19th June 2026

Gestational hypertension

Background

Gestational hypertension (GH) is hypertension (blood pressure > 140/90 mmHg on two occasions measured at least 4 hours apart) that develops after 20 weeks’ gestation in previously normotensive women in the absence of proteinuria. GH is a common complication in pregnancy and affects 6-10% of pregnancies globally.

Risk factors 

• Age > 40 years 
• Pre-existing hypertension, including essential hypertension, preeclampsia or gestational hypertension
• Pre-existing renal or vascular disease
• Obesity
• Diabetes
• Nulliparous
• Multiple pregnancy
• Pregnancy interval > 10 years
• Family history of preeclampsia
• Black or Hispanic ethnicity

Clinical features

• Most women are asymptomatic 
• Headache that is persistent and severe
• Visual disturbances 
• Women should be asked about symptoms that suggest pre-eclampsia, e.g. weight gain, peripheral oedema, headaches, and upper abdominal pain

Diagnosis and investigations

Table 6. Investigations for gestational hypertension

Severity classification of gestational hypertension:

• Hypertension: systolic BP ≥ 140/90 mmHg or diastolic BP ≥ 90 mmHg, or both
• Severe hypertension: BP persistently ≥ 160/100 mmHg for a minimum of 4 hours

Complications

• Pre-eclampsia: a severe form of GH, characterised by hypertension, proteinuria and end-organ damage
• Placental abruption: the placenta separates from the uterine wall, causing heavy bleeding and foetal distress
• Intrauterine growth restriction: leads to low birth weight and other complications
• Pre-term delivery: may be necessary if GH is severe or if there are other complications

Management

The management of GH depends on the severity of the condition, and ranges from close monitoring of BP and urine protein levels in mild GH to admission to hospital and antihypertensive treatment in the context of high or persistently elevated BP (summarised in Table 2).

Important considerations

• Lifestyle modifications: the same advice on rest, exercise and work to women with chronic hypertension 
• Antihypertensive treatment: Oral labetalol is 1st line (avoid in asthma). Alternatives include: 
  • Nifedipine if worsening hypertension previously controlled with oral labetalol 
  • Methyldopa, if labetalol or nifedipine are not suitable; avoid postpartum due to risk of depression, and change to an alternative within 2 days of delivery if started.
• Planned early delivery. Indications include the following:
  • Preterm labour or premature rupture of membranes
  • Vaginal bleeding
  • Abnormal foetal testing
  • Intrauterine growth restriction
  • Development of pre-eclampsia or eclampsia
  • Evidence of end-organ damage (e.g. neurological, hepatic or renal dysfunction)
• Corticosteroids (e.g. betamethasone), if planned early delivery < 37 weeks’ gestation is necessary to promote foetal lung maturation, as indicated
• Magnesium sulphate if planned early delivery < 34 weeks’ gestation, for neuroprotection, as indicated 
• Low-dose aspirin (PO 75mg) in subsequent pregnancies to reduce the risk of pregnancy-induced hypertension and pre-eclampsia

Table 7. Management of gestational hypertension

Postnatal investigation, monitoring and treatment

• Continue monitoring the mother’s BP. Measure BP daily for the first 2 days after birth, at least once between day 3 and day 5, and as clinically indicated afterwards.
• Continue antihypertensive treatment if required. Start treatment if BP ≥ 150/100 mmHg and they were not treated during pregnancy. Reduce treatment dosages if BP falls < 130/80 mmHg
• Follow-up with GP or specialist 6-8 weeks after birth, or 2 weeks after transfer to community care for women who remain on antihypertensive treatment