What to Know About High Blood Pressure and Pregnancy

High blood pressure (hypertension) can increase the risk of complications for pregnant people and their babies.

High blood pressure during pregnancy can affect the development of the placenta, which provides nutrients and oxygen to the baby. This can lead to an early delivery, low birth weight, placental separation (abruption), and other complications for the baby.

With the proper management of high blood pressure, though, pregnant people with this condition can minimize the risk of these complications. Your healthcare provider will also closely monitor your condition and pregnancy if you have high blood pressure.

High Blood Pressure and Fertility

Fertility issues related to high blood pressure can affect both parents. Besides the condition itself, medications used to treat high blood pressure can have an impact on fertility as well.

Females living with high blood pressure have been found to have more trouble conceiving. One study revealed that the risk of pregnancy loss, or miscarriage, increased by 18% for every 10 mmHg increase in a person’s diastolic blood pressure.

Chronic high blood pressure before pregnancy has also been linked to poor egg quality due to excessive estrogen production, which is known to affect fertility. If a poor-quality egg is fertilized, the embryo may not be able to implant in the uterus. Even if the embryo succeeds at implanting, it may not be able to develop properly and may result in a miscarriage.

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Similarly, males with high blood pressure were found to have a lower semen volume, sperm motility (the ability of the sperm to move properly), total sperm count, and motile sperm count compared to people without the condition.

Sperm must be able to swim up to the fallopian tube to fertilize the egg for conception to occur. If sperm move too slowly or not at all, conception may not happen.

Additionally, medications to control high blood pressure like angiotensin receptor inhibitors and calcium channel blockers could impact fertility.

The use of beta-blockers, another type of antihypertensive drug, was associated with lower semen volume, concentration, motility, total sperm count, and total motile sperm count.

High Blood Pressure and Gestation

High blood pressure may increase your risk of complications during pregnancy.

You can have hypertension in pregnancy either as a continuation of a chronic problem that you had before you were pregnant or as a new problem that develops during your pregnancy, which is called gestational hypertension or preeclampsia.

Hypertensive disorders occur in 6% to 8% of pregnancies around the world, and about a quarter of hospital admissions for mothers during their pregnancy.

Risks

High blood pressure during pregnancy can prevent the placenta from receiving enough blood, which can lead to a low birth weight. Other complications can occur from high blood pressure during pregnancy, including:

• Seizures in the mother
• Stroke
• Kidney failure
• Liver problems
• Blood clotting problems
• Placental abruption, where the placenta pulls away from the wall of the uterus, causing distress to the baby and bleeding in the mother
• Premature delivery of the baby

Treatment

Whether or not high blood pressure is treated in pregnancy depends on a woman's blood pressure ranges, and there can be challenges even if medications are used.

Ideally, pregnant people will have already stopped smoking or consuming alcohol. Other lifestyle changes that can help lower blood pressure include dietary changes like limiting salt intake and exercise, but they should only be done under the direction of your healthcare provider. Stress reduction and meditation may be helpful, too.

Medications that could be used to treat high blood pressure during pregnancy include:

• Methyldopa
• Labetalol
• Procardia (nifedipine)

Your healthcare provider may also recommend more prenatal visits, ultrasounds, and other tests—such as monitoring your baby’s heart rate or activity—to ensure the baby’s well-being.

Concerning Symptoms

If your blood pressure becomes high, such as the case with preeclampsia, you may experience symptoms that could indicate more extreme complications for your pregnancy.

Signs and symptoms of severe hypertension include:

• Blood pressure above 160/110 mmHg
• Impaired liver or kidney function
• Increased levels of protein in urine samples
• Low platelet counts
• Severe headache
• Vision changes

There is no clear way to prevent preeclampsia, but those at higher risk may be advised to take daily low-dose aspirin starting after 12 weeks of pregnancy to reduce their chances of developing this condition.

In severe cases, your healthcare provider may decide to deliver your baby. This is a decision between you and your doctor based on your individual risks and how your blood pressure is affecting the health of you and your baby.

High Blood Pressure and Postpartum

Even after delivery, your healthcare team will continue to monitor your blood pressure closely. Your blood volume and fluid levels shift dramatically in the postpartum period, and this can cause significant fluctuations in blood pressure. Eclampsia or preeclampsia can develop up to six weeks after delivery.

Impact on Recovery

If you develop complications of high blood pressure, especially if they advance to things like blood clotting or preeclampsia, you may not be discharged right away.

In some cases, high blood pressure that develops in pregnancy may even become chronic. In about 10% of cases, your doctor may find another reason for your hypertension after delivery, but if high blood pressure continues, you may need antihypertensive medications.

Breastfeeding

Medications used to control blood pressure are generally secreted into breast milk at very low levels that won’t harm your baby, but there are some medications that doctors prefer to avoid to be extra cautious. These include Norvasc (amlodipine), diuretics, Tenormin (atenolol), and methyldopa.

These medications can cause postnatal depression or a decrease in milk supply for breastfeeding mothers. This means that medications you take to control blood pressure during pregnancy, like methyldopa, may have to be replaced with other medications after delivery.

Suggested medications to treat blood pressure in breastfeeding mothers include:

• Labetalol
• Procardia (nifedipine)
• Enalapril

Summary

High blood pressure and some medications used to treat the condition can affect fertility in males and females, making it more difficult to conceive. It can also increase the risk of complications for you and your baby. Keeping your blood pressure under control can reduce that risk, and your healthcare provider will help you come up with the best plan during and after your pregnancy.

A Word From Verywell

Your body goes through a lot of changes during pregnancy. Even if you didn’t have any health issues like high blood pressure before pregnancy, the strain of the increased blood volume from your pregnancy and the strain on your cardiovascular system can trigger new problems.

If you have high blood pressure before you become pregnant or if you develop hypertension during your pregnancy, your healthcare provider will keep a close eye on your blood pressure throughout and after your pregnancy. If you are already taking medications to control your blood pressure, these may need to be stopped or changed.

Your doctor will advise you if lifestyle changes or medications are needed to control your blood pressure and prevent complications. Call your doctor immediately if you are experiencing severe headaches or other symptoms of very high blood pressure during pregnancy.

Frequently Asked Questions

What causes high blood pressure during pregnancy?

In some cases, high blood pressure existed before pregnancy, but it can also develop as a result of increased weight and blood volume, higher demand on the cardiovascular system, or unusual progression of the pregnancy (including problems with the placenta).

What is considered high blood pressure during pregnancy?

According to ACOG, a pregnant woman has gestational hypertension if she has a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher. The high blood pressure must first happen after 20 weeks of pregnancy. She must also have a history of normal blood pressure prior to becoming pregnant.

How do you control high blood pressure during pregnancy?

High blood pressure during pregnancy is controlled with a combination of lifestyle changes, such as lowering your salt intake and exercising, and antihypertensive medications. Some medications may not be safe, and your doctor will choose an appropriate one for you.

How common is high blood pressure during pregnancy?

Up to 8% of women around the world experience high blood pressure during their pregnancy, and 2% face postpartum hypertension.

What does a high blood pressure neck ache feel like in pregnancy?

Mothers who have high blood pressure during their pregnancy have an increased chance of developing conditions like preeclampsia. A sudden, sharp headache that won’t go away and aching or stiffness in the neck and shoulders can occur with either of these conditions. See your healthcare provider if you experience these symptoms.