Coping with High or Low Blood Pressure in Pregnancy

How to Deal With It

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Living with low or high blood pressure requires a comprehensive approach to managing the symptoms associated with hypotension and hypertension, which often includes medication and lifestyle changes. When you become pregnant, your doctor will work with you on how to best address these issues to keep you and your growing baby safe during these critical months of gestation. 

High Blood Pressure During Pregnancy: Preeclampsia 

High blood pressure during pregnancy is most often associated with preeclampsia, which is a pregnancy complication that causes a woman’s blood pressure to elevate. It can also cause damage to other organ systems, including the liver and kidneys.

What separates preeclampsia from high blood pressure is the fact that it only happens during pregnancy, and women with otherwise normal blood pressure levels can be diagnosed with this condition.

Preeclampsia occurs after 20 weeks of pregnancy, and if not treated, can lead to serious complications including, stillbirth, preterm deliveries, and even death for the mother.

Preeclampsia Symptoms

In addition to high blood pressure after week 20, some of the more common signs of preeclampsia to be aware of include:

  • Excess protein in the urine
  • Headaches, severe and more frequent
  • Nausea or vomiting
  • Abdominal pain, typically high on the right side of the belly
  • Blurred vision, temporary loss of vision or light sensitivity 
  • Decreased urine output

High Blood Pressure During Pregnancy: Chronic Hypertension

High blood pressure before pregnancy or before the 20-week mark is typically referred to as chronic hypertension or high blood pressure. If you have high blood pressure and become pregnant, your doctor will likely assess your readings to determine the stage of hypertension. 

According to the American Heart Association, there are three stages of hypertension:

  • Stage 1 hypertension: Systolic levels ranging from 130 to 139 mm Hg and diastolic levels at 80 to 89 mm Hg.
  • Stage 2 hypertension: Systolic levels 140 mm Hg or higher and diastolic levels 90 mm Hg or higher.
  • Stage 3 hypertension: Systolic levels higher than 180 mm Hg and/or diastolic levels above 120 mm Hg. 

At each prenatal visit, your doctor will take your blood pressure and make a note of it to compare to previous readings. If you fall into one of the hypertension categories, you may be asked to monitor your blood pressure from home or go into the office for more frequent blood pressure readings.

Complications

While many women who have hypertension prior to pregnancy do very well without too much risk, there are some complications to be aware of so that you and your doctor can come up with a plan to manage the symptoms.

According to Dr. Robert Atlas, an OB/GYN who specializes in high-risk pregnancy issues at Mercy Medical Center, physiologically, the effects of progesterone will lower your blood pressure during the first and second trimester of pregnancy, but it will increase back to pre-pregnancy levels in the third trimester. Additionally, he says the following are some of the more common complications associated with pregnancy and high blood pressure.

  • There is a 20 to 30 percent chance of developing superimposed preeclampsia if you have hypertension prior to pregnancy.
  • Increased risk of preterm birth and fetal growth problems.
  • Women who have underlying kidney problems have an even higher risk of complications in pregnancy. 

Treatment Options for High Blood Pressure

Similar to the treatment approaches for hypertension in non-pregnant patients, women who have high blood pressure prior to pregnancy can manage symptoms of hypertension through medication and lifestyle modifications.

Atlas says most mothers with elevated blood pressure will generally be treated with medications to lower the blood pressure. “We use Labetalol and Nifedipine often for patients as they have generally been shown to be safe in pregnancy,” he explains.

That said, Atlas does point out that some people may be on medications prescribed by Internists or Renal Doctors which are not safe in pregnancy, even though they are a superior medication for them. "Medications such as ACE and ARB inhibitors can be potentially harmful to the developing fetus," he explains.

In addition to medication, treating high blood pressure during pregnancy involves:

  • Eating a healthy diet rich in fruits, vegetables, lean protein, and complex carbohydrates
  • Exercising regularly
  • Managing stress levels
  • Avoiding alcohol and smoking

Low Blood Pressure During Pregnancy

It’s not uncommon to have periods of low blood pressure during pregnancy, especially if you had low blood pressure prior to becoming pregnant. While not as much of a concern as high blood pressure, it’s still important to address how having low blood pressure can impact your pregnancy.

A normal blood pressure reading is less than 120 mm Hg systolic and 80 mm Hg diastolic. With that in mind, anything below those numbers may be considered low blood pressure during pregnancy. 

In regards to complications related to lower numbers during pregnancy, Atlas says it really depends on if there are issues associated with the low blood pressure in general. “If a person who has low blood pressure does not have any symptoms, we would not be worried about that individual, but if a person who has low blood pressures is symptomatic, (i.e., dizzy, lightheaded, blurred vision, etc.) there would be some potential issues to be concerned about,” he explains. 

Low blood pressure does not have stages like high blood pressure. Anything less than 120 mm Hg systolic and 80 mm Hg diastolic may be considered low blood pressure.

Complications

While many women who have low blood pressure prior to pregnancy do very well without too much risk, there are some complications to be aware of. Atlas says one of the most concerning complications is dizziness because it can lead to fainting, falling, and injury, secondary to the fall. Additionally, some other complications or symptoms of low blood pressure include:

  • Nausea
  • Blurred vision
  • Fatigue
  • Rapid or shallow breathing

Treatment Options for Low Blood Pressure

The main goal in treating low blood pressure during pregnancy is symptom reduction, especially if you are experiencing dizziness and fainting. 

For the most part, you can manage symptoms of low blood pressure with lifestyle modifications such as: 

  • Staying hydrated 
  • Consuming enough calories to support you and your baby
  • Avoid standing for long periods of time
  • Move from a supine or prone position to a standing position slowly

“If a patient is on a medication that may cause low blood pressure, we would recommend discontinuing the medication,” explains Atlas. Like high blood pressure, treating low blood pressure with medication during pregnancy is only recommended when absolutely necessary.

Whether you’re dealing with low or high blood pressure, it’s always a good idea to schedule a preconception appointment with your doctor to discuss any complications or concerns you may have about getting pregnant. This is also the best time to collaborate on a plan to help manage your symptoms when you do become pregnant.

And if you are on any blood pressure medications, you should always talk with your physician to discuss the safety of your medication and whether or not you should take it during pregnancy. 

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Article Sources

Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • High Blood Pressure During Pregnancy. The Center for Disease Control and Prevention. 2019.

  • Mercy Medical Center, Atlas, R. Personal interview. 2019.

  • Preeclampsia. The Mayo Clinic. 2018.

  • Understanding Blood Pressure Readings. The American Heart Association. 2019.