What Causes Hypertension In Pregnancy

When Should You Call Your Doctor

Call or visit your doctor promptly if you have any signs of high blood pressure. Symptoms such as persistent headaches, vision changes, swelling, and less urine should be evaluated. However, pregnancy symptoms can sometimes mask hypertension symptoms. Hence, seek your doctors advice for any persisting symptoms in pregnancy .

Living With High Blood Pressure During Pregnancy

Go to each of your prenatal visits with your doctor. This will allow him or her to monitor your blood pressure. Your doctor may ask you to record your blood pressure at home. He or she can give advice on how to do that. Your doctor will check your urine at each visit. High levels of protein in urine can be a symptom of preeclampsia.

Discuss all your medicines with your doctor. Also, dont start or stop taking any medicines, including over-the-counter medicines, without talking to your doctor. Some of these may affect your blood pressure.

How Do I Know If I Have Gestational Hypertension

At each prenatal checkup, your healthcare provider will check your blood pressure and urine levels. Your doctor may also check your kidney and blood-clotting functions, order blood tests, perform an ultrasound scan to check your babys growth, and use a Doppler Scan to measure the efficiency of blood flow to the placenta.

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What Is Considered Low Blood Pressure During Pregnancy

While there isnt a definitive number that is too low, there are symptoms that are associated with low blood pressure:

As a woman progresses in her pregnancy, her blood pressure may change or return to pre-pregnancy levels. There are a few possible reasons for this.

The amount of blood in a womans body increases. According to the journal Circulation , a womans blood volume increases by as much as 45 percent during pregnancy. This is extra blood that the heart must pump throughout the body.

The left ventricle becomes thicker and larger. This temporary effect allows the heart to work harder to support the increased blood volume.

The kidneys release increased amounts of vasopressin, a hormone that leads to increased water retention.

In most cases, high blood pressure during pregnancy will decrease after the baby is delivered. In cases where blood pressure remains elevated, your doctor may prescribe medication to get it back to normal.

What Causes Hypertension After Pregnancy

Doctors are not certain what causes postpartum hypertension. However, certain risk factors may increase your likelihood of developing high blood pressure after giving birth.

Breastfeeding is recommended for all women and does not lead to postpartum hypertension. Breastfeeding is safe if youve had a hypertensive disorder, and in fact may help reduce hypertension according to the CDC,. Most medications used to treat high blood pressure during pregnancy or postpartum are safe for use during breastfeeding, but be certain to discuss this with your doctor or midwife.

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A Word From Mantra Care

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What Are The Symptoms Of Preeclampsia

Possible symptoms of preeclampsia include:

• High blood pressure
• Too much protein in your urine
• Swelling in your face and hands. Your feet may also swell, but many women have swollen feet during pregnancy. So swollen feet by themselves may not be a sign of a problem.
• Headache that does not go away
• Vision problems, including blurred vision or seeing spots
• Pain in your upper right abdomen
• Trouble breathing

Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output. If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.

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Potential Complication: Gestational Hypertension

• Can I Lower My Risk?

When you’re pregnant, it’s common to have high blood pressure. Up to 8% of pregnant women in the U.S. have high blood pressure, usually during their first pregnancies. If you first develop it when you’re expecting, it’s called gestational hypertension or pregnancy-induced hypertension .

Most women with gestational hypertension have healthy pregnancies and healthy babies. But, high blood pressure during pregnancy can be a sign of other conditions that can be much more harmful. That’s one reason why seeing your doctor early and often is so important in keeping you and your baby healthy.

High Blood Pressure In Pregnancy Diagnosis Steps

The initial evaluation should be based on the inspection if there is any target organ damage such as

• Left ventricular hypertrophy or any other heart disease
• Kidney disease
• Retinopathy

If there is evidence of no organ damage, then it is a good sign. If there is evidence of organ damage, it means the high blood pressure reached the critical level and the usual level of high blood pressure in the patient can be determined.

The cause of high blood pressure in the patient is a very important part of diagnosis. Based upon the cause of hypertension, treatment varies. Not only that, how much preventable the high blood pressure can be and what will be the outcome of treatment also depend upon the cause of high blood pressure.

Consideration of secondary causes is essential in this young population, but that greatest challenge in the diagnosis of secondary causes of hypertension is that the causes are complicated by normal pregnancy-related changes.

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How High Blood Pressure Impacts Labour And Birth

If you have high blood pressure, both you and your baby will be closely monitored during the pregnancy. During labour, the babys heart will be continuously monitored and you may have an intravenous drip to give you fluid and medication. If your condition seems to be worsening during labour, you may need an emergency caesarean.

If you have pre-eclampsia, it will normally be recommended that you have the baby in a large maternity hospital which can provide expert care for both mother and baby. It may mean the baby is born early or is smaller than expected.

How Is High Blood Pressure During Pregnancy Different From High Blood Pressure At Other Times

High blood pressure during pregnancy can impact the body in different ways than it normally would. Mothers with high blood pressure during pregnancy are at a higher risk of complications before, during and after the birth. Not only is the mothers health in danger, but the baby can be impacted by high blood pressure during pregnancy.

High blood pressure during pregnancy can affect the development of the placenta, causing the nutrient and oxygen supply to the baby to be limited. This can lead to an early delivery, low birth weight, placental separation and other complications for the baby.

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Will I Still Have High Blood Pressure After The Baby Is Delivered

High blood pressure during pregnancy typically goes away after the baby is delivered but increases the risk of high blood pressure and heart disease in the future. Women who had 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.

Last reviewed by a Cleveland Clinic medical professional on 01/21/2019.

References

What Will Happen To My High Blood Pressure After Delivery

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What To Do For A Safe Delivery With Gestational Hypertension

The following measures may help mothers with high blood pressure during pregnancy have a safe and healthy delivery :

• Take hypertension medications as prescribed

• Attend prenatal visits as recommended

• Maintain a healthy, low-sodium diet

• Follow the doctors advice regarding exercises and other activities

• Plan early delivery if suggested

Women with a blood pressure of more than 160/110mmHg are recommended to have an early delivery depending on the maternal and fetal indications. In addition, antenatal corticosteroids and magnesium sulfates are prescribed before early delivery .

Complications Of Hypertension During Pregnancy

Preeclampsia, eclampsia, stroke all are the result of hypertension in pregnant mothers. If the baby is weak, the mother may need to deliver early. There may be a need for labor induction which means giving medicine to induce labor. And in some cases, a cesarean section may be needed as well.Women may face problems after delivery also.

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Risks Of High Blood Pressure In Pregnancy

For mom

High blood pressure during pregnancy puts you at risk of:

• Stroke

• Heart attacks

• Breathing problems

• Fluid in other parts of your body It can also put you at risk of a serious complication called placental abruption and complications when giving birth.

For baby

High blood pressure can also affect your unborn babys growth and health. When the moms blood pressure runs high, this affects how much oxygen and nutrients are delivered to the growing baby. Unborn babies affected by high maternal blood pressure are more likely to be born preterm and underweight.

For the birth

Pregnancy-induced hypertension raises your risk of having an early delivery or a C-section.

High Blood Pressure And Pregnancy

High blood pressure, or hypertension, does not usually make you feel unwell, but it can sometimes be serious in pregnancy.

Your midwife will check your blood pressure at all your antenatal appointments.

If you are pregnant and have a history of high blood pressure, you should be referred to a specialist in hypertension and pregnancy to discuss the risks and benefits of treatment.

If you develop high blood pressure for the first time in pregnancy, you will be assessed in a hospital by a healthcare professional, usually a midwife, who is trained in caring for raised blood pressure in pregnancy.

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High Blood Pressure During Pregnancy Treatment

If you have chronic hypertension, you may have been taking medicine for it before you became pregnant. Tell your doctor which medicine youre taking. He or she may say its okay to continue that medicine. But if the medicine isnt safe for your baby, you may need to switch to another medicine during your pregnancy. Like with all pregnancies, your doctor will check your blood pressure and urine during your regular appointments.

If you have gestational hypertension, your doctor will monitor your blood pressure and urine more closely. He or she will do this to watch for signs of preeclampsia. Your doctor may also monitor your baby. One way to do that is with an ultrasound. This is a painless test that lets your doctor see your baby inside your body.

What Can You Do About High Blood Pressure Before Pregnancy

Heres what you can do:

• Get a preconception checkup. This is a medical checkup you get before pregnancy to take care of health conditions that may affect your pregnancy.
• Use birth control until your blood pressure is under control. Birth control is methods you can use to keep from getting pregnant. Condoms and birth control pills are examples of birth control.
• Get to a healthy weight. Talk to your provider about the weight thats right for you.
• Eat healthy foods.
• Do something active every day.
• Dont smoke. Smoking is dangerous for people with high blood pressure because it damages blood vessel walls.

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How Is Gestational Hypertension Diagnosed

If your blood pressure increases, your healthcare provider may diagnose you with this condition. You may also have the following tests to check for this issue:

• Blood pressure readings
• Urine testing to check for protein. This is a sign that your kidneys arent working well.
• Checking for swelling
• Checking your weight more often
• Liver and kidney function tests
• Blood clotting tests

Relevance Of Evolutionary History

It is the goal of evolutionary medicine to find treatments for diseases that are informed by the evolutionary history of a disease. It has been suggested that gestational hypertension is linked to insulin resistance during pregnancy. Both the increase in blood sugar that can lead to gestational diabetes and the increase in blood pressure that can lead to gestational hypertension are mechanisms that mean to optimize the amount of nutrients that can be passed from maternal tissue to fetal tissue. It has been suggested that techniques used to combat insulin insensitivity might also prove beneficial to those suffering from gestational hypertension. Measures to avoid insulin resistance include avoiding obesity before pregnancy, minimizing weight gain during pregnancy, eating foods with low glycemic indices, and exercising.

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Cardiovascular Findings In Preeclampsia

Home and ambulatory blood pressure measurements are increasingly being used in the pregnant population. Assuming the blood pressure device is accurate , the measurements may provide valuable additional data regarding hypertension severity and control during pregnancy.

In most normal pregnancies, the woman has some lower extremity edema by the third trimester. In contrast, a sudden worsening in dependent edema, edema in nondependent areas , or rapid weight gain suggest a pathologic process and warrant further evaluation for preeclampsia. Preeclampsia is a multisystem disease with various physical signs.

Women should be allowed to sit quietly for 5-10 minutes before each blood pressure measurement. Blood pressure should be measured in the sitting position, with the cuff at the level of the heart. Inferior vena caval compression by the gravid uterus while the patient is supine can alter readings substantially, leading to an underestimation of the blood pressure. Similarly, blood pressures measured in the left lateral position may yield falsely low values if the blood pressure is measured in the higher arm, unless the cuff is carefully maintained at the level of the heart.

Maternal SBP greater than 160 mm Hg or DBP greater than 110 mm Hg denotes severe disease depending on the gestational age and maternal status, delivery should be considered for sustained pressures in this range.

Home Blood Pressure Monitoring

It is important to note that while home blood pressure monitoring may be important, the readings must be validated with those of the office sphygmomanometer. A systematic review of the accuracy of blood pressure devices in pregnancy noted that only some of the ambulatory monitoring devices pass validation protocols. Another study comparing consecutive blood pressures by validated and non-validated automated blood pressure cuffs to sphygmomanometer readings in 127 pregnant patients showed that 69% of systolic and 77% of diastolic readings were within 5 mmHg of their manual standard and recommended that patients validate their home monitors in the office prior to use at home.

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How Is High Blood Pressure During Pregnancy Diagnosed

No one test diagnoses high blood pressure while pregnant. Instead, your doctor will take your blood pressure at each of your prenatal appointments. He or she will keep track of your blood pressure readings during your pregnancy and be able to spot any changes that could indicate an overall problem. He or she will also use urine and blood tests to watch for possible issues.

Can High Blood Pressure During Pregnancy Be Prevented

Since the cause of high blood pressure during pregnancy is not known, it is not a condition that can usually be prevented. In some women at high risk for developing high blood pressure, healthcare providers often recommend daily baby aspirin for prevention. High blood pressure during pregnancy can sometimes be managed and controlled with the help of a healthcare provider. However, this may often require delivery of the baby. Your blood pressure will be checked regularly during prenatal appointments. If you have any concerns about your blood pressure, speak with your healthcare provider.

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Treatments For High Blood Pressure

Your doctor or midwife will check your blood pressure regularly. If you have high blood pressure, it is important to:

• exercise regularly
• make sure you are a healthy weight

If high blood pressure is caused by a medical condition such as kidney disease, its important to talk to your doctor about what medications are safe to take during pregnancy.

Pre-eclampsia can be managed with medication and close monitoring of both you and the baby. However, it can become worse very quickly. If this happens, you may need to go to hospital or have the baby delivered early.

Key Points About Gestational Hypertension

• Gestational hypertension is a form of high blood pressure in pregnancy. It occurs in about 3 in 50 pregnancies.
• This condition can affect the health of both the mother and the baby, depending on how severe the issue is.
• The goal of treatment is to prevent the condition from getting worse and causing other problems.

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What Are The Treatments For Preeclampsia

Delivering the baby can often cure preeclampsia. When making a decision about treatment, your provider take into account several factors. They include how severe it is, how many weeks pregnant you are, and what the potential risks to you and your baby are:

• If you are more than 37 weeks pregnant, your provider will likely want to deliver the baby.
• If you are less than 37 weeks pregnant, your health care provider will closely monitor you and your baby. This includes blood and urine tests for you. Monitoring for the baby often involves ultrasound, heart rate monitoring, and checking on the baby’s growth. You may need to take medicines, to control your blood pressure and to prevent seizures. Some women also get steroid injections, to help the baby’s lungs mature faster. If the preeclampsia is severe, you provider may want you to deliver the baby early.

The symptoms usually go away within 6 weeks of delivery. In rare cases, symptoms may not go away, or they may not start until after delivery . This can be very serious, and it needs to be treated right away.