Hypertension

There are several different conditions which result in high blood pressure during  pregnancy. You may have been given a diagnosis of either:

Essential hypertension - high blood pressure presenting before 20 weeks pregnant.

Pregnancy induced (gestational) hypertension - high blood pressure presenting after 20 weeks pregnant.

Pre-eclampsia - high blood pressure presenting after 20 weeks pregnant with protein in your urine.

Severe pre-eclampsia - very high blood pressure presenting after 20 weeks pregnant with symptoms including protein in your urine and abnormal blood tests.

HELLP syndrome - very high blood pressure presenting after 20 weeks pregnant with symptoms including protein in your urine and very abnormal blood tests including haemolysis, elevated liver enzymes and low platelets. 

What happens after delivery whilst I am still in hospital?

You will be monitored closely. As pre-eclampsia can worsen in the first few days after delivery and, up to half of the women who develop eclampsia (convulsions) do so after delivery, you may need to stay in hospital for several days. During this time your blood pressure will be regularly measured.

You may need to continue taking medication to lower your blood pressure. Your medication may be changed but you will be given a medication which is safe during breast feeding.

You may need repeat blood tests if these were abnormal during pregnancy or labour.

What happens after I go home?

Your community midwife/maternity care assistant will continue to monitor your blood pressure during their visit. If your blood pressure starts to fall you may be advised to reduce or stop medication. Most women who start on blood pressure medication during pregnancy can stop their medication a few days after birth.

If you still need to take blood pressure medication after two weeks you will be asked to contact your GP for further advice. If you were on blood pressure medication before you were pregnant you are likely to need to continue the medication in the long term.

If your blood tests are still abnormal you may need further tests and these will be done at your GP practice.

Are there any symptoms I should look out for?

If you had pre-eclampsia you should look out for any of the following symptoms and contact your community midwife urgently if you are concerned:

  • Severe headache
  • Blurred or altered vision
  • Confusion
  • Sudden swelling of your face, hands or feet.

Do I require any follow up?

If you:

  • are still taking medication for your blood pressure at two weeks you should see your GP
  • are still taking medication which was started during pregnancy at 6 weeks after birth your GP may need to do some more investigations to look for the cause of your high blood pressure.
  • had protein in your urine during pregnancy you should have a urine sample tested at your eight week check.

You will be offered an appointment to see your obstetrician at the hospital if you had any of the following problems:

  • Delivery before 28 weeks because of pre-eclampsia
  • Eclampsia
  • Admission to the Intensive Care Unit (ITU) after your delivery
  • HELLP syndrome.

How can I prevent high blood pressure in my next pregnancy?

It has been shown that women who are overweight have an increased risk of high blood pressure in pregnancy. You should aim to have a normal BMI (19–24 kg/m2) before you conceive your next pregnancy.

All women who have high blood pressure in pregnancy are advised to take low dose (75mg) Aspirin per day from 12 weeks until birth in their next pregnancy to reduce the risk of high blood pressure. Aspirin is known to be safe to take in pregnancy although was not originally designed for this use. Your GP would need to prescribe this for you in any future pregnancy.

In a future pregnancy you would be advised to be under the care of a consultant obstetrician and would be seen at least once in the hospital antenatal clinic early in the pregnancy.

What are my future risks?

If you had a diagnosis of gestational hypertension you:

  • have a risk of gestational hypertension between 16- 47%
  • have a risk of pre-eclampsia between two - seven % in your next pregnancy
  • have an increased risk of hypertension in later life and so you are advised to have a blood pressure check every five years.

If you had a diagnosis of pre-eclampsia you:

  • have a risk of gestational hypertension between 13-53%
  • have a risk of pre-eclampsia of 16% in your next pregnancy
  • have an increased risk of hypertension in later life so you are advised to have a blood pressure check annually.

If you had a diagnosis of severe pre-eclampsia, eclampsia or HELLP syndrome:

  • if you delivered between 28-34 weeks you have a 25% risk of pre-eclampsia in your next pregnancy
  • if you delivered before 28 weeks you have a 55% risk of pre-eclampsia in your next pregnancy
  • you have an increased risk of hypertension and its complications in later life and should have a blood pressure check annually.

For more information visit www.nhs.uk/conditions/pregnancy-and-baby/pages/hypertension-blood-pressure-pregnant