High blood pressure in pregnancy

High blood pressure in pregnancy

What are the types of high blood pressure during pregnancy?

Sometimes high blood pressure is present before pregnancy. In other cases, high blood pressure develops during pregnancy.

• Gestational hypertension. Women with gestational hypertension have high blood pressure that develops after 20 weeks of pregnancy. There is no excess protein in the urine or other signs of organ damage. Some women with gestational hypertension eventually develop preeclampsia.
• Chronic hypertension. Chronic hypertension is high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy. But because high blood pressure usually doesn’t have symptoms, it might be hard to determine when it began.
• Chronic hypertension with superimposed preeclampsia. This condition occurs in women with chronic hypertension before pregnancy who develop worsening high blood pressure and protein in the urine or other blood pressure related complications during pregnancy.
• Preeclampsia. Preeclampsia occurs when hypertension develops after 20 weeks of pregnancy, and is associated with signs of damage to other organ systems, including the kidneys, liver, blood or brain. Untreated preeclampsia can lead to serious even fatal complications for mother and baby, including development of seizures (eclampsia).

Why is high blood pressure a problem during pregnancy?

High blood pressure during pregnancy poses various risks, including:

• Decreased blood flow to the placenta. If the placenta doesn’t get enough blood, your baby might receive less oxygen and fewer nutrients. This can lead to slow growth (intrauterine growth restriction), low birth weight or premature birth. Prematurity can lead to breathing problems, increased risk of infection and other complications for the baby.
• Placental abruption. Preeclampsia increases your risk of this condition in which the placenta separates from the inner wall of your uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for you and your baby.
• Intrauterine growth restriction. Hypertension might result in slowed or decreased growth of your baby (intrauterine growth restriction).
• Injury to your other organs. Poorly controlled hypertension can result in injury to your brain, heart, lungs, kidneys, liver and other major organs. In severe cases, it can be life-threatening.
• Premature delivery. Sometimes an early delivery is needed to prevent potentially life-threatening complications when you have high blood pressure during pregnancy.
• Future cardiovascular disease. Having preeclampsia might increase your risk of future heart and blood vessel (cardiovascular) disease. Your risk of future cardiovascular disease is higher if you’ve had preeclampsia more than once or you’ve had a premature birth due to having high blood pressure during pregnancy.

How will I know if I develop hypertension during pregnancy?

Monitoring your blood pressure is an important part of prenatal care. If you have chronic hypertension, your health care provider will consider these categories for blood pressure measurements:

• Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from 120 to 129 millimeters of mercury (mm Hg) and a diastolic pressure below 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure.
• Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.
• Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.

After 20 weeks of pregnancy, blood pressure that exceeds 140/90 mm Hg — documented on two or more occasions, at least four hours apart, without any other organ damage — is considered to be gestational hypertension.

How will I know if I develop preeclampsia?

Besides high blood pressure, other signs and symptoms of preeclampsia include:

• Excess protein in your urine (proteinuria) or additional signs of kidney problems
• Severe headaches
• Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
• Upper abdominal pain, usually under your ribs on the right side
• Nausea or vomiting
• Decreased urine output
• Decreased levels of platelets in your blood (thrombocytopenia)
• Impaired liver function
• Shortness of breath, caused by fluid in your lungs

Sudden weight gain and swelling (edema) — particularly in your face and hands — often accompanies preeclampsia. But they also occur in many normal pregnancies, so weight gain and swelling aren’t considered reliable signs of preeclampsia.

Is it safe to take blood pressure medication during pregnancy?

Some blood pressure medications are considered safe to use during pregnancy, but angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers and renin inhibitors are generally avoided during pregnancy.

Treatment is important, however. High blood pressure puts you at risk of heart attack, stroke and other major complications. And it can be dangerous for your baby.

If you need medication to control your blood pressure during pregnancy, your health care provider will prescribe the safest medication at the most appropriate dose. Take the medication exactly as prescribed. Don’t stop taking the medication or adjust the dose on your own.

What should I do to prepare for pregnancy?

If you have high blood pressure, schedule a preconception appointment with the health care provider who’ll handle your pregnancy. Also meet with other members of your health care team, such as your family doctor or cardiologist. They’ll evaluate how well you’re managing your high blood pressure and consider treatment changes you might need to make before pregnancy.

If you’re overweight, your health care provider might recommend losing the excess pounds before you try to conceive.

What can I expect during prenatal visits?

During pregnancy, you’ll see your health care provider often. Your weight and blood pressure will be checked at every visit, and you might need frequent blood and urine tests.

Your health care provider will closely monitor your baby’s health, as well. Frequent ultrasounds might be used to track your baby’s growth and development. Fetal heart rate monitoring might be used to evaluate your baby’s well-being. Your health care provider might also recommend monitoring your baby’s daily movements.

What can I do to reduce the risk of complications?

Taking good care of yourself is the best way to take care of your baby. For example:

• Keep your prenatal appointments. Visit your health care provider regularly throughout your pregnancy.
• Take your blood pressure medication as prescribed. Your health care provider will prescribe the safest medication at the most appropriate dose.
• Stay active. Follow your health care provider’s recommendations for physical activity.
• Eat a healthy diet. Ask to speak with a nutritionist if you need additional help.
• Know what’s off-limits. Avoid smoking, alcohol and illicit drugs. Talk to your health care provider before taking over-the-counter medications.

Researchers continue to study ways to prevent preeclampsia, but so far, no clear strategies have emerged. If you had a hypertensive disorder in a prior pregnancy, your doctor might recommend a daily low-dose aspirin (81 milligrams) beginning late in your first trimester.

What about labor and delivery?

Your health care provider might suggest inducing labor before your due date to avoid complications. The timing of your induction is based both on how well-controlled your blood pressure is, whether you have end-stage organ damage, and whether your baby has complications, such as intrauterine growth restriction due to your hypertension.

If you have preeclampsia with severe features, you might be given medication during labor to help prevent seizures.

Will I be able to breast-feed my baby?

Breast-feeding is encouraged for most women who have high blood pressure, even those who take medication. Discuss medication adjustments you’ll need to make with your health care provider before your baby is born. Sometimes an alternate blood pressure medication is recommended.