The Risks of High Blood Pressure in Pregnancy: Current and Future Considerations PART 2
- Dr. Amber McKinnon ND
- 2 days ago
- 11 min read
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
In part 1, we covered a lot! We’ve talked about what hypertensive disorders of pregnancy are, who may be at higher risk, how they can show up (even after delivery) and why they matter not just in pregnancy, but for long-term health. If you feel that you need a refresher, you can always go back to section 1. If you’ve been following along and you are feeling a little overwhelmed, that’s completely understandable. The good news is that while we can’t control everything, there are areas where we may be able to support your health and potentially influence risk. Let’s walk through some of those now.
What Can You Do to Decrease Your Risk
While some risk factors for preeclampsia are non-modifiable, like age, race, or personal history, others are deeply influenced by lifestyle, and the research on this is both encouraging and empowering 5.
Nutrition
Nutrition is one of the growing areas of research in relation to hypertensive disorders of pregnancy, and while the research does not point to a single “cause” or “solution,” it does suggest that overall nutritional status plays a meaningful role in shaping risk.
One of the more encouraging findings comes from a 2015 study by Madhuvrata et al., which looked at the impact of working with trained dietitians during pregnancy. They found that individuals who received structured nutritional support had an approximate 28% reduction in the risk of developing gestational hypertension24 . While this does not tell us that any one dietary change is protective on its own, it does highlight something important: having guidance, support, and awareness around nutrition may influence outcomes in a meaningful way.
When we look more closely at specific nutrients, calcium is one that comes up repeatedly in the literature. A Cochrane review in 2018 found that individuals with lower dietary calcium intake appeared to have a higher risk of developing preeclampsia25 . This finding has been echoed in larger analyses, including a meta-analysis in 2022, which suggested that improving calcium status in those with inadequate intake was associated with a reduction in preeclampsia risk, regardless of baseline risk factors26 . Understanding your calcium intake and whether a supplement is indicated is worth discussing with your ND or MD.
Vitamin D is another nutrient that has been studied in this context, particularly because of its role in immune modulation and inflammation27,28 . Lower vitamin D levels have been associated with an increased risk of preeclampsia, and some studies have suggested that improving vitamin D status may reduce that risk29–32 . While the exact mechanisms are still being explored, we do see an association. Understanding your vitamin D status can be done with a simple blood test. This is often something I assess my pregnant patients. Unfortunately, this is an out-of-pocket cost as it is not covered for this indication in Alberta, but it can be facilitated by your ND.
Folic acid has also been investigated, though the findings are a bit more complicated. Large meta-analyses, including those by Yu (2021) and Liu (2018), suggest that folic acid exposure after conception may be associated with a reduced risk of preeclampsia, though it does not appear to have the same effect on gestational hypertension overall33,34 . This distinction is important and reinforces the idea that these conditions, while related, do not always respond in the same way biologically. Further, this is yet another example of why understanding the nuance matters. We want to avoid the reductionistic thinking of “this” is “good for that”. Please work with a ND and/ or MD familiar with this area to build a plan that is right for you.
Beyond individual nutrients, broader dietary patterns appear to matter as well. A large cohort study with nearly 7800 women found that higher adherence to a Mediterranean-style dietary pattern in the 3 months surrounding conception was associated with a 28% lower risk of preeclampsia or eclampsia, as well as gestational diabetes35 . Similarly, recent review by Baroutis examining the DASH dietary pattern (originally developed for blood pressure management) found better blood pressure control and potential reduced incidence of preeclampsia among those who followed this approach during pregnancy36 .
What is particularly interesting about these dietary patterns is that they do not focus on a single nutrient in isolation. Instead, they reflect a broader pattern of eating, over time that supports cardiovascular and metabolic health, which may help explain their association with improved pregnancy outcomes.
Taken together, this body of research suggests that nutritional status, both at the level of individual nutrients and overall dietary patterns, reveal areas where we might be able to influence the development of hypertensive disorders of pregnancy. At the same time, it is important to recognize that nutrition is just one piece of a much larger and more complex puzzle, and these findings are best interpreted as part of a broader, individualized approach to care.
There are additional tools that may be considered as part of a broader approach to supporting healthy blood pressure in pregnancy. Some nutrients and supplemental strategies have emerging research in this area, though their role is often nuanced and best considered in the context of an individual’s overall health, dietary intake, and risk profile. Again, I will point you in the direction of working with a qualified health care professional with knowledge in this area.
A Note on Medications
In some cases, medications are an important and evidence-based part of managing or reducing the risk of hypertensive disorders of pregnancy. For individuals at higher risk, low-dose aspirin is commonly recommended as part of standard prenatal care, and antihypertensive medications may be used when blood pressure reaches certain thresholds. Please always reach out to your health care provider to discuss what is right for you. Medications including those that are over the counter should never be used without first consulting your health care provider especially while you are pregnant. These decisions are always made on an individual basis, taking into account personal risk factors, medical history, and the stage of pregnancy. If medications are recommended as part of your care, your healthcare provider will walk you through the rationale, safety considerations, and how they fit into your overall plan.
Exercise
Physical activity is another area where we see useful research in relation to hypertensive disorders of pregnancy. Like nutrition, there is no single type, intensity, or duration of exercise that eliminates risk. However, consistent patterns in the literature suggest that movement, particularly before and in early pregnancy, may play a protective role37–40 .
Several large analyses have explored this relationship. A 2023 meta-analysis by Martinez-Vizcaíno and colleagues found that exercise was associated with a significant reduction in the incidence of gestational hypertension, with some data suggesting the risk may be reduced by as much as half when exercise is introduced early in pregnancy 38. This highlights an important theme that comes up repeatedly in the research: timing matters.
Earlier studies support this as well. An earlier meta-analysis and systematic review found that engaging in approximately 140 min of moderate exercise like brisk walking, water aerobics, strength training or stationary cycling was associated with a 25% lower risk of developing gestational hypertension, preeclampsia or gestational diabetes41. This means that very accessible forms of movement were associated with a meaningful reduction in risk. Interestingly, they also observed a dose dependant effect in this early window; meaning that additional exercise led to further reductions in risk’ reinforcing the idea that early pregnancy may be a particularly important window 41.
At the same time, it is important to recognize that exercise is not always appropriate in every stage or clinical context. Once preeclampsia has been diagnosed, exercise is contraindicated due to the potential risks, and activity recommendations should be guided by a healthcare provider5.
This distinction is critical and again underscores that timing and individualization matter.
In summary, this body of research suggests that physical activity established prior to pregnancy and maintained especially through early pregnancy, may play a supportive role in reducing the risk of hypertensive disorders.
It Was Never Your Fault
One of the hardest parts for many patients is the shame, this is also the part the really breaks my heart. The quiet, creeping belief that somehow, they "failed" at pregnancy because their body struggled. Let me say this clearly: If you were handed a diagnosis of gestational hypertension or preeclampsia, you did not cause this.
Preeclampsia and gestational hypertension are not reflections of willpower. They are complex, multifactorial syndromes involving genetics, immune response, vascular biology, and more. You cannot “willpower” your way out of this. You could take on all the recommendations and execute them perfectly and still get a diagnosis. Please don’t take this to mean there is no hope or reason to even engage, that is not true. Doing what you can will put you in a better position even with a diagnosis.
So, moving forward, instead of blame, let’s focus on knowledge and continuity of care. Knowing your history empowers your care team in this and future pregnancies. Knowing your risks also arms you with the tools to protect your heart health down the line.
Your value as a person, as a parent, as a patient, is not diminished by any complication. The more we talk about this, without shame, and instead with compassion, the better we can care for ourselves and each other.
If this is part of your story, or something you’re navigating now, please know that you don’t have to do it alone. These conversations can feel overwhelming, and having the right support can make all the difference. If you’re looking for guidance, we’re here to help you make sense of your risk, your options, and what comes next.
*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/.
7. Bramham, K. et al. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ : Br. Méd. J. 348, g2301 (2014).
8. Gladstone, R. A., Pudwell, J., Nerenberg, K. A., Grover, S. A. & Smith, G. N. Cardiovascular Risk Assessment and Follow-Up of Women After Hypertensive Disorders of Pregnancy:A Prospective Cohort Study. J. Obstet. Gynaecol. Can. 41, 1157-1167.e1 (2019).
9. Wallis, A. B., Saftlas, A. F., Hsia, J. & Atrash, H. K. Secular Trends in the Rates of Preeclampsia, Eclampsia, and Gestational Hypertension, United States, 1987–2004. Am. J. Hypertens. 21, 521–526 (2008).
10. Kuklina, E. V., Ayala, C. & Callaghan, W. M. Hypertensive Disorders and Severe Obstetric Morbidity in the United States. Obstet. Gynecol. 113, 1299–1306 (2009).
11. McDermott, M., Miller, E. C., Rundek, T., Hurn, P. D. & Bushnell, C. D. Preeclampsia. Stroke 49, 524–530 (2018).
12. Creanga, A. A., Syverson, C., Seed, K. & Callaghan, W. M. Pregnancy-Related Mortality in the United States, 2011–2013. Obstet. Gynecol. 130, 366–373 (2017).
13. O’Kelly, A. C. et al. Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women. Circ. Res. 130, 652–672 (2022).
14. Dzakpasu, S. et al. Trends in rate of hypertensive disorders of pregnancy and associated morbidities in Canada: a population-based study (2012–2021). CMAJ 196, E897–E904 (2024).
15. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet. Gynecol. 135, e237–e260 (2020).
16. Brown, H. L. et al. Promoting Risk Identification and Reduction of Cardiovascular Disease in Women Through Collaboration With Obstetricians and Gynecologists. Circulation 137, e843–e852 (2018).
17. Wu, P. et al. Preeclampsia and Future Cardiovascular Health. Circ.: Cardiovasc. Qual. Outcomes 10, e003497 (2017).
18. Grandi, S. M. et al. Cardiovascular Disease-Related Morbidity and Mortality in Women With a History of Pregnancy Complications. Circulation 139, 1069–1079 (2019).
19. Benschop, L., Duvekot, J. J. & Lennep, J. E. R. van. Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy. Heart 105, 1273 (2019).
20. Brown, M. C. et al. Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. Eur. J. Epidemiology 28, 1–19 (2013).
21. Jones, O., Ormesher, L., Duhig, K. E., Peacock, L. & Myers, J. E. Pre-eclampsia and future cardiovascular disease risk: Assessing British clinicians’ knowledge and practice. Pregnancy Hypertens. 37, 101145 (2024).
22. Staff, A. C. The two-stage placental model of preeclampsia: An update. J. Reprod. Immunol. 134, 1–10 (2019).
23. Ray, J. G., Vermeulen, M. J., Schull, M. J. & Redelmeier, D. A. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet 366, 1797–1803 (2005).
24. Madhuvrata, P., Govinden, G., Bustani, R., Song, S. & Farrell, T. Prevention of gestational diabetes in pregnant women with risk factors for gestational diabetes: a systematic review and meta-analysis of randomised trials. Obstet. Med. 8, 68–85 (2015).
25. Hofmeyr, G. J., Lawrie, T. A., Atallah, Á. N. & Torloni, M. R. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst. Rev. 2018, CD001059 (2018).
26. Kinshella, M. W. et al. Calcium for pre‐eclampsia prevention: A systematic review and network meta‐analysis to guide personalised antenatal care. BJOG: Int. J. Obstet. Gynaecol. 129, 1833–1843 (2022).
27. O’Callaghan, K. M. & Kiely, M. Systematic Review of Vitamin D and Hypertensive Disorders of Pregnancy. Nutrients 10, 294 (2018).
28. Purswani, J. M. et al. The role of vitamin D in pre-eclampsia: a systematic review. BMC Pregnancy Childbirth 17, 231 (2017).
29. AlSubai, A. et al. Vitamin D and preeclampsia: A systematic review and meta-analysis. SAGE Open Med. 11, 20503121231212093 (2023).
30. Rouhani, P., Mokhtari, E., Lotfi, K. & Saneei, P. The association between circulating 25-hydroxyvitamin D levels and preeclampsia: a systematic review and dose-response meta-analysis of epidemiologic studies with GRADE assessment. Nutr. Rev. 81, 1267–1289 (2023).
31. Hu, K.-L., Zhang, C.-X., Chen, P., Zhang, D. & Hunt, S. Vitamin D Levels in Early and Middle Pregnancy and Preeclampsia, a Systematic Review and Meta-Analysis. Nutrients 14, 999 (2022).
32. Fogacci, S. et al. Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials. Clin. Nutr. 39, 1742–1752 (2020).
33. Liu, C., Liu, C., Wang, Q. & Zhang, Z. Supplementation of folic acid in pregnancy and the risk of preeclampsia and gestational hypertension: a meta-analysis. Arch. Gynecol. Obstet. 298, 697–704 (2018).
34. Yu, Y., Sun, X., Wang, X. & Feng, X. The Association Between the Risk of Hypertensive Disorders of Pregnancy and Folic Acid: A Systematic Review and Meta-Analysis. J. Pharm. Pharm. Sci. 24, 174–190 (2021).
35. Makarem, N. et al. Association of a Mediterranean Diet Pattern With Adverse Pregnancy Outcomes Among US Women. JAMA Netw. Open 5, e2248165 (2022).
36. Baroutis, D. et al. DASH Diet and Preeclampsia Prevention: A Literature Review. Nutrients 17, 2025 (2025).
37. Sanabria-Martínez, G. et al. Effects of physical exercise during pregnancy on mothers’ and neonates’ health: a protocol for an umbrella review of systematic reviews and meta-analysis of randomised controlled trials. BMJ Open 9, e030162 (2019).
38. Martínez‐Vizcaíno, V. et al. Exercise during pregnancy for preventing gestational diabetes mellitus and hypertensive disorders: An umbrella review of randomised controlled trials and an updated meta‐analysis. BJOG: Int. J. Obstet. Gynaecol. 130, 264–275 (2023).
39. Aune, D., Saugstad, O. D., Henriksen, T. & Tonstad, S. Physical Activity and the Risk of Preeclampsia. Epidemiology 25, 331–343 (2014).
40. Witvrouwen, I., Mannaerts, D., Berendoncks, A. M. V., Jacquemyn, Y. & Craenenbroeck, E. M. V. The Effect of Exercise Training During Pregnancy to Improve Maternal Vascular Health: Focus on Gestational Hypertensive Disorders. Front. Physiol. 11, 450 (2020).
41. Davenport, M. H. et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br. J. Sports Med. 52, 1367 (2018).
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.
Comments