Gestational hypertension - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Gestational hypertension is defined as a blood pressure (BP) of ≥140/90 mmHg on two occasions (at least 4 hours apart) after 20 weeks' gestation in a previously normotensive woman, without the presence of proteinuria or other clinical features (thrombocytopenia, impaired renal or kidney function, pulmonary edema, or new-onset headache) suggestive of preeclampsia.
Women with gestational hypertension are usually asymptomatic.
Women require regular monitoring of BP and urinalysis during the pregnancy to exclude preeclampsia.
Hypertension (systolic BP of 140 mmHg or more or diastolic BP of 90 mmHg or more, or both) is managed with lifestyle modification and/or antihypertensive therapy.
Severe hypertension (BP ≥160/110 mmHg) requires admission to the hospital for antihypertensive therapy.

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 222: gestational hypertension and preeclampsia. Jun 2020 [internet publication].[Abstract][Full Text]
Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2022 Mar;27:148-69.[Abstract]
National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. Apr 2023 [internet publication].[Full Text]

Referenced Articles

1. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 222: gestational hypertension and preeclampsia. Jun 2020 [internet publication].[Abstract][Full Text]
2. Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2022 Mar;27:148-69.[Abstract]
3. Ford ND, Cox S, Ko JY, et al. Hypertensive disorders in pregnancy and mortality at delivery hospitalization - United States, 2017-2019. MMWR Morb Mortal Wkly Rep. 2022 Apr 29;71(17):585-91.[Abstract][Full Text]
4. Knight M, Bunch K, Patel R, et al, eds; MBRRACE-UK. Saving lives, improving mothers' care core report - lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2022.[Full Text]
5. National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. Apr 2023 [internet publication].[Full Text]
6. Innes KE, Wimsatt JH, McDuffie R. Relative glucose tolerance and subsequent development of hypertension in pregnancy. Obstet Gynecol. 2001 Jun;97(6):905-10.[Abstract]
7. Vidaeff AC, Carroll MA, Ramin SM. Acute hypertensive emergencies in pregnancies. Crit Care Med. 2005 Oct;33(suppl 10):S307-12.[Abstract]
8. Wolf M, Sandler L, Jimenez-Kimble R, et al. Insulin resistance but not inflammation is associated with gestational hypertension. Hypertension. 2002 Dec;40(6):886-91.[Abstract][Full Text]
9. American College of Obstetricians and Gynecologists. Obstetric care consensus no. 11: pregnancy at age 35 years or older. Aug 2022 [internet publication].[Full Text]
10. Lombardi DG, Barton JR, O'Brien JM, et al. Does an obese prepregnancy body mass index influence outcome in pregnancies complicated by mild gestational hypertension remote from term? Am J Obstet Gynecol. 2005 May;192(5):1472-4.[Abstract]
11. Sibai BM, Ewell M, Levine RJ, et al. Risk factors associated with preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol. 1997 Nov;177(5):1003-10.[Abstract]
12. Michlin R, Oettinger M, Odeh M, et al. Maternal obesity and pregnancy outcome. Isr Med Assoc J. 2000 Jan;2(1):10-3.[Abstract][Full Text]
13. Sibai BM, Gordon T, Thom E, et al. Risk factors for preeclampsia in healthy nulliparous women: a prospective multicenter study. The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol. 1995 Feb;172(2 Pt 1):642-8.[Abstract]
14. Rasmussen S, Irgens LM. Pregnancy-induced hypertension in women who were born small. Hypertension. 2007 Apr;49(4):806-12.[Abstract][Full Text]
15. Bismuth E, Bouche C, Caliman C, et al. Management of pregnancy in women with type 1 diabetes mellitus: guidelines of the French-Speaking Diabetes Society (Société francophone du diabète [SFD]). Diabetes Metab. 2012 Jun;38(3):205-16.[Abstract]
16. Facchinetti F, Allais G, Nappi RE, et al. Migraine is a risk factor for hypertensive disorders in pregnancy: a prospective cohort study. Cephalalgia. 2009 Mar;29(3):286-92.[Abstract]
17. American College of Obstetricians and Gynecologists. Clinical practice guideline no. 3: headaches in pregnancy and postpartum. May 2022 [internet publication].[Full Text]
18. Hofmeyr GJ, Lawrie TA, Atallah ÁN, et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2018 Oct 1;(10):CD001059.[Abstract][Full Text]
19. World Health Organization. WHO recommendation on calcium supplementation before pregnancy for the prevention of pre-eclampsia and its complications. Apr 2020 [internet publication].[Full Text]
20. Rolnik DL, Wright D, Poon LC, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017 Aug 17;377(7):613-22.[Abstract][Full Text]
21. Duley L, Meher S, Hunter KE, et al. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2019 Oct 30;(10):CD004659.[Abstract][Full Text]
22. Henderson JT, Vesco KK, Senger CA, et al. Aspirin use to prevent preeclampsia and related morbidity and mortality: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021 Sep 28;326(12):1192-206.[Abstract][Full Text]
23. World Health Organization. WHO recommendations on antiplatelet agents for the prevention of pre-eclampsia. Dec 2021 [internet publication].[Full Text]
24. US Preventive Services Task Force final recommendation statement. Aspirin use to prevent preeclampsia and related morbidity and mortality: preventive medication. Sep 2021 [internet publication].[Full Text]
25. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 743: low-dose aspirin use during pregnancy. Jul 2018 [internet publication].[Full Text]
26. Ashworth DC, Maule SP, Stewart F, et al. Setting and techniques for monitoring blood pressure during pregnancy. Cochrane Database Syst Rev. 2020 Jul 23;(8):CD012739.[Abstract][Full Text]
27. Brown MA, Roberts LM, Mackenzie C, et al. A prospective randomized study of automated versus mercury blood pressure recordings in hypertensive pregnancy (PRAM Study). Hypertens Pregnancy. 2012;31(1):107-19.[Abstract]
28. National Institute for Health and Care Excellence. PLGF-based testing to help diagnose suspected preterm pre-eclampsia. Jul 2022 [internet publication].[Full Text]
29. Duhig KE, Myers J, Seed PT, et al; PARROT trial group. Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial. Lancet. 2019 May 4;393(10183):1807-18.[Abstract][Full Text]
30. National Institute for Health and Care Excellence. Antenatal care. Aug 2021 [internet publication].[Full Text]
31. US Preventive Services Task Force. Hypertensive disorders of pregnancy: screening. Sep 2023 [internet publication].[Full Text]
32. National Institute for Health and Care Excellence. Intrapartum care for women with existing medical conditions or obstetric complications and their babies. Apr 2019 [internet publication].[Full Text]
33. Magee LA, Smith GN, Bloch C, et al. Guideline no. 426. Hypertensive disorders of pregnancy: diagnosis, prediction, prevention, and management. J Obstet Gynaecol Can. 2022 May;44(5):547-71.e1.[Abstract]
34. Society of Obstetric Medicine of Australia and New Zealand. Hypertension in pregnancy guideline. Feb 2024 [internet publication].[Full Text]
35. Te Whatu Ora / Health New Zealand. Diagnosis and treatment of hypertension and pre-eclampsia in pregnancy in Aotearoa New Zealand. Oct 2022 [internet publication].[Full Text]
36. Broekhuijsen K, van Baaren GJ, van Pampus MG, et al; HYPITAT-II study group. Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial. Lancet. 2015 Jun 20;385(9986):2492-501.[Abstract]
37. Cluver C, Novikova N, Koopmans CM, et al. Planned early delivery versus expectant management for hypertensive disorders from 34 weeks gestation to term. Cochrane Database Syst Rev. 2017 Jan 15;(1):CD009273.[Abstract][Full Text]
38. National Institute for Health and Care Excellence. Preterm labour and birth. Jun 2022 [internet publication].[Full Text]
39. American College of Obstetricians and Gynecologists. Committee opinion no. 455. Magnesium sulfate before anticipated preterm birth for neuroprotection. Mar 2010 (reaffirmed 2023) [internet publication].[Full Text]
40. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 713. Antenatal corticosteroid therapy for fetal maturation. Aug 2017 [internet publication].[Full Text]
41. Gilbert GE, Wahlquist AH, eds. InfoPOEMs: induction of labor may be beneficial at 36 weeks with hypertension. J Natl Med Assoc. 2010 Feb;102(2):151-2.
42. Dowswell T, Middleton P, Weeks A. Antenatal day care units versus hospital admission for women with complicated pregnancy. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001803.[Abstract][Full Text]
43. Kiel DW, Dodson EA, Artal R, et al. Gestational weight gain and pregnancy outcomes in obese women: how much is enough? Obstet Gynecol. 2007 Oct;110(4):752-8.[Abstract]
44. Tita AT, Szychowski JM, Boggess K, et al; Chronic Hypertension and Pregnancy (CHAP) Trial Consortium. Treatment for mild chronic hypertension during pregnancy. N Engl J Med. 2022 May 12;386(19):1781-92.[Abstract][Full Text]
45. American College of Obstetricians and Gynecologists Practice Advisory. Clinical guidance for the integration of the findings of the Chronic Hypertension and Pregnancy (CHAP) Study. Apr 2022 [internet publication].[Full Text]
46. Abalos E, Duley L, Steyn DW, et al. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2018 Oct 1;(10):CD002252.[Abstract][Full Text]
47. Tuffnell DJ, Jankowicz D, Lindow SW, et al; Yorkshire Obstetric Critical Care Group. Outcomes of severe pre-eclampsia/eclampsia in Yorkshire 1999/2003. BJOG. 2005 Jul;112(7):875-80.[Abstract]
48. Shekhar S, Gupta N, Kirubakaran R, et al. Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta-analysis. BJOG. 2016 Jan;123(1):40-7.[Abstract]
49. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 203. Chronic hypertension in pregnancy. Obstet Gynecol. 2019 Jan;133(1):e26-50.[Abstract]
50. Medicines and Healthcare products Regulatory Agency. Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy. May 2019 [internet publication].[Full Text]
51. US Food and Drug Administration. FDA drug safety communication: FDA recommends against prolonged use of magnesium sulfate to stop preterm labor due to bone changes in exposed babies. May 2013 [internet publication].[Full Text]
52. Umesawa M, Kobashi G. Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis. Hypertens Res. 2017 Mar;40(3):213-20.[Abstract]
53. Yoder SR, Thornburg LL, Bisognano JD. Hypertension in pregnancy and women of childbearing age. Am J Med. 2009 Oct;122(10):890-5.[Abstract]
54. Fishel Bartal M, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. Am J Obstet Gynecol. 2022 Feb;226(2s):S819-34.[Abstract][Full Text]
55. Benschop L, Duvekot JJ, Roeters van Lennep JE. Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy. Heart. 2019 Aug;105(16):1273-8.[Abstract][Full Text]
56. Wenger NK, Lloyd-Jones DM, Elkind MSV, et al; American Heart Association. Call to action for cardiovascular disease in women: epidemiology, awareness, access, and delivery of equitable health care: a presidential advisory from the American Heart Association. Circulation. 2022 Jun 7;145(23):e1059-71.[Abstract][Full Text]
57. Haug EB, Horn J, Markovitz AR, et al. Life course trajectories of cardiovascular risk factors in women with and without hypertensive disorders in first pregnancy: the HUNT study in Norway. J Am Heart Assoc. 2018 Aug 7;7(15):e009250.[Abstract][Full Text]
58. Stuart JJ, Tanz LJ, Cook NR, et al. Hypertensive disorders of pregnancy and 10-year cardiovascular risk prediction. J Am Coll Cardiol. 2018 Sep 11;72(11):1252-63.[Abstract][Full Text]
59. O'Kelly AC, Michos ED, Shufelt CL, et al. Pregnancy and reproductive risk factors for cardiovascular disease in women. Circ Res. 2022 Feb 18;130(4):652-72.[Abstract][Full Text]
60. Paridisi G, Biaggi A, Savone R, et al. Cardiovascular risk factors in healthy women with previous gestational hypertension. J Clin Endocrinol Metab. 2006 Apr;91(4):1233-8.[Abstract][Full Text]
61. Forrester KJ, Barton JR, O'Brien JM, et al. The effect of gestational hypertension and gestational diabetes on neonatal outcome. Paper presented at: ACOG 54th annual clinical meeting. 6-10 May 2006. Washington, D.C. Obstet Gynecol. 2006;107(suppl 4):26S.
62. Agrawal A, Wenger NK. Hypertension during pregnancy. Curr Hypertens Rep. 2020 Aug 27;22(9):64.[Abstract]
63. Karjalainen L, Tikkanen M, Rantanen K, et al. Stroke in pregnancy and puerperium: validated incidence trends with risk factor analysis in Finland 1987-2016. Neurology. 2021 May 25;96(21):e2564-75.[Abstract]
64. Kremer C, Gdovinova Z, Bejot Y, et al. European Stroke Organisation guidelines on stroke in women: Management of menopause, pregnancy and postpartum. Eur Stroke J. 2022 Jun;7(2):I-XIX.[Abstract][Full Text]
65. Sep S, Smits L, Prins M, et al. Prediction tests for recurrent hypertensive disease in pregnancy, a systematic review. Hypertens Pregnancy. 2010 Jan;29(2):206-30.[Abstract]
66. Tucker KL, Mort S, Yu LM, et al; BUMP Investigators. Effect of self-monitoring of blood pressure on diagnosis of hypertension during higher-risk pregnancy: the BUMP 1 randomized clinical trial. JAMA. 2022 May 3;327(17):1656-65.[Abstract][Full Text]
67. Chappell LC, Tucker KL, Galal U, et al; BUMP 2 Investigators. Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: the BUMP 2 randomized clinical trial. JAMA. 2022 May 3;327(17):1666-78.[Abstract][Full Text]
68. World Health Organization. WHO guideline on self-care interventions for health and well-being, 2022 revision. Jun 2022 [internet publication].[Full Text]
69. Tucker KL, Taylor KS, Crawford C, et al. Blood pressure self-monitoring in pregnancy: examining feasibility in a prospective cohort study. BMC Pregnancy Childbirth. 2017 Dec 28;17(1):442.[Abstract][Full Text]
70. Tucker KL, Bowen L, Crawford C, et al. The feasibility and acceptability of self-testing for proteinuria during pregnancy: a mixed methods approach. Pregnancy Hypertens. 2018 Apr;12:161-8.[Abstract][Full Text]
71. Timpka S, Stuart JJ, Tanz LJ, et al. Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses' Health Study II: observational cohort study. BMJ. 2017 Jul 12;358:j3024.[Abstract][Full Text]
72. Meher S, Abalos E, Carroli G. Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003514.[Abstract][Full Text]