During pregnancy, your heart is working harder than usual to pump blood to you and your baby. Sometimes, the extra stress exposes risks to your heart health that were there before you got pregnant. The stress can also cause new problems to emerge during pregnancy, such as high blood pressure, diabetes, or preeclampsia (high blood pressure with signs of damage to another organ system such as the kidneys). These problems can happen to you during pregnancy, in labor and delivery -- even up to a year after your child is born.

Preeclampsia and eclampsia are part of the spectrum of high blood pressure, or hypertensive, disorders that can occur during pregnancy.

At the mild end of the spectrum is gestational hypertension, which occurs when a woman who previously had normal blood pressure develops high blood pressure when she is more than 20 weeks pregnant and her blood pressure returns to normal within 12 weeks after delivery. This problem usually occurs without other symptoms. In many cases, gestational hypertension does not harm the mother or fetus. Severe gestational hypertension, however, may be associated with preterm birth and infants who are small for their age at birth. Some women who have gestational hypertension later develop preeclampsia.

Preeclampsia is similar to gestational hypertension because it also involves high blood pressure at or after 20 weeks of pregnancy in a woman whose blood pressure was normal before pregnancy. But preeclampsia can also include blood pressure at or greater than 140/90 mmHg, increased swelling, and protein in the urine. The condition can be serious and is a leading cause of preterm birth (before 37 weeks of pregnancy). If it is severe enough to affect brain function, causing seizures or coma, it is called eclampsia.

A serious complication of hypertensive disorders in pregnancy is HELLP syndrome, a situation in which a pregnant woman with preeclampsia or eclampsia suffers damage to the liver and blood cells. The letters in the name HELLP stand for the following problems:

• H - Hemolysis, in which oxygen-carrying red blood cells break down
• EL - Elevated Liver enzymes, showing damage to the liver
• LP - Low Platelet count, meaning that the cells responsible for stopping bleeding are low

Postpartum preeclampsia describes preeclampsia that develops after the baby is delivered, usually between 48 hours and 6 weeks after delivery. Symptoms can include high blood pressure, severe headache, visual changes, upper abdominal pain, and nausea or vomiting. Postpartum preeclampsia can occur regardless of whether a woman had high blood pressure or preeclampsia during pregnancy.

Postpartum eclampsia refers to seizures that occur between 48 and 72 hours after delivery. Symptoms also include high blood pressure and difficulty breathing. About one-third of eclampsia cases occur after delivery, and nearly half of those are more than 48 hours after the birth.

Postpartum preeclampsia and eclampsia can be serious and, if not treated quickly, may result in death.

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes. Every year, 2% to 10% of pregnancies in the United States are affected by gestational diabetes. Managing gestational diabetes will help make sure you have a healthy pregnancy and a healthy baby.

What Causes Gestational Diabetes?

Gestational diabetes occurs when your body can’t make enough insulin during your pregnancy. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy.

During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin.

All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant. They start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.

Symptoms and Risk Factors

Gestational diabetes typically doesn’t have any symptoms. Your medical history and whether you have any risk factors may suggest to your doctor that you could have gestational diabetes, but you’ll need to be tested to know for sure.

Related Health Problems

Having gestational diabetes can increase your risk of high blood pressure during pregnancy. It can also increase your risk of having a large baby that needs to be delivered by cesarean section (C-section).

If you have gestational diabetes, your baby is at higher risk of:

• Being very large (9 pounds or more), which can make delivery more difficult
• Being born early, which can cause breathing and other problems
• Having low blood sugar
• Developing type 2 diabetes later in life

Your blood sugar levels will usually return to normal after your baby is born. However, about 50% of women with gestational diabetes go on to develop type 2 diabetes. You can lower your risk by reaching a healthy body weight after delivery. Visit your doctor to have your blood sugar tested 6 to 12 weeks after your baby is born and then every 1 to 3 years to make sure your levels are on target.

Testing for Gestational Diabetes

It’s important to be tested for gestational diabetes so you can begin treatment to protect your health and your baby’s health.

Gestational diabetes usually develops around the 24 week of pregnancy, so you’ll probably be tested between 24 and 28 weeks.

If you’re at higher risk for gestational diabetes, your doctor may test you earlier. Blood sugar that’s higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes.

Prevention

Before you get pregnant, you may be able to prevent gestational diabetes by losing weight if you’re overweight and getting regular physical activity.

Don’t try to lose weight if you’re already pregnant. You’ll need to gain some weight—but not too quickly—for your baby to be healthy. Talk to your doctor about how much weight you should gain for a healthy pregnancy.

Treatment for Gestational Diabetes

You can do a lot to manage your gestational diabetes. Go to all your prenatal appointments and follow your treatment plan, including:

• Checking your blood sugar to make sure your levels stay in a healthy range.
• Eating healthy food in the right amounts at the right times. Follow a healthy eating plan created by your doctor or dietitian.
• Being active. Regular physical activity that’s moderately intense (such as brisk walking) lowers your blood sugar and makes you more sensitive to insulin so your body won’t need as much. Make sure to check with your doctor about what kind of physical activity you can do and if there are any kinds you should avoid.
• Monitoring your baby. Your doctor will check your baby’s growth and development.

If healthy eating and being active aren’t enough to manage your blood sugar, your doctor may prescribe insulin, metformin, or other medication.

Each year, about 700 women in the U.S. die from pregnancy-related problems, and more than 50,000 women have life-threatening pregnancy complications. Heart and blood vessel conditions, such as coronary heart disease, high blood pressure, stroke, and cardiomyopathy, are leading causes. The good news is that most of these problems are preventable, meaning you can take steps before, during, and after pregnancy to help your heart health.

Pregnancy-related heart problems can happen to any woman, but your risk may be higher if you:

• Are 40 or older
• Are African American, American Indian, or Alaska Native
• Are overweight or have obesity
• Have heart problems
• Get little physical activity
• Use opioids or other illegal drugs
• Drink alcohol
• Smoke
• Have existing heart disease, such as congenital heart disease or heart valve disease
• Have an existing health condition, such as diabetes, high blood pressure, blood clotting disorders, sleep apnea, anemia, or polycystic ovary syndrome (PCOS)

In the United States, high blood pressure happens in 1 in every 12 to 17 pregnancies in women ages 20 to 44.

Did you know some problems due to pregnancy can happen up to a year after delivery? Be aware of urgent maternal warning signs and symptoms during pregnancy and in the year after delivery. Seek medical care immediately if you experience any signs or symptoms that are listed below. These symptoms could indicate a life-threatening situation.

The following list was developed by the Council on Patient Safety in Women’s Health Care. Learn about these urgent maternal warning signs below.

Headache that won’t go away or gets worse over time

• Feels like the worst headache of your life
• Lasts even after treatment with medication and fluid intake
• Starts suddenly with severe pain – like a clap of thunder
• Throbs and is on one side of your head above your ear
• Comes with blurred vision or dizziness

Dizziness or fainting

• You faint or pass out
• You have dizziness and lightheadedness that’s ongoing, or comes and goes over many days
• You experience a gap in time of which you have no memory

Changes in your vision

• You see flashes of light or bright spots
• You have blind spots or you can’t see at all for a short time
• Your vision is blurry, you can’t focus, or you’re seeing double

Fever of 100.4°F or higher

• You have a temperature of 100.4°F (38°C) or higher

Extreme swelling of your hands or face

• Swelling in your hands makes it hard to bend your fingers or wear rings
• Swelling in your face makes it hard to open your eyes all the way—they feel and look puffy
• Your lips and mouth feel swollen or you have a loss of feeling

This swelling is not like the usual slight swelling that most moms have during pregnancy, especially during the last few months of pregnancy.

Thoughts about harming yourself or your baby

• You may think about hurting yourself because you:
  • Feel very sad, hopeless, or not good enough
  • Don’t feel that you have control over your life
  • Feel extremely worried all the time
• You may think about hurting your baby and/or you may have scary thoughts that come when you don’t want or that are hard to get rid of

Trouble Breathing

• You feel short of breath suddenly or over time, as if you can’t breathe deeply enough to get enough air in your lungs
• Your throat and/or chest feel tight
• You have trouble breathing when you’re laying down flat, such as needing to prop your head up with pillows to sleep

Chest pain or fast-beating heart

• You have chest pain, such as:
  • A feeling of tightness or pressure in the center of your chest
  • Pain that travels to your back, neck, or arm
• You have a change in your heartbeat, such as:
  • A fast heartbeat or a pounding in your chest
  • An irregular heart rate or skipped heartbeats
• You feel dizzy, faint, or disoriented
• You have trouble catching your breath (talking and breathing are difficult)

These symptoms can happen at any time and anywhere or may be triggered by a specific event.

Severe nausea and throwing up

• You feel severely sick to your stomach (nauseous) beyond the normal queasy feeling and throwing up that many moms have in early pregnancy
• You are unable to drink for more than 8 hours or eat for more than 24 hours
• You throw up and can’t keep water or other fluids in your stomach
• You have:
  • A dry mouth
  • Headaches
  • Confusion
  • Fever
  • Dizziness or lightheadedness

Severe belly pain that doesn’t go away

• You have a sharp, stabbing, or cramp-like belly pain that doesn’t go away
• Your belly pain starts suddenly and is severe, or gets worse over time
• You have severe chest, shoulder, or back pain

Baby’s movement stopping or slowing during pregnancy

• You feel that your baby has stopped moving or your baby is moving less than before.

There is no specific number of movements that is considered normal, a change in your baby’s movement is what is important.

Vaginal bleeding or fluid leaking during pregnancy

• You have any bleeding from your vagina that is more than spotting – like a period
• You have fluid leaking out of your vagina
• You have vaginal discharge that smells bad

Vaginal bleeding or discharge after pregnancy

• You have heavy bleeding – soaking through one or more pads in an hour
• You pass clots bigger than an egg or you pass tissue
• You have vaginal discharge that smells bad

Severe swelling, redness or pain of your leg or arm

Anytime during pregnancy or up to 6 weeks after birth

• You have swelling, pain, or tenderness in your leg – usually your calf or in one leg:
  • It may or may not hurt when you touch it
  • It may hurt when you flex your foot to stand or walk
  • The painful area can also be red, swollen, and warm to the touch
• You have pain, tenderness or swelling in your arm, usually on just one side of your body

Overwhelming tiredness

• You are suddenly very tired and weak, not like chronic fatigue
• You don’t have enough energy to go about your day
• No matter how much you sleep, you don’t feel refreshed
• You feel so tired that you don’t get up to take care of your baby
• You feel sad after having your baby

This list is not meant to cover every symptom you might have. If you feel like something just isn’t right, or you aren’t sure if it’s serious, talk to your healthcare provider. Be sure to tell them if you are pregnant or were pregnant within the last year.

If you are pregnant or gave birth within a year, learn more about how to talk to your healthcare provider.

In the United States, high blood pressure happens in 1 in every 12 to 17 pregnancies. It’s important to monitor blood pressure before, during, and after pregnancy. High blood pressure during pregnancy can harm a mother’s kidneys and other organs and can cause early birth (called preterm birth) and low birth weight.

Planning for pregnancy

If you are thinking about having a baby and have high blood pressure, talk with your healthcare provider so you can take steps to lower or control your high blood pressure before and during the pregnancy.

Some medicines used to treat high blood pressure are not recommended during pregnancy. If you are taking medicines to lower or control your high blood pressure, talk with your provider about your choices for safely managing high blood pressure while pregnant.

Types of high blood pressure disorders during and after pregnancy

If you have high blood pressure before pregnancy, it will need to be managed during and after pregnancy.

In addition, some women who have a healthy blood pressure develop high blood pressure during or after pregnancy.

• Gestational hypertension is blood pressure greater than or equal to 140/90 that develops during pregnancy. It’s typically diagnosed after 20 weeks of pregnancy or close to delivery.
• Preeclampsia is a combination of high blood pressure during pregnancy and signs that your organs are not working well, such as high protein levels in your urine. This can lead to life-threatening seizures or coma, a condition known as eclampsia. Women who have had preeclampsia have a higher risk of developing high blood pressure and heart disease later in life.
• HELLP syndrome is a more severe type of preeclampsia or eclampsia.
• High blood pressure disorders may continue after the baby is born. Some women may continue to have high blood pressure problems, including preeclampsia, eclampsia, or HELLP syndrome, after the birth of their child, or their high blood pressure may get worse.
• A sudden spike in blood pressure (more than 160/110 mm HG) can also happen during pregnancy or after the baby is born. This is a medical emergency.

Watch for warning signs of a heart problem, including high blood pressure, during and after pregnancy. Some warning signs are a worsening headache, overwhelming tiredness, dizziness, trouble breathing, chest or belly pain, swelling, or nausea. If you feel like something is wrong, get medical care right away.

Managing high blood pressure during pregnancy

As part of your regular prenatal care, your healthcare provider will measure your blood pressure at each visit. Learn more about how to prepare for a blood pressure test.

If you have high blood pressure, you and your baby will be closely monitored so you can receive special care to lower the chance of complications. You may need to:

• Check your blood pressure at home. Visit Measure Your Blood Pressure for more information.
• Keep track of how many times you feel the baby kicking each day.
• Limit your physical activity. Talk to your healthcare provider about what level of physical activity is right for you.
• Take medicine to control your blood pressure. If you do, talk to your provider about which medicines are safe for your baby. These medicines may include calcium-channel blockers (nifedipine) taken by mouth, or beta blockers (labetalol) or vasodilators (hydralazine) through an intravenous (IV) injection.
• Take aspirin in the second trimester,if you are at risk of preeclampsia and your provider recommends aspirin.
• Visit your provider more often to monitor your condition and your baby’s growth rate and heart rate. He or she may order blood and urine tests to check how well your organs are working, which can help detect preeclampsia.

If your healthcare provider is concerned about you or your baby’s health, they may recommend that you deliver your baby before 39 weeks. You may need to stay in the hospital to get medicine that will help your baby’s lungs develop faster and to be monitored before and after you deliver your baby.

Heart attacks are not common among pregnant women, but they are possible both during and soon after delivery. Normal changes to your body during pregnancy can raise your risk of a heart attack. Your age, lifestyle habits, and other health conditions, such as bleeding disorders, obesity, preeclampsia (high blood pressure during pregnancy), and diabetes, can also raise your risk.

If you already have coronary artery disease, being pregnant can raise your risk of a heart attack. Coronary artery disease is a major cause of heart attacks during pregnancy. Ask your doctor whether it is safe for you to get pregnant and what steps you need to take to keep your heart healthy during your pregnancy.

Heart attacks caused by spontaneous coronary artery dissection (SCAD), a coronary artery embolus, or a coronary artery spasm are more common in pregnant women than in people who are not pregnant.

If you have symptoms of a heart attack during your pregnancy, or at any time, call 9-1-1 right away. Your healthcare team will take steps to protect your baby during these tests. Your healthcare team will also make sure that any treatment you take for a heart attack is safe to use during pregnancy.

If you are pregnant or planning on becoming pregnant, you can take these steps to help manage your heart health:

• Understand your risk. Know your body mass index (BMI), blood pressure, cholesterol, and blood sugar levels.
• Talk to your doctor about your risk and how it affects this pregnancy and your risk in future pregnancies. Tell your doctor about any medicines you are taking and keep all your medical appointments during and after pregnancy.
• If you’re not yet pregnant, develop heart-healthy habits now to set yourself up for a healthy pregnancy. This includes choosing healthy foods, getting regular physical activity, aiming for a healthy weight, managing stress, getting enough good quality sleep, and quitting smoking if you smoke.
• Watch for warning signs of a problem during and after pregnancy. Some warning signs of a heart problem during or after pregnancy are a worsening headache, overwhelming tiredness, dizziness, trouble breathing, chest or belly pain, swelling, or nausea. If you feel like something is wrong, call your doctor or seek medical care right away.

Heart and blood vessel problems in pregnancy can affect your heart health years and even decades after your child is born. For example, women who have gestational diabetes or any of the pregnancy-related high blood pressure disorders, such as gestational high blood pressure or preeclampsia, have a higher long-term risk of heart and blood vessel problems.

The first year after giving birth is an especially important time to work with your doctor. Some serious problems due to pregnancy can occur up to a year after delivery. Your doctor can also give you advice on developing heart-healthy habits for life.

Seeing the doctor regularly before and during your pregnancy is important for managing your risks. By taking regular height, weight, and blood pressure measurements, for example, your doctor can see how your body is adjusting to pregnancy’s changes. Take the opportunity to tell your doctor about any changes or symptoms you have noticed. Here are questions to discuss with your doctor.

• Are my blood pressure numbers normal?
• Am I at risk for developing problems during or after pregnancy?
• If I am at risk, will this affect my prenatal care or birthing plan?
• What can I do to lower my risks for problems during pregnancy?
• Is there a test I can have to rule out a serious problem?
• At what point should I consider going to the emergency room or calling 9-1-1?
• If I have health problems during pregnancy, will that affect my baby, and how does that affect my heart health in the future?
• What should I be aware of after delivery?
• Will any heart health problems during this pregnancy affect future pregnancies?