Postnatal information for women and birthing people with raised blood pressure in pregnancy

High blood pressure (known as hypertension) is when your blood pressure reading is higher than 140/90mmHg. Everyone’s blood pressure will be slightly different, what’s considered high or low for you may be normal for someone else. High blood pressure puts people at risk of serious and potential life-threatening health conditions such as:

• Heart disease
• Heart attacks
• Strokes
• Heart failure
• Peripheral arterial disease
• Kidney disease
• Vascular dementia.

Gestational hypertension

Gestational hypertension is high blood pressure during pregnancy. If you develop gestational hypertension the chance of it recurring in a future pregnancy is between 11% and 15%.

Those with gestational hypertension also have a higher chance of developing high blood pressure (2 to 4 times) or heart disease (1.5 to 3 times) in later life than those with who have never had gestational hypertension.

Pre-eclampsia

Having raised blood pressure and also being diagnosed with protein in your wee (urine) during or immediately after pregnancy is known as pre-eclampsia.

Those with pre-eclampsia also have a higher chance of developing high blood pressure (2 to 5 times) or heart disease (1.5 to 3 times) in later life than those with who have never had pre-eclampsia.

Risk of developing pre-eclampsia in a future pregnancy

• The risk of developing pre-eclampsia in a future pregnancy is around 16% (16 in every 100 pregnant people).
• If your baby was born before 34 weeks, the risk is about 25% (25 in every 100 pregnant people)
• If your baby was born before 28 weeks it is higher, about 55% (55 in every 100 pregnant people) will develop pre-eclampsia in future pregnancies.

Monitoring after you leave hospital

You should ensure that your blood pressure is monitored carefully over the first few weeks following the birth of your baby and also in the longer term by your GP.

Initially your blood pressure should be monitored frequently by your midwife or GP (every one to two days) but as your blood pressure settles it will be checked less often. When you are discharged home you will be given an individualised plan for when your blood pressure should be checked.

Advice about blood pressure tablets (anti-hypertensives)

If you are on blood pressure (antihypertensive) medication, it is usual to be able to stop taking this once the blood pressure is less than 130/80mmHg. Medication should only be stopped at the advice of a doctor, such as your GP or obstetrician. For most, this is in the first couple of months following birth.

Those who require blood pressure tablets to continue several months following birth may require specialist assessment of their raised blood pressure. Please discuss this with your GP.

Postural hypotension

Postural hypotension (low blood pressure) is a fall in blood pressure that occurs when changing position from lying to sitting or from sitting to standing. Some people experience this when taking blood pressure tablets. Common symptoms are feeling dizzy or lightheaded on standing up, visual changes or fatigue. You should try to avoid becoming dehydrated and getting up quickly from lying down or sitting. If any of these symptoms persist, please contact your GP and/or midwife to get your blood pressure re-checked and for advice regarding treatment.

Breast feeding/ chestfeeding

The blood pressure tablets usually given following birth (commonly labetalol or nifedipine) have no known adverse effects on babies receiving breastmilk.

For other less commonly used drugs such as enalapril, there is less evidence with how they interact with your milk and although they are generally thought to be safe, your baby should receive some additional monitoring. There should be additional consideration by the staff about breastfeeding / chestfeeding if your baby is born prematurely.

When to seek medical help

If you have had raised blood pressure or pre-eclampsia in pregnancy, there is still a small risk of complications in the few weeks following birth. If you feel unwell during this time you should seek medical advice from your GP or the maternity assessment unit at the Rosie (clinic 23, call 01223 217217). Symptoms that may suggest a problem include severe headache, disturbance in your vision, upper abdominal pain, vomiting and shortness of breath.

Follow up appointments

Your blood pressure medication should be reviewed by your GP 6-8 weeks after your birth. Some people are recommended to see a hospital specialist. You will be advised if this appointment has been arranged for you.

Future pregnancy advice

Low dose aspirin (150mg once a day) may be recommended in a future pregnancy starting at 12 weeks to reduce the risk of you developing high blood pressure.

Other lifestyle advice

Manage your weight so that it is appropriate for your height. Knowing your body mass index (BMI) will help you to do this. A BMI of 18.5-24.9 kg/m2 is recommended.

Ask your midwife, practice nurse or GP or you can use the NHS BMI calculator (opens in a new tab) to calculate this when you know your height (in metres) and weight (in kilograms).

Eat a low fat diet. This will help you manage your weight and keep your blood vessels (arteries) healthy.

Regular moderate to vigorous exercise (30 minutes) every day will help to keep your heart healthy.