Understanding pregnancy hypertension: clear guidance for patients and clinicians

Table of Contents

• What is pregnancy hypertension?
• Important terms and how they differ
•  How we diagnose proteinuria and organ dysfunction
•  Mild versus severe preeclampsia and what matters
• z HELLP syndrome explained
• Signs of impending eclampsia
• Risk factors that raise the chance of pregnancy hypertension
• Prevention and early measures
• Prediction and biomarkers
• z Management highlights and when to seek specialist care
• Practical takeaways
• Frequently asked questions

What is pregnancy hypertension?

Pregnancy hypertension means a blood pressure reading of more than 140/90 mmHg on two separate occasions at least four hours apart. The term covers several related conditions that can appear after conception. One key distinction is timing: if high blood pressure appears before 20 weeks or is present before pregnancy, it is chronic hypertension. If it develops after 20 weeks, it is usually called pregnancy induced hypertension.

Important terms and how they differ

Clear labels help guide care:

• Chronic hypertension: High blood pressure that existed before pregnancy or is detected before 20 weeks and usually persists after delivery.
• Gestational hypertension: High blood pressure that starts after 20 weeks without other complications such as proteinuria or organ dysfunction.
• Preeclampsia: New high blood pressure after 20 weeks with either proteinuria or signs of end-organ damage.
• Eclampsia: Preeclampsia plus generalized tonic-clonic seizures.
• Chronic hypertension with superimposed preeclampsia: A woman with chronic hypertension who develops new proteinuria or organ dysfunction during pregnancy.

 How we diagnose proteinuria and organ dysfunction

Proteinuria is an important marker. Use one of these criteria:

• 24-hour urine protein > 0.3 g
• Urine dipstick of 2+
• Urine protein/creatinine ratio > 0.3

Signs of end-organ dysfunction that define severe disease include:

• Platelet count < 100,000 cells/µL
• Serum creatinine > 1.1 mg/dL or a doubling of baseline
• Liver enzymes (AST/ALT) about twice the normal value
• Pulmonary edema or new neurological symptoms such as visual disturbance

 Mild versus severe preeclampsia and what matters

Mild preeclampsia is blood pressure above 140/90 but below 160/110, without evidence of end-organ failure. Severe preeclampsia shows blood pressure ≥ 160/110 mmHg and signs of organ involvement. Note that the amount of proteinuria alone does not determine mild or severe disease.

z HELLP syndrome explained

HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelets. It is a serious complication of severe preeclampsia. Look for:

• Hemolysis—schistocytes on the blood film, low haptoglobin, elevated bilirubin (often > 1.2 mg/dL) and LDH > 600 IU/L
• AST/ALT often > 70 IU/L
• Platelets < 100,000 cells/µL

The Tennessee criteria combine LDH > 600 IU/L, AST/ALT > 70 IU/L, and platelets < 100,000 cells/µL to identify HELLP. HELLP can cause bleeding problems because platelets are low, but global clotting time may remain normal. HELLP is more common in women with multiple prior pregnancies.

Signs of impending eclampsia

Severe preeclampsia can progress to eclampsia. Early warning symptoms include:

• Severe headache
• Visual changes—blurring, scotoma, diplopia
• Epigastric or right upper quadrant pain (from liver capsule stretch)
• Nausea and vomiting

If these symptoms appear, urgent treatment and close monitoring are needed. The drug of choice to prevent seizures in severe preeclampsia is magnesium sulfate.

Risk factors that raise the chance of pregnancy hypertension

Common risk factors include:

• First pregnancy (primigravida)
• Family history of preeclampsia
• Previous preeclampsia
• Multiple pregnancy, such as twins
• Diabetes or obesity
• Molar pregnancy or trophoblastic disease
• Antiphospholipid antibody syndrome
• New paternity—pregnancy with a new partner

Prevention and early measures

Women with identifiable risk factors should be offered low-dose aspirin from the end of the first trimester. Typical dosing is 150 mg daily starting from 12 weeks. This reduces the risk of developing preeclampsia in at-risk pregnancies.

Prediction and biomarkers

Research uses angiogenic and anti-angiogenic markers to predict risk. Elevated anti-angiogenic factors such as sFlt-1 and soluble endoglin and higher vasoconstrictors such as thromboxane A2 suggest increased risk. Lower levels of angiogenic and vasodilatory factors such as VEGF, PlGF, nitric oxide, and prostacyclin also point toward future disease. These tests can help assess risk but are not yet routine everywhere.

z Management highlights and when to seek specialist care

Treatment depends on severity and gestational age. For severe disease, hospital care, blood pressure control, seizure prevention with magnesium sulfate, and timely delivery are the mainstays. For milder cases, close outpatient monitoring may be possible. Assessment of maternal and fetal well-being guides timing of delivery.

Women who need focused pregnancy hypertension care may benefit from a specialist clinic. MediHope Fertility Clinic at Dataran Sunway, Kota Damansara Petaling Jaya offers women health and pregnancy support. Dr. Nurulhuda Mustoffa Ashukri is experienced in women health and helps patients achieve pregnancy naturally using modern medicine and traditional Chinese medicine where appropriate. The clinic provides personalized plans for prevention, monitoring, and treatment of pregnancy complications.

Practical takeaways

• Check blood pressure often. Readings > 140/90 mmHg on two occasions four hours apart need attention.
• Distinguish chronic hypertension from pregnancy induced hypertension by timing and persistence after delivery.
• Look for proteinuria and signs of organ dysfunction to diagnose preeclampsia.
• Offer low-dose aspirin from 12 weeks to women with risk factors.
• Use magnesium sulfate to prevent seizures in severe cases.
• Ask about risk factors such as multiple pregnancy, diabetes, molar pregnancy, previous preeclampsia, and new paternity.

Frequently asked questions

When is high blood pressure during pregnancy considered pregnancy hypertension?

High blood pressure that measures > 140/90 mmHg on two readings at least four hours apart is pregnancy hypertension. If it starts after 20 weeks it is usually pregnancy induced hypertension.

How is proteinuria defined for preeclampsia?

Proteinuria can be defined as 24-hour urine protein > 0.3 g, a urine dipstick reading of 2+, or a urine protein/creatinine ratio > 0.3.

What are the red flags that suggest progression to eclampsia?

Severe headache, visual disturbances, sudden epigastric pain, severe nausea or vomiting, and marked high blood pressure are red flags. These warrant urgent care and administration of magnesium sulfate.

Can pregnancy hypertension be prevented?

In women with risk factors, low-dose aspirin (150 mg daily) starting from 12 weeks can reduce the chance of developing preeclampsia. Healthy weight, blood sugar control, and close prenatal care also help.

What is HELLP syndrome and how is it linked to pregnancy hypertension?

HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelets. It is a severe complication of preeclampsia and can be life threatening. Look for hemolysis on blood film, AST/ALT elevation, LDH > 600 IU/L, and platelets < 100,000 cells/µL.

Where should I seek care for pregnancy hypertension?

Any woman with suspected pregnancy hypertension should receive prompt medical assessment. For specialized care, MediHope Fertility Clinic at Dataran Sunway, Kota Damansara Petaling Jaya can provide monitoring, prevention strategies, and treatment. Dr. Nurulhuda Mustoffa Ashukri offers integrated care to help women reach healthy pregnancies.