Coping With High or Low Blood Pressure in Pregnancy

Doctor taking pregnant woman's blood pressure

PeopleImages / Getty Images

In pregnancy, just like at any other time in life, high blood pressure (known as hypertension), requires a comprehensive management approach. Low blood pressure (known as hypotension), whether in pregnancy or otherwise, is less likely to be a cause for concern but will still be monitored.

Whether your blood pressure condition pre-existed your pregnancy or started in pregnancy (gestational), your doctor will work with you on how to best address your blood pressure issues to keep you and your growing baby safe. 

Overview

High and low blood pressure can happen in pregnancy for a variety of reasons, sometimes it occurs as a complication of pregnancy and other times due to a pre-existing condition. When high blood pressure develops for the first time during pregnancy, it is called gestational high blood pressure or hypertension.

Regardless of the cause, your health care provider will closely monitor your blood pressure throughout your pregnancy and treat your specific condition as needed. Below we explore the typical causes of high and low blood pressure in pregnancy, including preeclampsia, a serious high blood pressure condition. We will also review risk factors, symptoms, treatment options, and coping strategies.

High Blood Pressure

High blood pressure in pregnancy is a serious complication that your doctor will track at each prenatal visit. In pregnancy, both gestational high blood pressure and chronic hypertension carry the risk of developing into preeclampsia. All types of high blood pressure can share the same symptoms, including:

  • Dizziness
  • Headaches
  • Lightheadedness
  • Pounding feeling in the head or chest

Other times, there are no discernable symptoms other than a high reading, which is why it's critical to get regular prenatal exams where your blood pressure will be checked routinely. The appearance of high blood pressure or a sudden spike in blood pressure can be dangerous to both mother and baby. Let's take a closer look at what could be going on.

Preeclampsia

High blood pressure during pregnancy is most often associated with preeclampsia, which is a serious 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 regular 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. Plus, just like gestational high blood pressure, it normally goes away after the postpartum period.

Preeclampsia typically occurs after 20 weeks of pregnancy. If untreated, it can lead to serious complications including, stillbirth, preterm deliveries, and even death for the mother.

Risk Factors

Risk factors that increase the odds of developing preeclampsia in pregnancy include any of the following:

  • It's your first pregnancy
  • You had preeclampsia in a previous pregnancy
  • You had chronic hypertension before week 20
  • You are Black
  • You're carrying multiple fetuses
  • You have obesity
  • You have certain health conditions, including type 1 or type 2 diabetes, lupus, and chronic kidney disease
  • You became pregnant using in vitro fertilization (IVF), egg donor, or donor insemination
  • You are over 40

Symptoms

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

  • Abdominal pain, typically high on the right side of the belly
  • Blurred vision, temporary loss of vision or light sensitivity 
  • Decreased urine output
  • Difficulty breathing
  • Excess protein in the urine
  • Headaches that are severe, more frequent than normal, and/or don't go away
  • Nausea or vomiting
  • Sudden weight gain
  • Swelling of the face and hands

Some women do not experience any noticeable symptoms of preeclampsia (or gestational hypertension), making regular prenatal check-ups all the more important to ensure any changes in blood pressure are monitored throughout pregnancy.

Additionally, while rare, some women develop preeclampsia after delivery, typically within 48 hours, but it can occur within six weeks of having a baby. This is called postpartum preeclampsia and a condition that shares the symptoms of preeclampsia and is treated similarly.

Treatments for preeclampsia follow similar protocols for chronic hypertension, which are discussed in detail below.

Chronic Hypertension

High blood pressure before pregnancy or that occurs before the 20-week mark is typically referred to as chronic hypertension or gestational high blood pressure. In either case, your doctor will likely assess your readings to determine the stage of hypertension. 

According to the American Heart Association, there are five blood pressure classifications, including three stages of hypertension:

  • Normal: Systolic levels less than 120 mmHg AND diastolic levels less than 80 mmHg
  • Elevated: Systolic levels ranging from 120 to 129 mmHg AND diastolic levels less than 80 mmHg
  • Stage 1 Hypertension: Systolic levels ranging from 130 to 139 mmHg AND/OR diastolic levels at 80 to 89 mmHg
  • Stage 2 Hypertension: Systolic levels 140 mmHg or higher AND/OR diastolic levels 90 mmHg or higher
  • Stage 3 Hypertensive Crisis (consult your doctor immediately): Systolic levels higher than 180 mmHg AND/OR diastolic levels above 120 mmHg

At each prenatal visit, your doctor will take your blood pressure and make a note of it to compare to previous readings. If you are in stage 3, you will need immediate care. Uncontrolled stage 3 hypertension can induce a hypertensive crisis, which can cause serious complications including organ failure, heart attack, and stroke.

If you fall into one of the other hypertension categories (stage 1 or 2) or have elevated blood pressure, you may be asked to monitor your blood pressure from home or go into the office for more frequent blood pressure readings. This will also be the case for those diagnosed with preeclampsia.

High Blood Pressure Complications

While many women who have hypertension prior to pregnancy do very well, there are some potential complications to be aware of. You and your doctor will come up with a plan to manage your symptoms. Additionally, women who have chronic or gestational hypertension are at risk of developing preeclampsia in their second or third trimesters.

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 typically lower your blood pressure during the first and second trimester of pregnancy, but blood pressure will return back to pre-pregnancy levels in the third trimester.

Additionally, he says the following are some of the more common complications associated with high blood pressure in pregnancy:

  • 20% to 30% chance of developing superimposed preeclampsia, if you have hypertension prior to pregnancy
  • Increased risk of preterm birth
  • Increased risk of fetal growth problems, which may result in low birth weight
  • Women who have underlying kidney problems have an even higher risk of blood pressure complications in pregnancy 

Treating 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. These are the same treatments used with preeclampsia as well.

Dr. 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, Dr. Atlas does point out that some people may be on medications prescribed by internists or renal doctors that are not safe to take in pregnancy. "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
  • Limiting sodium
  • Exercising regularly
  • If overweight, limiting weight gain
  • Managing stress levels
  • Avoiding alcohol
  • Quitting smoking

If high blood pressure spikes too high and does not respond to medication and/or lifestyle accommodations, other possible treatments include bed rest and induction of labor. Particularly with preeclampsia, if a woman's pressure is too high and her baby is viable (especially when close to full term) inducing labor will be considered.

Low Blood Pressure

Normal blood pressure is a reading that is anything less than 120 mm Hg systolic and 80 mm Hg diastolic. There is no official barometer for distinguishing "low" blood pressure from normal, and within limits, lower readings are usually a good thing.

In fact, it’s common to have periods of low blood pressure during pregnancy, especially in the first 24 weeks and/or if you have had low blood pressure prior to becoming pregnant. Generally, low blood pressure is not a concern unless symptoms accompany it.

“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 pressure is symptomatic, (i.e., dizzy, lightheaded, blurred vision, etc.) there would be some potential issues to be concerned about,” explains Dr. Atlas. 

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 normal to low blood pressure.

Low Blood Pressure Complications

While many women who have low blood pressure prior and during pregnancy do not have any related issues, there are some complications to be aware of.

Some symptoms of low blood pressure include:

  • Blurred vision
  • Cold, clammy, pale skin
  • Dehydration and unusual thirst
  • Depression
  • Dizziness or lightheadedness
  • Fatigue
  • Lack of concentration
  • Nausea
  • Rapid or shallow breathing

One of the most concerning complications is dizziness because it can lead to fainting, falling, and injury, secondary to the fall. Additionally, research has shown a link between low blood pressure and increased symptoms of morning sickness.

Treating 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, many people can manage symptoms of low blood pressure with lifestyle modifications, such as: 

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

Blood pressure tends to be lower when a person is at rest and can cause blood to pool in the legs, so it's important to move positions or get up from a seated or reclining position slowly to avoid the onset of symptoms, such as dizziness or fainting.

“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—and only with medications known to be safe during pregnancy are used.

A Word From Verywell

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

If you develop low or high blood pressure (including preeclampsia) while pregnant, the same is true. You'll want to work with your doctor to effectively manage your symptoms to keep both you and your baby safe.

Was this page helpful?
Article Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Understanding Blood Pressure Readings. American Heart Association.

Additional Reading
Related Articles