blood pressure but does not have protein in her urine. Like preeclampsia, it is usually diagnosed after 20 weeks of pregnancy. Blood pressure typically returns to normal after delivery and treatment is typically like what is provided to pregnant women with preeclampsia without severe features.

It’s important for women with elevated blood pressure to speak with their health care provider before they get pregnant to optimize their health and to ensure the medications, they are taking are safe for pregnancy.

Pregnant women who develop high blood pressure or other conditions that create a high-risk pregnancy should seek specialized care. The OB-GYN and maternal fetal medicine specialists at Scripps provide expert care for pregnant women with hypertension and other chronic health conditions.

“We want to provide excellent clinical care to our high-risk moms with compassion and respect,” Dr. Daneshmand says.