Blood pressure changes across pregnancy and postpartum: from physiological adaptations to pathological deviations

Pregnancy represents a unique physiological period characterized by dynamic cardiovascular adaptations and changes in blood pressure (BP) throughout gestation and the postpartum period. Deviations from these expected patterns may represent a risk to maternal health and be associated with the development of hypertensive disorders of pregnancy (HDP). Personalized and continuous monitoring, including BP measurements and the assessment of longitudinal and circadian BP patterns, can contribute to the earlier identification of women at risk. Accurate BP assessment remains central to the diagnosis and management of HDP. In this context, out-of-office BP assessment, particularly 24-hour ambulatory blood pressure monitoring, may provide additional information and identify abnormalities that remain undetected by conventional office measurements. HDP are among the most frequent complications of pregnancy and are associated with increased long-term cardiovascular risk. Their management extends beyond delivery, as postpartum hypertension remains underrecognized, and adequate follow-up and timely, targeted antihypertensive treatment are essential. Emerging strategies, including home BP monitoring, telemedicine-based programs, and multidisciplinary postpartum hypertension clinics, may improve continuity of care. This review examines physiological and pathological BP changes across pregnancy and the postpartum period, with particular emphasis on longitudinal BP trajectories and circadian patterns, beyond absolute BP values alone, as potential early indicators of HDP, while integrating current evidence and guideline recommendations on their diagnosis, monitoring, and management.