# Hypertension in Pregnancy: Maternal and Fetal Context

Use obstetric thresholds and multisystem assessment; delivery does not end the risk of hypertension or preeclampsia.

![Infographic: Hypertension in Pregnancy: Maternal and Fetal Context](https://urinenephrology.org/visual-reference/images/pregnancy-hypertension.png?v=20261003c)

## Establish timing and baseline

Hypertension before pregnancy or before 20 weeks usually suggests chronic hypertension. New hypertension after 20 weeks raises gestational hypertension or preeclampsia. Baseline CKD/proteinuria makes comparison with earlier BP, creatinine, and protein measurements especially important.

## Severe pressure needs urgent action

Persistent SBP ≥160 or DBP ≥110 mmHg is severe hypertension in pregnancy/postpartum and needs urgent obstetric treatment. Confirm promptly; do not wait hours for repeated routine readings. Headache, visual symptoms, upper-abdominal pain, dyspnea, confusion, or seizures increases urgency.

## Preeclampsia is more than protein

Assess urine protein, platelets, creatinine, liver tests, pulmonary/neurologic symptoms, and fetal well-being. Proteinuria is not required when qualifying organ dysfunction is present. A previously normal pregnancy does not exclude new postpartum disease.

## Treat mild chronic hypertension appropriately

CHAP supports treatment of mild chronic hypertension rather than waiting for severe disease. ACOG uses 140/90 as the threshold to initiate or titrate therapy in this population. This is not a substitute for evaluating superimposed preeclampsia or fetal concerns.

## Choose a pregnancy-specific regimen

Labetalol and extended-release nifedipine are common chronic options; acute severe treatment follows an obstetric protocol. Avoid ACE inhibitors, ARBs, and ARNIs in pregnancy. Magnesium sulfate is for seizure prevention/treatment in appropriate preeclampsia/eclampsia settings, not the primary BP-lowering drug.

## Continue after delivery

Arrange early postpartum BP/symptom review, medication and lactation reconciliation, and follow-up of kidney abnormalities. Explain the future cardiovascular/CKD risk and the transition to primary care. New severe headache, visual change, breathlessness, or severe BP postpartum still requires urgent assessment.

## Supporting evidence

- [Clinical evidence and guidance](https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2022/04/clinical-guidance-for-the-integration-of-the-findings-of-the-chronic-hypertension-and-pregnancy-chap-study)
- [PubMed 30575639](https://pubmed.ncbi.nlm.nih.gov/30575639/)
- [PubMed 35363951](https://pubmed.ncbi.nlm.nih.gov/35363951/)

## Source lessons

- [pregnancy special populations](https://urinenephrology.org/2025_UDPA_Lectures_Live/hypertension/pregnancy-special-populations.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.