Pregnant in a rural town of 400: How this mom is getting vital medical care miles away from her doctor
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Pregnant in a rural town of 400: How this mom is getting vital medical care miles away from her doctor
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High blood pressure is a common condition that occurs with pregnancy. One form, gestational hypertension, has become substantially more common in the United States, a new report has found
The rate of gestational hypertension increased 73% between 2016 and 2024, and more than 1 in 10 women giving birth in 2024 had it, according to the report published on July 29 by the US National Center for Health Statistics
Why is this condition concerning, who is most at risk, and what can people do to prevent and treat it?
To help us understand the findings and what pregnant patients should know about this form of hypertension, I spoke with CNN wellness expert Dr. Leana Wen. Wen is an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore’s health commissioner
Keeping track of long-term health conditions while you’re pregnant can help reduce the risk of gestational hypertension.
CNN: What is gestational hypertension, and how is it different from other types of high blood pressure during pregnancy?
Dr. Leana Wen: Gestational hypertension refers to high blood pressure that develops during pregnancy in someone who previously had normal blood pressure. Clinically, the condition is diagnosed after 20 weeks of pregnancy when blood pressure reaches 140/90 mm Hg or higher on repeated measurements
This form of high blood pressure is one of several hypertensive disorders of pregnancy. Chronic hypertension is high blood pressure that started before pregnancy or is otherwise diagnosed during the first 20 weeks. Preeclampsia is hypertension that develops after 20 weeks and is accompanied by signs that other organs, such as the kidneys, are being affected
CNN: What did this new report find about how common gestational hypertension has become?
Wen: The researchers analyzed birth certificate data from all births registered in the United States between 2016 and 2024. Six percent of women giving birth in 2016 were reported as having gestational hypertension. By 2024, that rate had risen to 10.4%. The number of cases increased from nearly 236,000 a year to more than 377,000
The increase was widespread. Rates rose in every age group and every racial and ethnic group studied. Rates also increased in all 50 states and the District of Columbia, though substantial geographic disparities persisted — in 2024, rates ranged from 6.9% in New Jersey to 14.6% in Louisiana
One caveat is that the definition used on birth certificates includes pregnancy-induced hypertension and preeclampsia and is therefore broader than the clinical definition of gestational hypertension
Still, the authors specifically caution that gestational hypertension is probably underreported because health conditions are often underreported on birth certificates. However, the same methodology was used throughout the study period, which strengthens the finding of an increase over time. The overall trend is also consistent with other research showing that hypertension during pregnancy has become increasingly common
CNN: Why is gestational hypertension problematic? What are the potential risks to the baby and the mother?
Wen: For the baby, hypertensive disorders are associated with problems with growth, low birth weight, preterm delivery and stillbirth. High blood pressure during pregnancy can also affect blood flow to the placenta. The condition increases the risk of serious complications including placental abruption, in which the placenta separates from the uterus before delivery
For the mother, severe hypertension can damage organs and increase the risk of stroke. Gestational hypertension can progress to preeclampsia, which, in severe cases, can lead to eclampsia, which involves seizures and can be life-threatening
CNN: Who is most at risk for developing gestational hypertension?
Wen: In 2024, women ages 40 and older had the highest rate of gestational hypertension among the age groups studied, according to the new report. There was also a strong association with weight before pregnancy. The rate among those with obesity prior to pregnancy was more than double that of people with normal weight. Women carrying twins or more babies at once also had substantially higher rates than those carrying one baby
Rates varied by race and ethnicity as well. American Indian and Alaska Native women had the highest rate, at 13.2%, followed by Black women at 12.3%. These rates may be influenced by multiple factors, including differences in access to healthcare services
CNN: Do we know why rates of gestational hypertension have increased so substantially?
Wen: One likely contributor is that some of the factors associated with gestational hypertension have become more common. More people are becoming pregnant at older ages; obesity has become more prevalent among those of reproductive age; and there are more twin, triplet and other multiple births
This, though, may not fully explain the large rise in prevalence, especially as the report found substantial increases across every age and body mass index category. Another explanation is that there could be changes over time in diagnosis and reporting, or there could be other biological factors underlying why this condition appears to be increasing. More research is needed to determine how much of the rise reflects changes in the health of pregnant individuals versus changes in how these conditions are identified and recorded.
CNN: How is gestational hypertension detected? Are there symptoms pregnant patients should watch for?
Wen: The US Preventive Services Task Force recommends that blood pressure be measured at every prenatal visit. An elevated reading should be confirmed with repeat measurements
Certain symptoms should prompt urgent medical evaluation because they can be signs of preeclampsia. These include a severe or persistent headache, changes in vision such as blurred vision or seeing spots, pain in the upper abdomen, significant swelling of the face or hands, shortness of breath, and nausea or vomiting later in pregnancy
Importantly, though, many people with high blood pressure will not feel any different. That means someone should not assume that because they feel well, their blood pressure must be normal. Pregnant patients should know their usual blood pressure and ask their clinician about it during clinic visits
CNN: How is gestational hypertension treated if it develops?
Wen: Treatment depends on how high the blood pressure is, whether there are signs of preeclampsia, and how far along the pregnancy is and how the baby is doing
Someone with gestational hypertension will need more frequent monitoring, which may include home blood pressure measurements, blood and urine tests, and additional monitoring of fetal growth and well-being. Some people may require blood pressure medications
Severely elevated blood pressure accompanied by signs of organ damage may require early delivery. In some cases, clinicians have to weigh the risks of continuing the pregnancy against the risks of delivering early
CNN: Is there anything patients can do before or during pregnancy to reduce their risk of developing gestational hypertension and other hypertensive disorders of pregnancy?
Wen: Some risk factors, such as age or carrying twins, cannot be changed. But optimizing health before pregnancy can help reduce risk
People who are planning pregnancy should make sure that existing conditions such as chronic hypertension and diabetes are well-controlled. Those who have overweight or obesity can discuss with their healthcare provider whether weight loss before pregnancy would benefit their health. Regular physical activity, a nutritious diet and not smoking are essential for cardiovascular and overall health generally
CNN: What should people who have had gestational hypertension know about their health after pregnancy?
Wen: In the immediate term, they should know that delivery does not immediately eliminate the risk. Blood pressure problems can persist or worsen in the initial days and weeks after childbirth, and preeclampsia can first appear during the postpartum period
Patients should also be aware that hypertensive disorders during pregnancy are associated with an increased risk of developing chronic hypertension and cardiovascular disease later in life. People who have developed hypertension during pregnancy should make sure that this remains part of their medical history so that future primary care providers and other healthcare professionals are aware of this potential risk factor
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