Gestational hypertension

Definition

Chronic vs. gestational hypertension

• Chronic hypertension is either known to be pre-existing or is first diagnosed before 20+0 weeks and persists after the pregnancy.
• Gestational hypertension (formerly pregnancy-induced hypertension or PIH) newly occurs from 20+0 weeks onwards and is characterised by the absence of proteinuria and end-organ damage.
• Gestational hypertension typically resolves within 12 weeks postpartum.

• Gestational hypertension is new-onset hypertension after 20 weeks (at least 140 mmHg systolic and/or 90 mmHg diastolic on at least two measurements at least 4 hours apart) without criteria of pre-eclampsia; it resolves by 6 weeks after birth.

Classification

• It is distinguished from chronic hypertension, which is present before pregnancy or before 20 weeks.
• Pre-eclampsia is present when hypertension after 20 weeks is accompanied by new unexplained proteinuria and/or signs of end-organ damage.

Occurrence & epidemiology

Epidemiology

• Gestational hypertension occurs in about 5–10% of pregnancies, more often in multiple pregnancy, and usually only after 37 weeks.

Aetiopathogenesis

Aetiology and pathogenesis

• Gestational hypertension increases the risk of pre-eclampsia and eclampsia and of other severe complications such as HELLP syndrome, hypertensive encephalopathy and stroke.
• Risk factors for pre-eclampsia include previous pre-eclampsia, multiple pregnancy, renal and autoimmune disease, diabetes mellitus, chronic hypertension, first pregnancy, age 35 years or older and a pre-pregnancy BMI above 30.

Clinical features

Clinical features and complications

• Signs of severe pre-eclampsia include severe headache, visual disturbances, confusion, right upper quadrant or epigastric pain, nausea, dyspnoea and oliguria; oedema of the face and hands is more specific than dependent oedema.
• Reduced uteroplacental blood flow increases the risk of fetal growth restriction, hypoxia and placental abruption.

Diagnosis

• Blood pressure is measured at every antenatal visit; values of 160 mmHg systolic and/or 110 mmHg diastolic or more are regarded as severe.
• Pre-eclampsia is distinguished by detection of proteinuria (for example a protein/creatinine ratio of 0.3 or more) and by platelets, transaminases and creatinine.

Keep learning in the app

Further reading (selection)

1. Geburtshilfe Frauenheilkd 2025: S2k-Leitlinie der DGGG, OEGGG und SGGG zu hypertensiven Erkrankungen in der Schwangerschaft (AWMF 015/018, Juni 2024), englische Fassung (PubMed Central)
2. MSD Manual Professional Edition: Hypertension in Pregnancy
3. MSD Manual Professional Edition: Preeclampsia and Eclampsia
4. DocCheck Flexikon, Schwangerschaftsinduzierte Hypertonie

Cross-references