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Monitor blood pressure during pregnancy

High blood pressure during pregnancy requires rest, and possibly medication, preferably with labetalol or nifedipine.

High blood pressure in a pregnant woman can lead to severe complications for the mother and the fetus.

Blood pressure should be monitored at each ante-natal visit. Blood pressure is considered to be high if it is over or equal to 140/90 mm Hg.

When blood pressure is high after 20 weeks of pregnancy, this is generally due to gestational hypertension, which is a placental disorder. Pre-eclampsia (failure of blood supply to the placenta) is confirmed when there are other symptoms, particularly protein in the urine. Pre-eclampsia can lead to severe complications for the mother (damage to various organs, risk of stroke, etc.) and the infant (especially growth retardation).

Rest and reduced physical effort seem to lessen the risk of severe hypertension, i.e. above or equal to 160/110 mm Hg. In the case of severe hypertension, medication and hospitalisation for monitoring are required.

Labetalol is the antihypertensive treatment of choice during pregnancy, with nifedipine as an alternative. Conversely, angiotensin-converting enzyme inhibitors, angiotensin II antagonists and aliskiren should be avoided due to the risks of malformation and toxicity for the fetus.

After the birth, the mother’s blood pressure should continue to be monitored.

©Prescrire February 2011

"Management of uncomplicated hypertension during pregnancy" Prescrire Int 2011; 20 (113): 50-51. (Pdf, subscribers only)
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