Gestational Hypertension

Last Update: 07 Apr 2026

Condition

Table of content

1. What is it? 2. Why managing? 3. Non-Medical Options 4. Medications 5. Breastfeeding/ chestfeeding 6. Key Takeaways 7. Limits of Research

Welcome to our Fact Sheet on gestational hypertension in pregnancy and lactation. The information is based on current research and may evolve with new scientific knowledge. This content does not replace personalized advice your healthcare professionals.

1. What Is gestational hypertension?

Gestational hypertension is when high blood pressure develops for the first time after 20 weeks of pregnancy.

Hypertension, or high blood pressure, means that the force of blood pushing against your artery walls is higher than it should be and stays that way over time.

Blood pressure is measured using two numbers.

The first number shows the pressure in your blood vessels when your heart beats.
The second number shows the pressure when your heart rests between beats.

In pregnancy, blood pressure is considered high when it is 140/90 mmHg or higher, confirmed by two separate readings taken 15 minutes apart.

If you had high blood pressure before 20 weeks of pregnancy, it is called chronic hypertension. You can read more about chronic hypertension here.

Very high blood pressure (160/110 mmHg or higher) can cause symptoms like headaches, blurred vision, chest pain, or shortness of breath. However, most people with high blood pressure do not feel any symptoms. The only way to know if you have hypertension is to measure your blood pressure, which is why regular prenatal checkups are so important.

Some people are more likely to develop high blood pressure during pregnancy. This includes people who:

live with obesity or diabetes
are over the age of 35
have had a hypertensive disorder in a previous pregnancy
are pregnant with twins or more
have a family history of high blood pressure or heart disease

Also, people who self-identify as Black experience higher rates of hypertension during pregnancy. This reflects the impact of social and health inequities and highlights the importance of personalized and culturally safe care.

In some situations, gestational hypertension can evolve into preeclampsia, a serious complication that combines high blood pressure with signs that the placenta or other organs are not working well. You can read more about preeclampsia here.

With regular follow-up and, when needed, medication, gestational hypertension can usually be managed well. Most people with high blood pressure during pregnancy can go on to have pregnancies with good outcomes and healthy babies.

2. Why is it important to manage gestational hypertension during pregnancy?

Hypertension is one of the most common health conditions during pregnancy affecting about 4 to 5% of pregnant people in Canada (Dzakpasu, 2024). When gestational hypertension is not well monitored or controlled, it can increase the risk of complications for both you and your baby, including the chance of developing preeclampsia.

Managing blood pressure during pregnancy helps protect your health and supports healthy blood flow to the placenta, which is important for your baby’s growth and development.

Understanding Pregnancy Risks

Research helps us estimate the risks linked to common pregnancy-related conditions. Miscarriages (loss of the baby), congenital malformations (birth defect, malformation present at birth), premature birth (before 37 weeks), and other complications can happen in any pregnancy for many reasons. This is the background risk. Research helps us understand whether these risks may be higher when gestational hypertension is not well managed during pregnancy.

It’s also important to remember:

Some risks are well studied, while others need more research.
Your personal risk depends on factors like age, medical history, genetics, lifestyle (e.g. alcohol use), and other health conditions.

Based on current research, high blood pressure puts extra strain on the heart and blood vessels. This can increase the risk of long-term health problems like high blood pressure and cardiovascular disease. For the baby, uncontrolled high blood pressure can reduce blood flow to the placenta, which may affect growth or lead to early birth.

The table below provides a summary of what research says about those risks.

Table 1. Possible risks of unmanaged hypertension during pregnancy.

Who?	What?	What does research say?
Pregnant person	Preeclampsia	Higher chance of developing preeclampsia compared to people without high blood pressure.
	Maternal health	When blood pressure is very high or not well controlled, there is a higher risk of complications affecting the kidneys, brain (such as stroke), or heart.
	Cesarean delivery	Higher chance of needing a cesarean delivery.
	Placental abruption	Increased risk that the placenta separates too early from the uterus, which can be serious.
	Long-term health	Higher risk of developing high blood pressure later in life and other cardiovascular disease.
Unborn baby	Congenital malformations	Gestational hypertension is not associated with an increased risk of malformations.
	Premature birth	Slightly increased risk of preterm birth (before 37 weeks).
	Low birth weight	Some studies found a slight increased risk of low birth weight (less than 5 pounds and 8 ounces [2,500g])
	Stillbirth	Slightly higher risk compared to the background risk, though still uncommon.
Future child	Brain development	Research results are mixed on the risk of autism spectrum disorder and ADHD. We need more research to confirm.
Future child	Long-term health issues	More research is needed to understand possible long-term effects. Most children do well.

*These findings describe patterns seen in research studies of many pregnancies. They do not predict what will happen in any one pregnancy.

3. What can I do to manage gestational hypertension other than medications?

Managing high blood pressure in pregnancy might often include healthy daily habits, but lifestyle changes alone do not always lower blood pressure enough during pregnancy. Research is still limited on how much lifestyle changes can treat high blood pressure once it has started.

The most important step is regular follow-up. Going to your prenatal appointments helps your healthcare team monitor your blood pressure and your baby’s well-being, and decide if or when treatment is needed.

If your healthcare provider says it is safe for you, they may also suggest steps like gentle physical activity, stress management, and home blood pressure checks. Some conditions, like uncontrolled high blood pressure, can make exercise unsafe, so it’s important to follow your provider’s advice. Your healthcare provider will work with you to create a plan that fits your needs.

Discover You, Me, Baby, a free and virtual program to support your mental health throughout your pregnancy.

Learn more

4. Medications prescribed to manage gestational hypertension

When needed, your healthcare provider may prescribe medications to help lower your blood pressure. Managing gestational hypertension during pregnancy often involves medications tailored to your needs.

What does research say?

For people with low dietary calcium intake (less than 900 mg/day), calcium supplementation (at least 500 mg per day) may help lower the risk of hypertensive disorders in pregnancy, especially preeclampsia. Calcium is used for prevention, not as a treatment for high blood pressure once it has developed.

When medication is needed, treatment usually starts with one medication (monotherapy). Common first-line options include:

Oral Labetalol (a beta-blocker) is the one most commonly used.
Oral Nifedipine (long-acting) (a calcium channel blocker)
Oral Methyldopa (an alpha-2 agonist, less common but sometimes used)

These are the most commonly used medications because they are effective and generally safe for pregnancy. Other oral beta-blockers such as acebutalol, metoprolol, pindolol or propranolol may be used in some situations.

The choice of medication depends on your health history, side effects, and how your body responds to treatment.

Some blood pressure medications are not used during pregnancy because they can harm the developing baby. These include:

ACE inhibitors (like enalapril, lisinopril, ramipril)
Angiotensin-receptor blockers (ARBs) (like losartan, valsartan)

Always talk with your healthcare provider before starting, stopping, or changing any medication during pregnancy.

Large studies and clinical experience in Canada show that the medications commonly used to treat gestational hypertension, when prescribed appropriately, are generally safe and help reduce the risk of serious complications. To know more about a specific medication, please consult the associated Fact Sheet for more details on a specific medication.

Table 2. Some oral medications prescribed in Canada for gestational hypertension

Medication Types	Medication Names	Brand names
First-line treatments	Labetalol	e.g. Apo-labetalol®, Riva-labetalol®, Trandate®
	Methyldopa	e.g. Aldomet®
	Nifedipine (long-acting)	e.g. Adalat XL®
	Acebutolol	e.g. Monitan®, Sectral®
	Metoprolol	e.g. Lopressor®, Betaloc®
	Pindolol	eg. Visken®
	Propranolol	e.g. Hemangiol®

* Not all of these medications are recommended during pregnancy. Always check with a healthcare professional before using medication during pregnancy.

How do I know which medication to take?

Each medication has its risks and benefits. Your healthcare team is best equipped to guide you in making an informed decision adapted to your personal needs.

Always discuss any changes in your medication intake with your healthcare team (pharmacist, nurse, doctor).

5. Can gestational hypertension or its treatment affect breastfeeding or milk supply (lactation)?

If you have gestational hypertension, you can still breastfeed or chestfeed if that is your choice. Lactation is possible for people with high blood pressure and may bring additional health benefits, such as lowering the risk of long-term conditions like high blood pressure and high cholesterol, especially when lactation continues for a longer time.

If you take medication to manage your blood pressure, most commonly used options – like labetalol, methyldopa, nifedipine, enalapril, and captopril – are considered compatible with lactating. Only very small amounts of these medicines pass into breast milk, and they are not expected to cause problems for most babies. Your healthcare team can tell you what to watch for, and you can contact them if you have any concerns.

Some people, especially those who had complications, a difficult delivery, or an early birth, may need more time for milk production to fully establish. This does not mean breast/ chest feeding is not possible. Support from your healthcare team and a lactation consultant can be very helpful.

If you have any concerns or questions about breastfeeding, don’t hesitate to talk to your healthcare professional (doctor, nurse, pharmacist) or a lactation consultant from your region (e.g. Canadian Lactation Consultant Association).

Key Takeaways

Gestational hypertension is when you have high blood pressure (140/90 mmHg or higher) that starts after 20 weeks of pregnancy.
If blood pressure is not well monitored or controlled, it can increase the risk of preeclampsia, preterm birth, low birth weight, or, in rare cases, other health problems for the pregnant person.
Some people need medication to help keep blood pressure in a safe range. Labetalol is the most commonly used medication, and research is reassuring about its use during pregnancy.
Lactating is safe for most people, even if they took blood pressure medication during pregnancy.
Always talk with healthcare professionals before starting, changing, or stopping medications.

Research Is Great, But It Is Not Perfect

Making informed health decisions also means understanding what research knows and what it cannot say. Here’s what our experts have found about the research on hypertension during pregnancy:

Several studies: Many studies have been done which make the clinical guidelines less harder.
Short-term focus: Most studies look only at pregnancy and the weeks after birth. We know less about long-term health effects for parents and babies.
Limited diversity: Many studies are from wealthier countries, which may not reflect experiences in other parts of the world.

These observations highlight the need for larger, more diverse, and long-term research to improve care for pregnant people with hypertension.

References

Yemane, A., Teka, H., Ahmed, S. et al. Gestational hypertension and progression towards preeclampsia in Northern Ethiopia: prospective cohort study. BMC Pregnancy Childbirth 21, 261 (2021). https://doi.org/10.1186/s12884-021-03712-w
Brand JS, Lawlor DA, Larsson H, Montgomery S. Association Between Hypertensive Disorders of Pregnancy and Neurodevelopmental Outcomes Among Offspring. JAMA Pediatr. 2021;175(6):577–585. doi:10.1001/jamapediatrics.2020.6856
Wang, H., László, K.D., Gissler, M. et al. Maternal hypertensive disorders and neurodevelopmental disorders in offspring: a population-based cohort in two Nordic countries. Eur J Epidemiol 36, 519–530 (2021). https://doi.org/10.1007/s10654-021-00756-2
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