Hypertension in Pregnancy: Management and Clinical Approach
Hypertension during pregnancy is a significant medical condition that can develop unexpectedly, even in women who initially show no risk factors. Throughout antenatal follow-up, elevated blood pressure may appear in later stages of pregnancy and lead to serious maternal and fetal complications if not properly managed.
How Common Is Hypertension in Pregnancy?
Hypertensive disorders complicate approximately 12–22% of all pregnancies, meaning that 1 to 2 out of every 10 pregnant women may develop high blood pressure.
When combined with preeclampsia—a condition characterized by elevated blood pressure and protein leakage in the urine—hypertension poses severe risks to both mother and baby.
In the United States, around 17% of maternal deaths related to pregnancy are attributed to hypertensive disorders.
What Is Preeclampsia?
Preeclampsia is a disorder that typically develops in the second half of pregnancy (after 20 weeks) and is defined by:
- High blood pressure, and
- Proteinuria (the presence of protein in urine).
It occurs in 5–8% of pregnancies.
While preeclampsia can present in a mild form, in some cases it progresses rapidly to severe or malignant hypertension, leading to dangerous spikes in blood pressure.
Potential Complications for the Mother
If untreated, preeclampsia and gestational hypertension can cause life-threatening complications such as:
- Intracranial hemorrhage (sudden bleeding in the brain)
- Placental abruption (premature separation of the placenta)
- Disseminated intravascular coagulation (DIC) — a widespread clotting disorder
- Acute tubular necrosis (sudden kidney injury)
These complications are major contributors to maternal morbidity and mortality.
Potential Risks for the Baby
Hypertension in pregnancy also has serious consequences for the fetus, including:
- Prematurity (preterm birth)
- Intrauterine Growth Restriction (IUGR) — the baby being smaller than expected for gestational age
- Intrauterine hypoxia — lack of oxygen supply to the fetus
- Ischemic encephalopathy — brain injury caused by oxygen deprivation
For this reason, close fetal and maternal monitoring throughout pregnancy is essential.
Monitoring and Management of Hypertension in Pregnancy
For women with high blood pressure or those at risk of developing it, the following measures are typically taken:
- Regular blood pressure monitoring
- Urine testing to check for protein leakage
- Blood tests to assess kidney and liver function
- Frequent fetal ultrasounds to evaluate growth and well-being
- Early delivery planning, if indicated
Effective management of hypertensive disorders in pregnancy requires early intervention and a multidisciplinary approach, involving collaboration between obstetricians, perinatologists, and internal medicine specialists.
Such coordinated care plays a critical role in protecting both maternal and fetal health, ensuring the safest possible pregnancy outcome.
