High Blood Pressure Condition Can Affect Mother And Baby
High blood pressure, or hypertension, is a common condition that can raise the risk of heart disease, heart attack or stroke. In pregnant women, high blood pressure can also cause major complications for both mother and baby.
In this video, San Diego Health host Susan Taylor and guest Sean Daneshmand, MD, an OB-GYN and medical director of the Scripps ClinicPerinatology Program, discuss hypertension in pregnancy.
Why is hypertension during pregnancy a concern?
High blood pressure and related conditions, such as obesity and diabetes, are on the rise in the general population, so it makes sense that high blood pressure would also be increasing among pregnant women. This can lead to several significant problems that affect the heart, lungs or brain. The main concern is preeclampsia, a condition that can develop during pregnancy or up to six weeks after delivery.
Preeclampsia, also called toxemia or pregnancy-induced hypertension , may or may not be severe:
In preeclampsia without severe features, blood pressure is typically between 140-159/80-109 mmHG . These women typically have no symptoms and their blood test results are normal.
In preeclampsia with severe features, blood pressure is typically over 160/110 mmHg and women tend to have severe headache or visual problems, as well as blood test abnormalities, such as elevated liver enzymes and low platelets. Pregnant women whose severe preeclampsia is not treated could develop eclampsia, which is a seizure disorder.
Preventing High Blood Pressure During Pregnancy
Common risk factors for high blood pressure, such as obesity, can be minimized through diet and exercise.
During pregnancy, its normal to gain some weight. If youre concerned, talk to your doctor about a target weight gain and ways to stay within a range thats healthy for you.
Dietary guidelines for pregnant women vary from person to person. A nutritionist can help create a meal plan thats designed for your specific height and weight.
Avoid smoking and drinking alcohol. Both are known to raise blood pressure and to cause other complications during pregnancy.
Salt is important during pregnancy and its usually not necessary to limit salt intake, even for women with high blood pressure. Restricting salt too much is harmful for pregnant women and can impact fetal growth and development.
Pregnancy causes hormone shifts as well as psychological and physical changes. This can bring on stress, which can make high blood pressure harder to manage. Try stress reduction techniques such as yoga and meditation.
Some traditional blood pressure medications can cause problems in pregnant women.
These medications for lowering blood pressure are typically not recommended during pregnancy:
Risk Factors Of Hypertension Disorders During Pregnancy
This study was conducted to identify the possible risk factors, maternal and perinatal outcomes of hypertensive disorders in pregnancy in Nekemte Referral Hospital, Ethiopia. The study revealed that the proportion of hypertensive disorders of pregnancy was 3.56%, which was lower than the study conducted in Tikur Anbessa Hospital, Jimma University Specialized Hospital and Debre Berhan Referral Hospital . The reason might be due to the development of awareness creation made on controlling danger signs of maternal health by extension health workers in the current study than earlier study in a rural area.
This study showed that the extreme ages of reproductive years were found to be risk factors for hypertension during pregnancy with high incidence rates in old ages of greater than 35years in comparison with the age range of 2529years. Concerning the current study, a hospital-based cross-sectional study conducted in Dassie Referral Hospital and in Derashe, woreda in Ethiopia reported that late age 30years in some cases and age greater than 35years in most cases were significantly associated with Hypertensive disorders of pregnancy.
About two folds of cases of HDP were living in a rural area comparing to urban residence for this study. Then the rural residential area was found to be one of the risk factors of HDP.
This finding was similar to a study done in Jimma hospital of a similar country .
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Things You Can Try Yourself To Reduce High Blood Pressure
Keeping active and doing some physical activity each day, such as walking or swimming, can help keep your blood pressure in the normal range. Eating a balanced diet and keeping your salt intake low can help to reduce blood pressure.
There isn’t enough evidence to show that dietary supplements such as magnesium, folic acid or fish oils are effective at preventing high blood pressure.
The Risk For High Blood Pressure During Pregnancy
If not treated, high blood pressure can be dangerous for the mother and the baby.
While many women with high blood pressure deliver healthy babies, hypertension can affect a mothers kidneys and increase her risk of heart disease, kidney disease, and stroke.
Other possible complications include:
Low Birth Weight Since high blood pressure can decrease the flow of nutrients to the baby through the placenta, the baby may not grow as expected.
Preterm Delivery If the placenta is not providing enough nutrients and oxygen to your baby, your doctor may recommend early delivery.
Placental Abruption This is a medical emergency that occurs when the placenta prematurely detaches from the wall of the uterus.
Cesarean Delivery Women with hypertension are more likely to have a C-section than women with normal blood pressure.
Preeclampsia This severe condition, also called toxemia of pregnancy, can be life-threatening to both the mother and baby. It is characterized by high blood pressure and signs of damage to an organ system, most commonly the liver and kidneys.
HELLP Syndrome This stands for hemolysis , elevated liver enzymes, and low platelet count, and is a more severe form of preeclampsia. Symptoms include nausea and vomiting, headache, and upper right abdominal pain. HELLP can become life-threatening very quickly, as it may damage several organ systems.
And women who develop gestational hypertension are at risk for complications, too.
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Why Is Gestational Hypertension A Concern
With high blood pressure, there is an increase in the resistance of blood vessels. This may hinder blood flow in many different organ systems in the expectant mother including the liver, kidneys, brain, uterus, and placenta.
There are other problems that may develop as a result of severe gestational hypertension . Placental abruption may occur in some pregnancies. Gestational hypertension can also lead to fetal problems including intrauterine growth restriction and stillbirth.
If untreated, severe gestational hypertension may cause dangerous seizures and even death in the mother and fetus. Because of these risks, it may be necessary for the baby to be delivered early, before 37 weeks gestation.
Hypertension During Pregnancy And After Delivery: Management Cardiovascular Outcomes And Future Directions
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Disease Spectrum
Hypertension during pregnancy can occur in one of three forms: chronic hypertension, gestational hypertension and preeclampsia . Chronic hypertension is defined as elevated blood pressure known before conception or diagnosed before 20 weeks of gestation. GH is hypertension that develops any time after 20 weeks of gestation without proteinuria. PE is defined as hypertension with organ damage that develops after 20 weeks of gestation and has the potential to result in serious adverse consequences for the mother and fetus. Target organ damage can be manifested by proteinuria, thrombocytopenia, elevated creatinine or liver transaminases, pulmonary edema or cerebral or visual symptoms. Severe hypertension is defined as systolic blood pressure above 170 mmHg or diastolic blood pressure above 110 mmHg.1,2
Implications on Cardiovascular Outcomes
In a recent prospective observational study, women with severe PE had higher right ventricular systolic pressure, decreased global right ventricular longitudinal systolic strain and lower mitral septal e velocity when compared to the control cohort of normal pregnancies. Twelve percent of patients with PE also had grade II diastolic dysfunction and 9.5% had peripartum pulmonary edema.10 These data demonstrate that adverse outcomes of pregnancy are common and highlight the need for antenatal surveillance, risk stratification and close long term follow up of patients with these complications.
Guideline Directed Management
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Signs Suggesting A Secondary Medical Cause Of Chronic Hypertension
Centripetal obesity, buffalo hump, and/or wide purple abdominal striae suggest glucocorticoid excess other clinical signs may demonstrate hyperthyroidism, hypothyroidism, or growth hormone excess. In addition, a systolic bruit heard over the abdomen or in the flanks suggests renal artery stenosis, whereas radio femoral delay or diminished pulses in the lower versus upper extremities suggests coarctation of the aorta.
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High Blood Pressure During Pregnancy
Some women have high blood pressure during pregnancy. This can put the mother and her baby at risk for problems during the pregnancy. High blood pressure can also cause problems during and after delivery.1,2 The good news is that high blood pressure is preventable and treatable.
High blood pressure, also called hypertension, is very common. In the United States, high blood pressure happens in 1 in every 12 to 17 pregnancies among women ages 20 to 44.3
High blood pressure in pregnancy has become more common. However, with good blood pressure control, you and your baby are more likely to stay healthy.
The most important thing to do is talk with your health care team about any blood pressure problems so you can get the right treatment and control your blood pressurebefore you get pregnant. Getting treatment for high blood pressure is important before, during, and after pregnancy.
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How Hypertension During Pregnancy Is Diagnosed
Your blood pressure will be monitored during prenatal visits and you will undergo a few other tests and checks, including:
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Testing your urine for excess protein
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Taking a blood pressure reading along with your other vital signs like heart rate, respiratory rate, and temperature
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Weighing you to determine if youre gaining weight at a normal rate
If your doctor detects high blood pressure, they will recommend more frequent visits to monitor both you and your baby. You will also undergo additional testing, including:
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Fetal ultrasound to check your babys amniotic fluid, placenta, development, and growth
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Electronic fetal heart monitoring to evaluate your babys heart rate and rhythm
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Doppler ultrasound to determine if there is enough blood flow to the placenta
A blood test will be ordered to monitor your blood cells and liver and kidney function if you are diagnosed with preeclampsia.
High Blood Pressure Treatment In Pregnancy Is Safe Prevents Maternal Heart Risks
Statement Highlights:
- High blood pressure during pregnancy remains a major cause of maternal and fetal pregnancy-related complications and death, and it increases womens short- and long-term risks for cardiovascular disease.
- Emerging data from clinical trials and observational research support the benefits and safety of blood pressure treatment during pregnancy.
- Continued investigation is critical to determine which blood pressure levels, during- and post-pregnancy, both for starting therapy and as treatment goals, are beneficial for the mother and safe and beneficial for the fetus.
- The statement advises multidisciplinary, team-based personalized care where clinicians partner with the patient to determine preferred treatment and consider the risks for hypertension-related adverse outcomes
Embargoed until 4 a.m. CT / 5 a.m. ET Wednesday, Dec. 15, 2021
DALLAS, Dec. 15, 2021 Treatment for high blood pressure during pregnancy appears safe for many women and may reduce maternal risk for severe hypertension without increasing fetal and neonatal risks, according to a new American Heart Association scientific statement published today in the Associations journal Hypertension.
The goals of treatment during pregnancy include preventing severe hypertension and preventing early delivery to allow the fetus time to mature before delivery.
The statement also highlights these areas of concern:
Additional Resources:
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What Are The Risks Of Hypertension During Pregnancy
If high blood pressure during pregnancy is not treated early enough, there is a risk of complications for you and your baby. Fortunately, with proper treatment and management, most pregnant women with hypertension deliver healthy babies. Note that women with hypertension during pregnancy are more likely to have a cesarean section delivery than women with normal blood pressure.
High blood pressure risks during pregnancy can cause serious complications, including:
Reduced blood flow to the placenta
Hypertension can reduce blood flow to the placenta, limiting the delivery of nutrients and oxygen to your baby. This contributes to slow growth and can cause premature birth or low birth weight. If you deliver your baby prematurely, the risk of infection, breathing problems, and other related complications is higher.
If your doctor suspects blood supply to the placenta is limited, they may recommend early delivery.
Placental abruption
This is a medical emergency where the placenta prematurely disconnects from the uterus wall, depriving the baby of blood carrying oxygen and nutrients.
Injury to organs
High blood pressure can damage your lungs, brain, heart, liver, kidneys, and other vital organs.
HELLP syndrome
Eclampsia
Eclampsia is a rare and dangerous condition that affects some women with preeclampsia. The condition can cause the mother to have seizures, which places her and the baby at risk.
Future high blood pressure
Who Is At Risk For Preeclampsia
You are at higher risk of preeclampsia if you:
- Had chronic high blood pressure or chronic kidney disease before pregnancy
- Had high blood pressure or preeclampsia in a previous pregnancy
- Damage to your kidneys, liver, brain, and other organ and blood systems
- A higher risk of heart disease for you
- Eclampsia, which happens when preeclampsia is severe enough to affect brain function, causing seizures or coma
- HELLP syndrome, which happens when a woman with preeclampsia or eclampsia has damage to the liver and blood cells. It is rare, but very serious.
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Tips For Tracking Blood Pressure During Pregnancy
There are ways to track your blood pressure between doctor visits.
You can buy a blood pressure monitor from a pharmacy or online medical goods store. Many of these devices will go on your wrist or upper arm. To check the monitors accuracy, take it to your doctors office and compare the readings on the monitor to those from your doctor.
Visit a grocery store, pharmacy, or other store that has a machine that takes blood pressure readings.
For the most accurate readings, take your blood pressure at the same time every day. Take it while seated with your legs uncrossed. Use the same arm each time.
Notify your doctor immediately if you have repeated high blood pressure readings that are four hours apart or symptoms of high blood pressure.
If you have high blood pressure during pregnancy, there can be complications.
Will I Still Have High Blood Pressure After My Baby Is Delivered
High blood pressure during pregnancy typically goes away after your babys delivered. However, it increases your risk of high blood pressure and heart disease in the future. If you had a severe form of preeclampsia or gestational hypertension, you may need medication for a few weeks after delivery. Its important to see your provider within 10 days postpartum if you had a severe form of high blood pressure at delivery.
People with chronic hypertension before pregnancy will usually still have the condition after delivery. Sometimes, blood pressure can remain high after delivery, requiring treatment with medication. Your healthcare provider will work with you after your pregnancy to manage your blood pressure.
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Risk Factors Or Complications Of Hypertension During Pregnancy
If Preeclampsia develops, it might cause serious damages to organs including brain and kidneys. Hypertension during pregnancy with seizures may become Eclampsia.
Eclampsia is the condition in which one or more convulsion occur in a pregnant woman suffering from high blood pressure this often followed by a coma causing a threat to the health of mother and baby.
Hypertension during pregnancy can also have an effect on the babys growth rate. This can result in a low birth weight of the baby.
Some other complications can include
- Preterm delivery
Treatment Of Acute Hypertension In Pregnancy
Acute severe hypertension in pregnancy is a medical emergency requiring treatment to lower blood pressures within 30 minutes of confirmation to reduce risk of maternal stroke. According to the February 2015 ACOG Committee Opinion #623 Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Post-Partum Period, first line options for treatment include oral immediate-release nifedipine, IV labetalol, and IV hydralazine.
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Does Blood Pressure Remain High After Birth
High blood pressure in pregnancy usually disappears after the birth of a baby. However, there is still some possibility of some complications during the first few days after the birth and you will need to be monitored closely for some weeks.
And in the case of chronic hypertension where blood pressure rises due to another medical condition, you will need to see their doctor to make sure their blood pressure returns to safe levels.
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Tracking Blood Pressure During Pregnancy
A blood pressure reading is a fraction: your systolic blood pressure over your diastolic blood pressure.
The top number is your systolic pressure, which is a measurement of the pressure on your arteries when the heart is beating or squeezing blood forward through your body.
The diastolic pressure, or the lower number, is a measurement of the blood pressure in your arteries when the heart is at rest.
To determine what your normal blood pressure is during pregnancy, your doctor will likely take a baseline blood pressure measurement at your first visit. Then they will measure your blood pressure at every visit that follows.
Normal blood pressure is anything less than 120/80 mm Hg.
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Sample Description And Characteristics
A total of 4782 women from 2443 sibships participated in the second FBPP study visit between 2000 and 2004. Demographic characteristics measured at the second FBPP visit are shown by network in . At least one pregnancy that lasted more than 6 months was reported by 4064 women , overall. Of these women, 643 reported hypertension in at least one of their pregnancies. Among those, 209 reported a history of preeclampsia. The percentages of women reporting hypertension in pregnancy did not differ significantly among non-Hispanic blacks , non-Hispanic whites , and Hispanic whites however, the percentage was significantly lower in Asians . Education had no significant effect on the percentage of women reporting hypertension in pregnancy, that is, the percentage did not differ significantly between those who did or did not complete high school. As major differences were present across the networks, all subsequent analyses were adjusted for age, network, education, and race.
