Melomed Articles


13 February 2019 - Dr. Jayeshnee Moodley

Hypertension In Pregnancy


Pregnancy is a wonderful journey in a woman's life. Most women have uncomplicated pregnancies and deliveries, however there are a subset of women who are at risk for medical disorders during the antenatal and postnatal period. High blood pressure and pregnancy isnt necessarily a dangerous combination.

What are the types of high blood pressure during pregnancy?

         Gestational hypertension. Women with gestational hypertension have high blood pressure that develops after 5 months of pregnancy. There are no signs of kidney or 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 5 months of pregnancy.

         Chronic hypertension with superimposed preeclampsia. This condition occurs in women with chronic hypertension before pregnancy who develop worsening high blood pressure and other blood pressure related complications during pregnancy.

         Preeclampsia. Preeclampsia occurs when hypertension develops after 5 months 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 fatal complications for mother and baby.

         In rare cases, a woman may experience high blood pressure after giving birth. This is known as Postpartum preeclampsia.

Pre-eclampsia is a serious condition with known risk factors and affects about 2 % - 8%  of pregnancies. The exact cause of pre-eclampsia is unknown. However, trials have shown that there are abnormalities within the placental blood vessels and there is an implied genetic link. With narrowing of the blood vessels, blood flow is limited. This results in varying degrees of affectation to mum and baby.

The high blood pressure of preeclampsia can develop rapidly and thus your obstetrician will monitor for preeclampsia regularly at your prenatal visits and treat it, if necessary. It must be reiterated that most women with preeclampsia go on to have healthy babies.

 

How should I do to prepare for pregnancy?

If you have high blood pressure, schedule a pre-conception appointment with your obstetrician and physician. This gives us the opportunity to evaluate the management of your blood pressure and consider treatment changes you might need to make before pregnancy. If youre overweight, your health care provider might recommend losing the excess weight before you try to conceive. Certain high risk women are treated with low dose aspirin even prior to conception

Although it's not always clear what causes preeclampsia during pregnancy, there are some known risk factors, including if

      this is your first pregnancy

      new paternity: this is your first pregnancy by a new father

      the pregnancy gap is less than 2 years or more than 10 years

      you had preeclampsia in a previous pregnancy

      you have a family history of preeclampsia

      you have a history of high blood pressure or kidney disease

      youre over 40 years old

      youre carrying twins, triplets, or other multiples

      you have diabetes, a blood clotting disorder, lupus, or migraines

      youre obese

      your pregnancy is a result of IVF

 

Hypertension during pregnancy requires close monitoring as it poses various risks including:

Decreased blood flow to the placenta. 

If the placenta doesnt 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.

 

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.

Eclampsia: This is a combination of preeclampsia and seizures. The woman may experience pain under the ribs on the right side of her body, intense headache, blurry vision, confusion, and decreased alertness. If left untreated the woman is at risk of going into a coma, suffering permanent brain damage, and death. The condition is life-threatening for the baby as well.

 

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).


Premature delivery. Sometimes an early delivery is needed to prevent potentially life-threatening complications when you have high blood pressure during pregnancy.


Preeclampsia can have some long-term consequences for the developing baby. Research has shown that high blood pressure in pregnant women may affect the babys cognitive skills, which can carry through into later life


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 youve had preeclampsia more than once or youve had a premature birth due to having high blood pressure during pregnancy.

 

How will I know if I develop hypertension during pregnancy?

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 levels of platelets (clotting factors) in your blood

         Impaired liver function

         Shortness of breath, caused by fluid in your lungs

         Sudden rapid weight gain and swelling particularly in your face and hands

Swelling is a common part of pregnancy, especially during the third trimester, and tends to occur in the lower parts of the body, such as the ankles and feet. Symptoms are typically milder first thing in the morning and build up during the day. This is not preeclampsia

During pregnancy, you will have frequent antenatal visits. Your weight and blood pressure will be checked at every visit, and you might need frequent blood and urine tests. With the confirmation of hypertension, an antihypertensive will be initiated. The anti-hypertensive is specific for pregnancy and the dose is measured against blood pressure control. Your baby will also be monitored closely.  You may also be asked to start aspirin in addition to an anti-hypertensive drug. Frequent ultrasounds might be used to track your babys growth and development. Fetal heart rate monitoring will be used to evaluate your babys well-being. You will also be asked to monitor baby's movements with a fetal kick-count chart. Severe pre-eclampsia will generally warrant admission for blood pressure control, close fetal monitoring and intravenous anticonvulsant medication called Magnesium sulphate, to prevent seizures from raised blood pressure. Severe Pre-eclampsia will usually necessitate an earlier delivery. Mild pre-eclampsia can be managed with regular outpatient antenatal consultations.

 

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

         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 providers recommendations for physical activity.

         Eat a healthy diet. Ask to speak with a nutritionist if you need additional help.

         Know whats off-limits. Avoid smoking, alcohol and illicit drugs. Talk to your obstetrician before taking over-the-counter medications.

         Take time to rest. Resting helps bring the blood pressure down, which in turn increases the flow of blood to the placenta, which benefits the baby.

 

The only cure for preeclampsia and eclampsia is to deliver your baby. Your obstetrician will talk with you about when to deliver based on the gestation, the severity of your preeclampsia and the fetus's well-being. Most women with preeclampsia have healthy babies. If your baby has developed enough, usually by 37 weeks or later, your obstetrician will discuss delivery - either by an induction or a cesarean section.  If your baby is not close to term, you and your doctor may be able to treat preeclampsia until your baby has developed enough to be safely delivered. The closer the birth is to your due date, the better for your baby. Steroids injections may be given prior to delivery to help improve liver and platelet function, and to help your baby's lungs mature in premature babies. If you have preeclampsia with severe features, you might be given medication during labour 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 youll need to make with your obstetrician before your baby is born. Sometimes an alternate blood pressure medication is recommended.

 

Pregnancy is one of the most satisfying experiences in a woman's life. Pre-eclampsia can make this journey is a bumpy ride! Your obstetrician is there to assist and guide you throughout your pregnancy. A well monitored pregnancy is a healthy pregnancy and will result in a healthy baby.


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