Why Blood Pressure Monitoring in Pregnancy & Postpartum Is More Important Than Ever

As an expectant parent, you’re likely keeping track of many aspects of your health—nutrition, fetal movements, and overall well-being. However, blood pressure is a crucial health indicator that sometimes doesn’t get enough attention. Monitoring your blood pressure regularly during pregnancy and postpartum is essential for identifying potential complications like hypertension and preeclampsia, which have been on the rise since 2020.

It hurts my heart when pregnant folks I support develop hypertension and pre-eclampsia, particularly because many I work with are seeking to avoid interventions. And when one or both of these issues develop, then an intervention-heavy induction is all the more likely (and in many cases medically necessary). So, let’s talk about some valuable considerations on this topic!

Why Blood Pressure Monitoring Matters

Blood pressure is a key measure of your cardiovascular health. During pregnancy, significant changes occur in the body, and blood pressure can fluctuate. Hypertension (high blood pressure) and preeclampsia can develop suddenly, even if you’ve never had issues before. These conditions increase the risk of complications such as:

  • Preterm birth

  • Low birth weight (because these issues restrict placental blood flow to the baby)

  • Placental abruption

  • Stroke or organ damage in the birthing parent

Since 2020, there has been a notable increase in cases of gestational hypertension and preeclampsia. While research is ongoing, potential contributing factors include increased stress, changes in prenatal care accessibility, and lingering effects of COVID-19 infections on vascular health.

Postpartum Blood Pressure: The Often Overlooked Factor

Many parents assume that once the baby is born, blood pressure concerns diminish. However, postpartum preeclampsia—a serious condition that can develop days or even weeks after delivery—requires just as much attention. In fact, some cases arise up to six weeks postpartum, making home monitoring a critical tool for early detection. This is why we recommend everyone purchase an at-home blood pressure monitor to regularly monitor BP in the weeks after birth (read on for details and recommendations).

Who’s At Risk for Gestational Hypertension & Pre-eclampsia?

According to American College of Obstetricians & Gynecologists, factors that may put a pregnant person in the “high risk” category include

  • preeclampsia in a past pregnancy

  • carrying more than one fetus (twins, triplets, or more)

  • chronic hypertension

  • kidney disease

  • diabetes mellitus

  • autoimmune conditions, such as lupus (systemic lupus erythematosus or SLE)

  • having multiple moderate risk factors (see below)

Factors that may put you in the “moderate risk” category include

  • being pregnant for the first time

  • being pregnant more than 10 years after your previous pregnancy

  • body mass index (BMI) over 30

  • family history of preeclampsia (mother or sister)

  • being age 35 or older

  • complications in previous pregnancies, such as having a baby with a low birth weight

  • in vitro fertilization (IVF)

  • Black race (because of racism and inequities that increase risk of illness)

  • lower income (because of inequities that increase risk of illness)

Tips for Getting an Accurate Blood Pressure Reading

Whether you’re at the doctor’s office or using a home monitor, ensuring an accurate reading is key. As we learn the following guidelines, many of us realize we’re likely to not be getting accurate results. Follow these tips for the best results:

  1. Empty your bladder

  2. Rest for 5 Minutes with the cuff on – Sit in a quiet place and relax before taking your reading.

  3. Use the Correct Cuff Size – A too-tight or too-loose cuff can give inaccurate readings.

  4. Seated position – Keep your feet flat on the floor, sit upright, and support your back. Do not cross your legs.

  5. Keep Your Arm at Heart Level – Your forearm should be supported, resting on a table or pillow to ensure proper positioning. (If your entire arm is resting at your side, this can cause a deceptively high reading. Yet have you noticed this is the way most of our clinical settings do it?)

  6. Take Multiple Readings – Measure your blood pressure twice, a minute apart, and record the average. Prenatally, if you get a prenatal read that’s over 140/90 (but not so high that it’s an emergency), request to wait 4 hours and then take another read

  7. Avoid Caffeine, Alcohol, Stress, Phone usage before Measuring – Refrain from these 30+ minutes before a BP reading, because they can temporarily spike your blood pressure.

  8. Use relaxation techniques such as deep breathing, visualization, affirmations, meditation, prayer, or other mindfulness techniques to lower your blood pressure.

On a related note, around 1 in 3 people have “white coat syndrome” (medical anxiety) so that BP will often become elevated whenever in a clinical setting. In these cases, you could 1) ask your care provider if you could do some at-home blood pressure monitoring to compare readings and 2) you may want to consider giving birth outside a clinical setting, such as in a free-standing birthing center or at home.

Investing in a Reliable At-Home Blood Pressure Monitor

Having an at-home blood pressure monitor is a simple yet powerful way to stay proactive about your health — particularly in postpartum when we don’t usually see our care providers for several weeks after birth. The American Heart Association (AHA) and other health organizations recommend monitors that have been clinically validated for accuracy.

A couple of the best-tested home monitors we’ve curated for you:

*Disclosure: If you purchase with these links, we will receive a small commission at no additional cost to you.

You can do some research yourself at ValidateBP.org to see what at-home blood pressure monitors have been tested for accuracy or to verify one you already own (as we did!). Keep in mind that just because a blood pressure monitor is FDA-approved doesn’t mean it’s been tested for accuracy.

When choosing a monitor, look for one with an upper-arm cuff (rather than wrist or finger monitors) for the most precise readings.

Advocating for Your Health

Monitoring your blood pressure is not about causing fear—it’s about empowerment. If you notice elevated readings (typically 140/90 mmHg or higher) twice in a row, contact your healthcare provider promptly. Trust your intuition, ask questions, and prioritize your well-being.

Your health matters, and by staying informed and proactive, you’re taking an important step in ensuring a safe and healthy pregnancy and postpartum experience.

For further reading/research:

One more important thing: a lot of OBs/midwives are recommending pregnant folks (particularly those at higher risk of hypertension/preeclampsia) take baby aspirin in pregnancy because there’s evidence showing it reduces the risk of developing pre-eclampsia (to which hypertension is a predecessor). In fact, the U.S. Preventative Task Force recommends all pregnant folks take baby aspirin after 12 weeks of pregnancy, and it’s most effective for pre-eclampsia prevention when starting it before 16 weeks. ACOG is a bit less broad in its recommendations of who should take baby aspirin, including the following risk factors: history of early-onset preeclampsia and preterm delivery at less than 34 0/7 weeks of gestation, or for women with more than one prior pregnancy complicated by preeclampsia. Their official dosage/timing recommendations is as follows: “Low-dose aspirin (81 mg/day) prophylaxis is recommended in women at high risk of preeclampsia and should be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery.” Consider having a discussion with your midwife/OB about whether or not this might be recommended during your pregnancy.

We’re curious to hear from you on this. Does your midwife/OB follow the above guidelines to get a truly accurate reading? Have they recommended taking baby aspirin? We welcome your thoughts!