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 preeclampsia (thrombocytopenia, impaired renal or kidney function, pulmonary edema, or new-onset headache).
Patient is usually asymptomatic.
Patient requires regular monitoring of BP and urinalysis during the pregnancy to exclude preeclampsia 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 preeclampsia (thrombocytopenia, impaired renal or kidney function, pulmonary edema, or new-onset headache).
History and exam
Key diagnostic factors
- previously normotensive
- BP ≥140/90 mmHg
Other diagnostic factors
- >20 weeks' gestation
- absence of symptoms that suggest preeclampsia
- black or Hispanic ethnicity
- mother small for gestational age
- type 1 diabetes mellitus
1st investigations to order
- electrolytes, BUN, 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
- Hypertension, essential
- Perinatal forms guideline: a guide for completion of the British Columbia maternal and fetal levels of service classification tool (PSBC 1589)
- Hypertension in pregnancy: diagnosis and management
Diabetes type 2: should I take insulin?
Diabetes type 2: what treatments work?More Patient leaflets
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