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The Risks of High Blood Pressure in Pregnancy: Current and Future Considerations PART 1

Picture of woman with her hands over her stomach, signaling upset stomach with text that reads, "The Impact Of Stress On The Digestive System" By Dr. Melanie Robinson, Naturopathic Doctor. Www.naturallyinclinedhealth.com with a logo of Naturally Inclined Health

A Gentle Note Before We Begin


This article discusses complications that can occur during pregnancy, including high blood pressure and preeclampsia. For some readers—especially those who have experienced pregnancy complications, loss, or difficult births—this information may feel heavy or emotional to read. If anything in this article raises concerns or brings up questions about your own pregnancy or health history, I encourage you to reach out to your healthcare provider or connect with our clinic so we can support you and talk through it together.


Introduction


I still remember the first time I saw a postpartum patient in clinic who had dangerously high blood pressure two weeks after giving birth. She looked exhausted but brushed it off as "just adjusting to the newborn phase." What really struck me though, was that the possibility of a gestational hypertensive disorder and the associated risks were not even on her radar. She simply thought that this was part of being a new mom. Luckily, both her family doctor and I caught it. This moment, however, crystallized something for me: we need to talk more openly and honestly about hypertension and preeclampsia in pregnancy, and we need to discuss what this means for mom’s health in the moment and for her lifetime.


Pregnancy is often painted as a beautiful journey of transformation, and it is, but behind the scenes, complex physiological shifts are taking place. For some, those changes can quietly veer off course in ways that are dangerous if not caught early. Among the most under-discussed and underestimated threats is high blood pressure during or directly following pregnancy or gestational hypertension. This diagnosis is especially important to catch and manage because it puts you and your baby at serious risk and can increase your lifetime cardiovascular risk1 . In fact, high blood pressure complicates 5-10% of all pregnancies and is a leading cause of both fetal and maternal morbidity and mortality globally 2–4.

 

Understanding Hypertensive Disorders of/in Pregnancy (HDP)


Let’s start with the basics. According to the 2022 SOGC guidelines5, hypertension in pregnancy is defined in three main categories:


  • Chronic Hypertension: Systolic (the top number on your blood pressure reading) equal to or over 140 mmHg and/or diastolic (the bottom number on your blood pressure reading) equal to or over 90 mmHg, before pregnancy or before 20 weeks’ gestation5. This often reflects an underlying condition that predated the pregnancy and may or may not have been diagnosed beforehand.


  • Gestational Hypertension: The same blood pressure levels as Chronic Hypertension, but occurring after 20 weeks without proteinuria (protein in your urine) 5. While it may seem benign initially, gestational hypertension can evolve into preeclampsia and is itself associated with significant long-term risks5.


  • Preeclampsia: Gestational Hypertension with proteinuria or other signs of maternal end-organ dysfunction (e.g., neurological symptoms, liver or kidney issues, hematologic complications, or pulmonary edema5. 


    • It may manifest as severe headaches, vision changes, sudden swelling, or even changes in mental status; these would all be reasons to seek medical attention immediately. Sometimes, however, it is completely silent until blood pressure is measured.


    • Preeclampsia can become life-threatening for both mother and baby. HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is one such severe variant that warrants immediate medical intervention6. If your provider sees any signs of this, it often requires urgent assessment.


We know that preeclampsia and eclampsia are associated with the greatest risk to mom and baby, but all hypertensive disorders in pregnancy are associated with risks for both mother and child and need to be taken seriously5,7,8. The risks we see for babies of mothers diagnosed with a gestational hypertensive disorder included increased incidence of fetal growth restriction, preterm birth, and perinatal death9. Mothers diagnosed with hypertensive disorders of pregnancy are at increased risk of kidney failure, pulmonary edema, respiratory distress syndrome, stroke, heart attack, spontaneous coronary dissection, and death10–13. 


While this is an extensive list, and it all might sound intimidating or even downright scary, you should know that your providers are watching closely for this, and there are effective treatment options. This is one of the many reasons it is particularly important to stay on top of your prenatal and postnatal visits. As you will see, this is also one of the reasons you want to keep up with all your general screening tests and medical follow-up visits. A recent Canadian study from 2024 reviewing hypertensive disorders of pregnancy in Canada (excluding Quebec) found that while the incidence of these disorders is increasing (they looked at rates from 2012-2021), the good news is that the incidence of adverse pregnancy outcomes is on the decline; it is suggested that this is due to improved perinatal clinical care14.


What Are the Risk Factors for Developing HDP


Hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, can happen to anyone. Many people who develop these conditions have no obvious warning signs beforehand. At the same time, research has identified several factors that can increase the likelihood of developing them.


Some of these factors are non-modifiable, meaning they cannot be changed. The modifiable risk factors mean that they relate to aspects of health that may be influenced over time with appropriate care and support. The modifiable risk factors are the ones that we want to focus on because you have an opportunity to make a change here. Both types of risk factors help us to identify those we need to watch more closely for the development of one of these disorders.

Understanding these factors is NOT about assigning blame; it is about improving awareness, guiding screening, and helping healthcare providers identify pregnancies that may benefit from closer monitoring.


Non-Modifiable Risk Factors


Here are some of the characteristics associated with a higher baseline risk of hypertensive disorders during pregnancy:


  • History of preeclampsia in a previous pregnancy

  • Multiple pregnancy (twins, triplets, or more)

  • Chronic hypertension prior to pregnancy

  • Pre-existing medical conditions, including:

    • Type 1 or Type 2 diabetes

    • Chronic kidney disease

    • Autoimmune conditions such as lupus or antiphospholipid syndrome

  • First pregnancy

  • Family history of preeclampsia

  • Maternal age over 35

  • Pregnancy conceived through assisted reproductive technologies such as IVF5,15 


These factors are routinely considered during prenatal care to determine who may benefit from additional monitoring or preventive strategies.


Modifiable or Partially Modifiable Risk Factors


Other factors relate to underlying cardiometabolic health and may influence risk over time:


  • Higher pre-pregnancy body mass index (BMI)

  • Metabolic health concerns, such as insulin resistance

  • Pre-existing cardiovascular risk factors

  • Nutritional status, including certain nutrient deficiencies

  • Lifestyle factors that influence cardiovascular health 5,15


Importantly, many of these factors reflect broader systemic influences, including access to healthcare, nutrition, safe environments for physical activity, and long-standing social inequities, rather than simply individual choices or personal responsibility.

Later in this article, we will explore some of the areas researchers have investigated, including nutrition, physical activity, and early screening, which may influence risk when addressed before or early in pregnancy.


For many clinicians, pregnancy offers a unique opportunity to identify and support cardiovascular health early. In fact, hypertensive disorders of pregnancy are sometimes described as a window into future heart health, providing valuable information about long-term risk 16.


Preeclampsia Can Appear Postpartum


One of the most overlooked facts is that preeclampsia can arise after delivery. This is known as postpartum preeclampsia, and it can show up anywhere from immediately postpartum to 6 weeks after delivery5. Postpartum hypertension and de novo postpartum hypertension account for 25% of all hypertensive disorders of pregnancy5. This is a considerable number worth paying attention to.


That’s why monitoring must continue beyond the hospital stay. Current recommendations include blood pressure checks:


  • At 3–7 days postpartum (ideally at 72 hrs for high-risk individuals)

  • Twice more in the first two weeks and/ or at home monitoring

  • At 6 to 12 weeks

  • Again at 6 months, 12 months, and annually thereafter 1 


This ongoing surveillance allows for timely treatment and prevention of long-term complications. But unfortunately, many new mothers are unaware of this need, and postpartum follow-up often falls through the cracks.


Why This Matters Long-Term


The impact of hypertensive disorders of pregnancy doesn’t end after delivery. Research now shows us that these conditions are often early warning signs of future cardiovascular disease. With a focus on perimenopausal and menopausal care, this is something that I pay close attention to in my practice. I often see that this is missed as part of a woman’s cardiometabolic risk screening during the late reproductive and midlife stages. Women who experience gestational hypertension or preeclampsia are at significantly higher risk for future cardiovascular events. Over time, research shows:


  • ~4 x higher risk of chronic hypertension

  • ~2x risk of stroke later in life

  • ~4x risk of heart failure

  • ~2x higher risk of ischemic heart disease5,13,17–21


These numbers should not be taken lightly. For many, these conditions may be the earliest visible signs of underlying endothelial dysfunction, systemic inflammation, or metabolic syndrome16,22,23. If you have experienced an HDP in your past, this is not your destiny. There is good news: there is plenty that you can do to decrease your risk. 


In Part 2, we’ll explore the areas where we may be able to reduce risk and support your health, both during pregnancy and beyond. Stay Tuned, part 2 drops next month!


If you’re looking for support before, during, or after pregnancy, you can book a free virtual 15-minute Meet and Greet with Dr. Amber McKinnon, ND here.


*Disclaimer: The information contained within this post is for general educational and information purposes only; no doctor-patient relationship is formed. It is not professional medical advice, diagnosis, treatment, or care, nor is it intended to be a substitute, therefore. If you have any concerns or questions about your health, always seek the advice of a qualified healthcare professional.



References:


1. Countouris, M. et al. Hypertension in Pregnancy and Postpartum: Current Standards and Opportunities to Improve Care. Circulation 151, 490–507 (2025).

2. Hinkle, S. N. et al. Pregnancy Complications and Long-Term Mortality in a Diverse Cohort. Circulation 147, 1014–1025 (2023).

3. Duley, L. The Global Impact of Pre-eclampsia and Eclampsia. Semin. Perinatol. 33, 130–137 (2009).

4. Say, L. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob. Heal. 2, e323–e333 (2014).

5. Magee, L. A. et al. Guideline No. 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management. J. Obstet. Gynaecol. Can. 44, 547-571.e1 (2022).

6. Khalid, F., Mahendraker, N. & Tonismae, T. HELLP Syndrome - StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK560615/.

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A picture of Dr. Melanie Robinson, Naturopathic Doctor, with text that reads: Dr. Mélanie Robinson (she/her) is a licensed naturopathic doctor and graduate of the Boucher Institute of Naturopathic Medicine, where she received the Clinical Excellence Award. She holds a degree in Bilingual Biological Sciences from the University of Alberta and is licensed in Alberta. Dr. Robinson provides gentle, evidence-based, individualized care with a focus on women’s health, pediatrics, digestive and hormonal concerns. She is fluent in English and French.



About Naturally Inclined Health:


Naturally Inclined Health is an integrative health clinic located in the heart of Edmonton, Alberta, Canada, proudly serving Albertans with comprehensive naturopathic care, acupuncture, IV therapy, and nutrition support with our on-site naturopathic doctors and registered dietitian. We believe every person is unique, and health concerns deserve an individualized, patient-centered approach.


Naturopathic medicine uses a wide range of evidence-informed assessment tools, healing modalities, and natural treatments to create customized care plans that evolve with your health needs. Our Naturopathic Doctors in Edmonton are highly trained clinicians with a holistic lens, addressing root causes rather than just symptoms.


Whether you’re seeking support for digestive health, stress management, chronic conditions, or preventative care, our integrative team is here to help. Visit our Edmonton naturopathic clinic in person or access virtual naturopathic care throughout Alberta to support your long-term health and wellness.



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