Gestational hypertension is defined as a blood pressure (BP) of ≥140/90 mmHg on two occasions (at least 4 hours apart) after 20 weeks' gestation in a previously normotensive woman, without the presence of proteinuria or other clinical features (thrombocytopenia, impaired renal or kidney function, pulmonary edema, or new-onset headache) suggestive of preeclampsia.
Women with gestational hypertension are usually asymptomatic.
Women require regular monitoring of BP and urinalysis during the pregnancy to exclude preeclampsia.
Hypertension (systolic BP of 140 mmHg or more or diastolic BP of 90 mmHg or more, or both) is managed with lifestyle modification and/or antihypertensive therapy.
Severe hypertension (BP ≥160/110 mmHg) requires admission to the hospital 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 after 20 weeks' gestation in a previously normotensive woman, without the presence of proteinuria (<300 mg in 24 hours) or other clinical features (thrombocytopenia, impaired renal or kidney function, pulmonary edema, or new-onset headache) suggestive of preeclampsia.
History and exam
Key diagnostic factors
- previously normotensive
- BP ≥140/90 mmHg
Other diagnostic factors
- >20 weeks' gestation
- absence of symptoms that suggest preeclampsia
- maternal age >35 years
- black or Hispanic ethnicity
- mother small for gestational age
- type 1 diabetes mellitus
1st investigations to order
- electrolytes, BUN, creatinine
- placental growth factor
Investigations to consider
- uric acid
- 24-hour BP monitoring
- fetal ultrasound
- umbilical artery Doppler velocimetry
- proteinuria (spot testing, 24-hour urine collection)
- Hypertension, essential
- Hypertensive disorders of pregnancy: diagnosis, prediction, prevention, and management
- Diagnosis and treatment of hypertension and pre-eclampsia in pregnancy in Aotearoa New Zealand
Diabetes type 2: should I take insulin?
Diabetes type 2: what treatments work?More Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer