What You Need To Know About Postpartum Hypertension

Changes in your blood pressure are normal. It fluctuates throughout the day and during your pregnancy. Many pregnant people experience a drop in their blood pressure in the early stages of pregnancy. This happens because the body releases hormones that help blood vessels dilate so that an increased blood supply is available for both mother and baby. For most people, blood pressure levels return to a normal range during the second half of the pregnancy.

Some women may experience high blood pressure (hypertension) during their pregnancy. This occurs in around one out of every 12 to 17 pregnancies among women aged 22 to 40 in the US. High blood pressure during pregnancy can put the mother at risk of preeclampsia, eclampsia, stroke, and other serious health problems. For the baby, it may lead to early delivery or low birth weight.

The risks associated with hypertension don't end at childbirth. Up to 28% of women experience postpartum hypertension¹, which is high blood pressure after giving birth. It's important to know who is at risk of developing postpartum hypertension, what the symptoms are, and when you should speak to a doctor.

What is postpartum hypertension?

Hypertension is the medical term for high blood pressure. Your blood pressure is the measure of the force placed on your arteries as the heart pumps blood through your body. High blood pressure means the circulatory system is working harder to move your blood supply around. This can put a strain on the arteries, causing them to harden and narrow while losing their elasticity. It also puts more strain on your heart as it is working harder.

While it's possible to experience high blood pressure at any time of your life, some people experience postpartum hypertension. This is high blood pressure (hypertension) experienced after giving birth. Normal blood pressure is 120/80mm Hg, while postpartum hypertension is high blood pressure of 140/90mm Hg or above. 

Blood pressure tends to drop in the early stages of pregnancy before returning to normal by the third trimester. It's common for blood pressure to fall directly after the baby is born, then rise until it reaches its peak between three and six days after delivery¹. This can be due to many factors including pain, medication, and fluid retention, and usually doesn't last long.

Your doctor or midwife will closely monitor your blood pressure during this time. They will take blood pressure readings during your labor, immediately after you’ve given birth, and throughout your hospital stay. They will also take routine readings at your postnatal appointments.

In 50% to 85% of cases, blood pressure normalizes on its own within a week of delivery¹ and it doesn't require any medication or further intervention. However, postpartum hypertension can occur for up to six months after delivery.

What risks are associated with postpartum hypertension?

High blood pressure can increase your risk of developing other serious health concerns, including:

• Heart attack

• Stroke

• Vision loss

• Kidney damage

High blood pressure after delivery may also be a warning sign of postpartum preeclampsia.

Preeclampsia is characterized by persistent high blood pressure that usually develops after the 20th week of pregnancy. However, some women may develop high blood pressure during the postpartum period.

Symptoms of postpartum preeclampsia are similar to those of preeclampsia during pregnancy, including:

• Headaches

• Changes in vision

• Nausea, vomiting, or pain in the stomach

• Sudden weight gain

• Difficulty breathing

• Sudden swelling in the face, hands, or feet

If you experience any of these symptoms, it's important to contact your doctor right away. If left untreated, preeclampsia can develop into eclampsia. This is a serious medical emergency that can cause seizures and loss of consciousness and can be life-threatening.

The best way to prevent these health concerns is to regularly monitor your blood pressure. Your doctor will check it at your post-pregnancy follow-up appointments. If you have concerns, you can purchase a blood pressure monitor to use at home. You can also ask your local pharmacy if they offer free blood pressure checks.

What are the symptoms of postpartum hypertension?

People with hypertension often do not have any symptoms. That's why it's sometimes called the ‘silent killer’. Whether you are pregnant or not, you won't be able to tell if you have high blood pressure without having it checked.

It's important to attend your doctor's appointments both during and after your pregnancy. This will give your doctor a chance to check your blood pressure and track those numbers over time. They'll do this by placing a blood pressure cuff on your arm and inflating it. The cuff will feel tight on your arm, and while it may be briefly uncomfortable, it shouldn't be painful.

If your blood pressure is high, your doctor may recommend continuing to monitor it over a period of time. They will also examine you for HELLP syndrome², a rare liver and blood-clotting disorder. Your doctor may run additional tests to determine any underlying cause of your hypertension. They may also ask you to provide a urine sample to test for protein in your urine, a sign of preeclampsia.

Around 5.7% of preeclampsia cases start in the postpartum period², so it's important to monitor yourself for any new or unusual symptoms once your baby has been born. Watch for symptoms such as persistent headaches, stomachaches, changes in your vision, or sudden swelling in your face, hands, or feet. If you start to experience any of these symptoms, contact your doctor right away.

What causes postpartum hypertension?

High blood pressure, or hypertension, can develop at any stage of pregnancy. After pregnancy, blood pressure may rise temporarily due to pain, medication, or anxiety¹. However, there is no definitive cause for postpartum hypertension or associated postpartum preeclampsia.

However, certain factors can increase your risk of developing the condition. You may be at more risk of developing postpartum hypertension if: 

• You had high blood pressure before or during your pregnancy

• You had hypertension or preeclampsia with previous pregnancies

• You have a high body mass index (BMI)³

• You gave birth to multiple babies

• You have type 1 or type 2 diabetes

• You had preeclampsia during your pregnancy

• You were over the age of 40 when you gave birth

• Your family has a history of hypertension

If you have any of these risk factors, your doctor will carefully monitor your blood pressure throughout your delivery and during the postpartum period.

In most cases, high blood pressure after delivery resolves within a few days. If your blood pressure remains consistently high, your doctor may recommend treatment. This could include lifestyle changes and medication or may require hospital admission for monitoring.

How do you get rid of postpartum hypertension?

In many cases, high blood pressure after delivery will resolve on its own within a week or so. If it doesn't, your doctor may recommend further treatment. Treatment options include: 

Watchful waiting

If your blood pressure is high but not high enough to concern your doctor, they may recommend that you continue to monitor your blood pressure over time. That might mean taking your own blood pressure readings at home with an at-home machine or coming into their office to get checked regularly. 

Antihypertensive medication

These can help bring your blood pressure back into a normal range. Your doctor will determine which medication is best for you based on your condition, your age, and whether you are breastfeeding. There are many options available, and you may require a combination to achieve the best results.

Your doctor may also recommend lifestyle changes to help prevent hypertension from developing further. This might include stopping smoking, maintaining healthy body weight, and exercising regularly.

Is postpartum hypertension permanent?

In most cases, no. Fluctuations in blood pressure are normal, including throughout the postpartum period. Blood pressure will usually return to normal levels within a week. If it doesn’t, your doctor may recommend that you start treatment. About 20% of people who had hypertension during their pregnancy develop persistent, or chronic hypertension¹.

Hypertension is a highly treatable condition. With the right combination of lifestyle changes and medication, it's possible to reduce the health risks associated with the condition and live a healthy life.

When should you see a doctor?

It is rarely possible to know if you have high blood pressure without seeing your doctor because there are usually no obvious symptoms. It's important that you attend all your postpartum appointments. This will allow your doctor to take your blood pressure reading regularly and monitor any changes over time.

If you have any of the risk factors for high blood pressure, including a family history of hypertension or preeclampsia, your doctor may recommend that you monitor your blood pressure between visits. You can do this using an at-home blood pressure monitor, or you may be able to have your blood pressure checked for free at your local pharmacy. Contact your doctor immediately if your blood pressure suddenly goes up or if it stays consistently high for a period of time.

It is very important to watch for any signs of preeclampsia after delivery. If you experience any of the symptoms described above, or any unusual symptoms, get in touch with your doctor right away.

If your blood pressure reading is above 160/110, you experience a loss of consciousness or have a seizure, call 911. These are signs of eclampsia, which is a serious medical emergency and could be life-threatening.

The lowdown

It's normal for blood pressure to fluctuate before, during, and after pregnancy.  However, some women develop high blood pressure, or hypertension, while they are pregnant or after the baby is born. Hypertension can increase the mother’s risk of serious health problems like heart attack, stroke, and preeclampsia. For babies, it may increase the risk of low birth weight and premature birth.

After delivery, high blood pressure may be an indication of postpartum preeclampsia. This is a serious health problem with symptoms such as nausea, headache, and swelling in the face and hands.

There is no definitive cause of postpartum hypertension. You may be at increased risk of the condition if you had high blood pressure before or during your pregnancy or if hypertension runs in your family. In most cases, blood pressure returns to normal levels within a week after delivery. 

Around 20% of people with postpartum hypertension develop chronic, or persistent, hypertension. In these cases, medication can bring the blood pressure level back to a normal range, and there are treatment options for mothers who are breastfeeding.

It's important to monitor blood pressure after delivery and watch for signs of postpartum preeclampsia for six weeks after birth. If you do experience any symptoms of postpartum preeclampsia, contact your doctor immediately.