High Blood Pressure During Pregnancy: How to Recognize and Manage It for the Health of Mother and Baby

High blood pressure during pregnancy is diagnosed when systolic blood pressure is 140 mmHg or higher and/or diastolic blood pressure is 90 mmHg or higher, confirmed by repeated measurements taken in a clinic or hospital on two separate occasions or at least 15 minutes apart.

Severe hypertension is defined as blood pressure readings of 160/110 mmHg or higher.

Several forms of hypertension can occur during pregnancy, each with different implications for monitoring and treatment:

• Gestational hypertension, which develops after the 20th week of pregnancy without evidence of organ damage and usually resolves within six weeks after delivery. It is associated with an increased risk of preeclampsia, preterm birth, placental abruption, and future cardiovascular disease.
• Chronic hypertension, which is present before pregnancy or diagnosed early in gestation.
• Chronic hypertension with superimposed complications.
• Preeclampsia, the most complex form, which affects not only blood pressure but also other organs.

"Correctly identifying the type of hypertension is essential for assessing the level of risk and selecting the most appropriate management strategy," explains Dr. Castelvecchio.

During pregnancy, a woman's body undergoes significant physiological changes to ensure an adequate blood supply to the developing baby through the placenta. The cardiovascular system also adapts to these changes, and in most cases, this process occurs without complications. However, in some women, these adaptive mechanisms do not function optimally, increasing the risk of developing high blood pressure.

"The most common risk factors include:

• an individual genetic predisposition;
• a first pregnancy;
• a multiple pregnancy, such as twins.

Maternal age, whether very young or advanced, as well as conditions such as obesity, diabetes, and kidney disease can also increase the risk. In some cases, however, no specific cause can be identified," explains the specialist.

High blood pressure during pregnancy can remain silent for a long time without causing noticeable symptoms. This is why routine blood pressure measurement during prenatal visits is essential and remains one of the most effective preventive tools.

When symptoms do occur, they may include:

• persistent headaches that feel different from usual;
• vision changes, such as blurred vision or flashing lights;
• sudden swelling of the face, hands, or legs;
• pain in the upper abdomen;
• rapid, unexplained weight gain;
• reduced fetal movements.

"Even a single one of these symptoms should prompt immediate medical evaluation," emphasizes Dr. Castelvecchio.

If left untreated or poorly controlled, hypertension during pregnancy can pose significant risks for both the mother and the baby.

For the mother, it increases the likelihood of:

• severe preeclampsia;
• placental abruption;
• damage to organs such as the kidneys and liver.

It is also associated with a higher long-term risk of cardiovascular disease.

For the baby, the main risks include:

• fetal growth restriction (intrauterine growth restriction);
• preterm birth;
• low birth weight;
• fetal distress.

"It is important to stress that, with early diagnosis and appropriate monitoring, most pregnancies have a positive outcome," Dr. Castelvecchio explains.

Preeclampsia: One of the Most Serious Pregnancy Complications

Preeclampsia is one of the most significant complications associated with hypertension during pregnancy. It usually develops after the 20th week of gestation and can affect multiple organs in addition to the cardiovascular system.

"Preeclampsia is a systemic condition that may involve the kidneys, liver, and blood-clotting system," explains Dr. Castelvecchio.

In addition to elevated blood pressure, signs may include:

• proteinuria (protein in the urine);
• impaired liver or kidney function;
• a reduced platelet count;
• neurological symptoms such as severe headaches or visual disturbances.

In severe cases, preeclampsia may progress to eclampsia, a medical emergency characterized by seizures or loss of consciousness that cannot be explained by other neurological disorders and may occur alongside all the signs and symptoms of preeclampsia. Without prompt treatment, eclampsia can lead to coma or even death.

Diagnosis is based on repeated blood pressure measurements together with clinical and laboratory tests to assess both maternal and fetal health, including:

• blood tests;
• urine tests;
• obstetric ultrasound examinations to monitor fetal growth;
• fetal well-being assessments.

In some cases, home blood pressure monitoring may also be recommended.

Treatment is tailored to the severity of the condition. In mild cases, close maternal and fetal monitoring may be sufficient. When medication is required, doctors prescribe pregnancy-safe antihypertensive medications, selected according to their proven safety and effectiveness.

Lifestyle measures may also be recommended alongside medical treatment, including:

• following a balanced diet;
• reducing salt intake;
• engaging in moderate physical activity;
• managing stress under medical supervision.

More severe cases may require hospitalization for intensive monitoring.

Planning Delivery

The timing and mode of delivery are determined individually based on:

• the mother's and baby's condition;
• the severity of hypertension;
• the stage of pregnancy.

"In some situations, an earlier delivery may be recommended to reduce the risks, always with the primary goal of protecting both mother and baby," says Dr. Castelvecchio.

Although hypertension during pregnancy cannot always be prevented, careful management of risk factors and early monitoring can significantly reduce the likelihood of complications. Key preventive measures include:

• checking blood pressure before conception;
• managing chronic medical conditions;
• attending all scheduled prenatal appointments.

Women should consult a cardiologist if they experience repeatedly elevated blood pressure readings or symptoms such as persistent headaches, visual disturbances, upper abdominal pain, sudden swelling, or reduced fetal movements.

"Prompt medical assessment is one of the most important factors in ensuring a safe pregnancy," concludes Dr. Serenella Castelvecchio.

Hypertensive disorders of pregnancy, particularly preeclampsia, are known to increase the long-term risk of developing cardiomyopathy and heart failure later in life.

To reduce this risk, women should adopt a healthy lifestyle both before and during pregnancy and remain aware of the importance of regular cardiovascular follow-up. Monitoring and promptly treating cardiovascular risk factors, such as high blood pressure, high cholesterol, and diabetes—are essential for reducing the long-term risk of heart disease.