History and exam
Key diagnostic factors
common
previously normotensive
If the woman's previous blood pressure (BP) status is unknown, it may not be possible to distinguish gestational hypertension from chronic hypertension at presentation.
BP ≥140/90 mmHg
A diagnosis of gestational hypertension should be made only after two readings ≥140/90 mmHg, spaced at least 4 hours (but no more than 7 days) apart.
Measurement of diastolic BP during pregnancy should include K5 or the disappearance of the Korotkoff sound as opposed to K4 or the muffling of this sound.
Other diagnostic factors
common
>20 weeks' gestation
If hypertension is noted before 20 weeks' gestation, it is likely to be chronic hypertension.
uncommon
absence of symptoms that suggest preeclampsia
Significant weight gain, peripheral edema, headaches, and upper abdominal pain are suggestive of preeclampsia.
Risk factors
strong
nulliparous
maternal age >35 years
The risk of gestational hypertension increases with increasing age, and women ages 35 years and older are more likely to undergo induction of labor or cesarean delivery.[9]
weak
black or Hispanic ethnicity
Black women are at greater risk than white women.[3]
obesity
mother small for gestational age
Women who were born small for gestational age may be at increased risk of developing gestational hypertension during their first and subsequent pregnancies.[14]
type 1 diabetes mellitus
Women with type 1 diabetes may be at increased risk of gestational hypertension.[15]
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