What are the official activity recommendations for pregnant women with hypertension (high blood pressure) at risk for pre-eclampsia and those who have developed pre-eclampsia?

Activity Recommendations for Pregnant Women with Elevated Blood Pressure

For Women at Risk for Pre-eclampsia (Not Yet Diagnosed)

Women at risk for pre-eclampsia should exercise regularly during pregnancy, specifically at least 3 days per week for an average of 50 minutes using a combination of aerobic exercise, strength training, and flexibility training. 1

Exercise Benefits and Rationale

• Regular physical activity during pregnancy has been associated with less weight gain and reduced incidence of hypertensive disorders in pregnancy 1
• Exercise should be maintained to promote health, achieve appropriate body weight, and reduce the likelihood of developing hypertension 1
• There are no significant adverse effects of exercise in pregnancy when performed appropriately 1

Additional Preventive Measures

Women at high risk should also receive:

• Low-dose aspirin (75-162 mg/day, ideally started before 16 weeks but definitely before 20 weeks of gestation) 1
• Calcium supplementation (1.2-2.5 g/day) if dietary calcium intake is low (<600 mg/day) 1

Long-term Lifestyle Approach

• Aim to maintain ideal body weight with BMI <30 kg/m² 2
• Continue structured physical activity programs with regular aerobic exercise 2
• Follow a balanced diet with reduced sodium intake, preferably Mediterranean-style 2

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For Women Who Have Developed Pre-eclampsia

Once pre-eclampsia is diagnosed, activity recommendations shift dramatically toward restriction and close monitoring rather than continued exercise, as the management priority becomes maternal and fetal surveillance with timely delivery. 1

Management Approach After Diagnosis

The guidelines do not explicitly recommend continued exercise once pre-eclampsia develops. Instead, management focuses on:

• Hospital assessment is required at initial diagnosis for all women with pre-eclampsia 1
• Some women with stable disease may be managed as outpatients only after establishing stability and reliable patient monitoring 1
• Women with severe features (proteinuria with severe hypertension, or hypertension with neurological signs/symptoms) require hospitalization 1

Activity Restrictions Based on Severity

For pre-eclampsia with severe features or complications:

• Maternal hospitalization is required 3
• Close monitoring with BP and clinical condition assessed at least every 4 hours while awake 1
• Delivery planning takes priority over activity considerations 1

For stable pre-eclampsia without severe features:

• Outpatient management may be possible with frequent monitoring 1
• More frequent prenatal visits than normal pregnancy 3
• Home blood pressure monitoring or nursing contacts 3

Critical Delivery Timing

Delivery becomes necessary when any of the following develop:

• Inability to control BP despite ≥3 antihypertensive classes 1
• Maternal oxygen saturation <90% 1
• Progressive organ dysfunction (liver, kidney, hematologic) 1
• Ongoing neurological features (severe headache, visual scotomata, eclampsia) 1
• Fetal compromise 1

Important Caveats

• The level of BP itself is not a reliable way to stratify immediate risk in pre-eclampsia, as serious organ dysfunction can develop at relatively mild BP levels 1
• All cases of pre-eclampsia may become emergencies, often rapidly, regardless of initial severity classification 1
• Decisions to admit and monitor should be based on having developed pre-eclampsia regardless of initial BP levels 1

Postpartum Activity Recommendations

After delivery, women with history of pre-eclampsia should:

• Adopt a healthy lifestyle including regular exercise long-term 1
• Aim to achieve pre-pregnancy weight by 12 months postpartum 1
• Maintain ideal body weight and regular aerobic exercise for cardiovascular risk reduction 2, 4
• Receive annual medical review lifelong 1