High Blood Pressure and Preeclampsia: Signs, Aspirin, Checks

The types

• Chronic hypertension: high blood pressure before pregnancy or before 20 weeks.
• Gestational hypertension: new readings of 140/90 or higher after 20 weeks, with no other signs.
• Preeclampsia: high blood pressure after 20 weeks plus protein in the urine or signs that organs (kidneys, liver, brain, blood) are affected. It can appear suddenly, even with normal earlier readings.
• Severe features include readings of 160/110 or higher, a bad headache, vision changes, or pain under the right ribs. HELLP syndrome is a serious variant affecting the liver and blood.
• Postpartum preeclampsia can start up to 6 weeks after birth, most often in the first week, even if pregnancy was fine.

Who is at higher risk

A first pregnancy, past preeclampsia, twins, chronic high blood pressure, diabetes, kidney disease, lupus, higher weight, age 35 or older, IVF, and Black families (reflecting unequal care and stress, not biology alone).

Prevention

• Low-dose aspirin daily from 12-28 weeks (ideally before 16) until birth lowers the risk for people at higher risk. Don't start it on your own; ask whether you qualify.
• Staying active and attending every visit help. Salt restriction and bed rest don't prevent it.

Checking at home

• Your team may ask you to check twice a day with a validated upper-arm cuff in the right size.
• Sit quietly 5 minutes first, back supported, feet flat, arm resting at heart level, no talking. Take two readings a minute apart and log both.
• Bring your cuff to a visit once to compare it with the office machine.

Treatment and birth timing

• Blood pressure medicines that are safe in pregnancy are used when readings stay at 140/90 or above, especially with chronic hypertension.
• Expect extra lab tests, growth scans and fetal monitoring.
• The only cure for preeclampsia is birth. Without severe features, birth is often planned at 37 weeks; with severe features, by 34 weeks or sooner. Steroid shots may be given to mature the baby's lungs.
• Magnesium in an IV may be given in labor and after birth to prevent seizures.

After the birth

• Keep checking at home in the first 1-2 weeks if asked; readings often peak 3-6 days after birth.
• Most blood pressure medicines are compatible with breastfeeding.
• Preeclampsia raises your lifelong risk of heart disease and stroke. Tell every future doctor about it and get yearly blood pressure, cholesterol and sugar checks.

When to check in

• Report home readings of 140/90 or higher to your team the same day, per their instructions.
• Contact your provider or labor and delivery right away for 160/110 or higher, a headache that won't go away, vision changes, pain under the right ribs, or sudden swelling of the face or hands, in pregnancy or the 6 weeks after.
• If you have chest pain, trouble breathing or a seizure, call 911 and say you are pregnant or recently gave birth.