Defined by blood pressure (BP) ≥140/90 mmHg on two occasions (at least 4 hours apart) during pregnancy after 20 weeks' gestation in a previously normotensive patient, without the presence of proteinuria or other clinical features suggestive of pre-eclampsia (thrombocytopenia, impaired renal or kidney function, pulmonary oedema, or new-onset headache).
Patient is usually asymptomatic.
Patient requires regular monitoring of BP and urinalysis during the pregnancy to exclude pre-eclampsia and gestational diabetes.
Mild hypertension is managed with lifestyle modification and antihypertensive therapy.
Severe hypertension (BP ≥160/110 mmHg) requires admission for antihypertensive therapy.
For women ≥37 weeks' gestation, induction should be considered.
Gestational hypertension is defined by BP readings of ≥140/90 mmHg on two occasions at least 4 hours apart during pregnancy after 20 weeks’ gestation in a previously normotensive patient, without the presence of proteinuria (<300 mg in 24 hours) or other clinical features suggestive of of pre-eclampsia (thrombocytopenia, impaired renal or kidney function, pulmonary oedema, or new-onset headache).
History and exam
Key diagnostic factors
- presence of risk factors
- previously normotensive
- BP ≥140/90 mmHg
Other diagnostic factors
- >20 weeks' gestation
- absence of symptoms that suggest pre-eclampsia
- black or Hispanic ethnicity
- mother being small for gestational age
- type 1 diabetes mellitus
1st investigations to order
- electrolytes, urea, creatinine
- uric acid
Investigations to consider
- 24-hour BP monitoring
- fetal ultrasound
- proteinuria (spot testing, 24-hour urine collection)
<37 weeks' gestation
≥37 weeks' gestation
Aparna Sundaram, DO, MBA, MPH
Board-certified, General Preventive Medicine & Public Health
Preventive Medicine Consultants, PLLC
AS declares that she has no competing interests.
Caroline Apovian, MD
Associate Professor of Medicine
Boston University School of Medicine
CA declares that she has no competing interests.
James Walker, MD, FRCP(Glas), FRCP(Edin), FRCOG
Professor of Obstetrics and Gynaecology
St James's University Hospital
JW declares that he has no competing interests.
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