Hypertension in Pregnancy

High blood pressure is one of the most common medical problems in pregnancy and can affect both mother and baby. Because the kidneys play a central role in blood pressure control, a nephrologist often works with the obstetrician to monitor and manage it, especially when kidney disease or protein in the urine is present.

What Is Hypertension in Pregnancy?

Hypertension in pregnancy refers to blood pressure readings that are persistently higher than normal before, during or shortly after pregnancy. It includes several different conditions, and the type matters because it guides monitoring and treatment.

• Chronic hypertension: high blood pressure present before pregnancy or detected early in pregnancy
• Gestational hypertension: high blood pressure that develops in the second half of pregnancy without other features
• Pre-eclampsia: high blood pressure with protein in the urine or signs of organ involvement, such as the kidneys or liver
• Chronic hypertension with superimposed pre-eclampsia

Risk Factors

Any pregnant woman can develop high blood pressure, but some are at higher risk.

• Pre-existing kidney disease or high blood pressure
• Diabetes or autoimmune conditions such as lupus
• Pre-eclampsia in a previous pregnancy
• First pregnancy, twin or multiple pregnancy
• Maternal age above 35 or excess body weight
• Family history of pre-eclampsia

Symptoms and Warning Signs

Raised blood pressure often causes no symptoms, which is why regular antenatal checks are important. Seek urgent medical care if you experience any of these warning signs.

• Severe or persistent headache
• Blurred vision, flashing lights or spots before the eyes
• Pain under the ribs or in the upper abdomen
• Sudden swelling of the face, hands or feet
• Breathlessness or reduced urine output
• Reduced movements of the baby

Diagnosis

Diagnosis is based on repeated blood pressure measurements, ideally with a properly sized cuff. Your doctors may also check urine for protein, blood tests for kidney and liver function and platelet count, and arrange ultrasound scans to monitor the baby. Home blood pressure monitoring may be recommended in some women.

If home monitoring is advised, measure your blood pressure while seated and rested, using a validated machine, and keep a written log to show your doctors. Report any reading that is higher than the limit your doctor has given you, even if you feel well.

Treatment and Monitoring

Treatment aims to keep blood pressure in a safe range, detect complications early and plan delivery at the right time. Decisions are shared between the obstetrician and the nephrologist or physician.

• Blood pressure medicines that are considered safe in pregnancy, chosen by your doctor
• Stopping or replacing medicines that are not recommended in pregnancy
• Regular checks of blood pressure, urine protein and blood tests
• Preventive measures advised by your obstetrician for women at high risk of pre-eclampsia
• Hospital care if pre-eclampsia becomes severe
• Continued monitoring after delivery, as blood pressure may stay high for some weeks

When to See a Nephrologist

A nephrologist review is helpful if you have kidney disease or long-standing high blood pressure and are planning a pregnancy, if protein is found in your urine, if your creatinine is raised, or if blood pressure remains high after delivery. Women who have had pre-eclampsia may have a higher long-term risk of high blood pressure and kidney disease, so periodic follow-up is sensible.

This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.