High Blood Pressure In Pregnancy

What you need to know to protect yourself—and your baby.

High blood pressure, or hypertension, can present in a few different ways during pregnancy. It is one of the most common medical problems during pregnancy, complicating up to 15% of pregnancies. If you have—or develop—high blood pressure in pregnancy, you are likely to require special care in your pregnancy and should go for regular follow-ups with your obstetrician. Here are some facts that you need to know to take care of yourself—and your baby.

What Are the Different Types of High Blood Pressure During Pregnancy?

1. Chronic Hypertension

Chronic hypertension is high blood pressure (usually more than 140/90 mmHg) that was present before pregnancy or that manifests in the first 20 weeks of pregnancy. It usually carries on after delivery.

2. Gestational Hypertension
Gestational hypertension (or pregnancy-induced hypertension), is high blood pressure that develops after 20 weeks of pregnancy without significant protein in the urine or other signs of organ damage. This transient hypertension usually goes away after delivery.

3. Preeclampsia
This is a serious condition in pregnancy which can arise from both chronic hypertension or gestational hypertension. Symptoms include high blood pressure and protein in the urine, and is occasionally associated with other signs of organ damage. Left untreated, it can give rise to serious complications to both mother and baby.

What Are the Problems with Regards to High Blood Pressure in Pregnancy?

Untreated or poorly controlled hypertension or preeclampsia in pregnancy can lead to serious risks:

For the mother, you can be at risk of damage to your kidneys and liver, stroke, blood clotting problems as well as bleeding from the placenta. There is also the risk of preeclampsia leading to eclampsia which is an acute and life-threatening complication which is characterized by seizures and possibly coma in pregnancy.
For the baby, your foetus can be at risk of poor growth, an increased risk of premature delivery and stillbirth and premature separation of the placenta from the inner wall of the uterus before the delivery, also known as placental abruption.

Who Is More Likely to Develop High Blood Pressure in Pregnancy?

Here are some of the risk factors for developing high blood pressure in pregnancy and preeclampsia.

Women in their first pregnancy
Women who had high blood pressure or hypertensive disease in a previous pregnancy
Women with a first-degree relative who had high blood pressure in pregnancy
Women with twins or multiple pregnancies
Women above the age of 40 or under 20
Women who are overweight
Women with chronic kidney problems or diabetes
Women whose last pregnancy was over 10 years ago

How Will I Know if I Develop High Blood Pressure in My Pregnancy?

At each checkup in pregnancy, your healthcare provider will measure your blood pressure and may check your urine for protein. Sometimes, blood tests may be necessary to assess your kidney and liver function. Regular checks and ultrasound scans to measure the growth of your baby may also be helpful.

Frequently, mild or moderate hypertension may not be associated with any symptoms. However, pregnant women should be made aware of the need to seek urgent medical attention if they develop symptoms of preeclampsia, such as severe headache, visual disturbances such as blurring or flashing before the eyes, sudden swelling of the feet, face or hands, upper abdominal pain or vomiting.

How Is High Blood Pressure in Pregnancy Treated?

Treatment depends on several factors, including how close you are to your estimated due date, how high your blood pressure is, and whether there is any element of preeclampsia.

If you are on medications for high blood pressure before getting pregnant, your doctor will probably review your medications and prescribe some medication suitable for pregnancy. You may be offered additional checks like blood or urine tests, and it would be advisable to go for regular checkups, the frequency of which would likely depend on how the sever the condition is. Ultrasound scans to assess the growth and development of your baby will also be helpful.

It’s also a good idea to limit your salt intake, as too much salt in your diet can push your high blood pressure. Other good pregnancy tips would include getting enough rest, exercising regularly, elevating your feet several times during the day, avoiding alcohol and beverages containing caffeine, and drinking enough water.

If you are close to your due date, and your baby has developed enough, your doctor may want to deliver your baby earlier.

Will High Blood Pressure Affect the Birth of My Baby?

Management of high blood pressure in pregnancy should be individualized for each pregnant woman. It may be possible to have a smooth normal labour and delivery.

Sometimes, your doctor may suggest starting your labour earlier, depending on how high your blood pressure is or other factors in your pregnancy. This is called an induction.

Your blood pressure will have to be monitored regularly during labour, or in some cases, continuously. If you are on medications to stabilize your blood pressure, you will need to continue them during labour. Your baby will likely need continuous monitoring during labour as well.

Depending on individual circumstances, sometimes instruments may be necessary to speed up the delivery process. This is called an assisted birth. Birth by Caesarean section may also be offered by your doctor, particularly when speed is essential or if there are other factors which make a vaginal birth difficult or dangerous.

Will My Blood Pressure Come Back Down to Normal After Delivery?

If your blood pressure was normal before pregnancy, it is very likely that it will return to normal within 6 weeks after delivery. However, this may lead to an increased likelihood of high blood pressure developing in a subsequent pregnancy or later on in life.

If your blood pressure does not return to normal after 6 weeks, you may have chronic hypertension. Depending on the levels, dietary and lifestyle modification or medications may be necessary to control your blood pressure. Be sure to let your doctor know if you are breastfeeding so that he or she can prescribe you a medication which is safe for your baby as well.

In summary, high blood pressure in pregnancy is a common condition. While many women with high blood pressure in pregnancy can deliver healthy babies normally, high blood pressure can be dangerous. Some background knowledge as well as regular antenatal check-ups with your obstetrician will go a long way towards ensuring that you have a safe and healthy pregnancy.