February 28, 2018

Hypertension and pregnancy: What are the dangers?


It’s important to see a doctor as soon you might be pregnant to begin assessing the risks of hypertension.

I often see patients who aren’t aware of the risks that hypertension in pregnancy can present, or what they can do to help reduce their risk. Here is what to know to help take care of yourself and your baby.

What is hypertension in pregnancy?

Hypertension, or high blood pressure, and other related high blood pressure disorders complicate up to 10 percent of pregnancies worldwide. These disorders are extremely important as they can cause serious problems for both the mother and the baby if left undiagnosed and untreated.

There are several categories of high blood pressure disorders and these categories depend on the timing of diagnosis and the severity of the associated signs and symptoms.

1. Chronic Hypertension: Women with preexisting hypertension who become pregnant or are found to have elevated blood pressure (higher than 140/90) before 20 weeks gestation are placed in this category.

2. Gestational Hypertension: This is hypertension diagnosed after 20 weeks of pregnancy in a patient who before pregnancy did not have high blood pressure.

3. Preeclampsia: This serious hypertensive disorder occurs in about 8 percent of pregnant women. It normally happens after 20 weeks gestation and is diagnosed in women with persistently elevated blood pressures and proteinuria, changes in laboratory values, or symptoms such as a severe, unrelenting headache, visual changes and upper abdominal pain.

What puts me at risk for pregnancy-induced hypertension?

Risk factors for developing preeclampsia can include: first pregnancy, twins or other multifetal pregnancy, younger than 20 years of age, older than 40 years of age, preeclampsia in a previous pregnancy, chronic kidney disease, chronic high blood pressure and obesity.

What happens if I am diagnosed with high blood pressure during pregnancy?

In both gestational and chronic hypertension, medications to lower your blood pressure likely will be started if your blood pressures are consistently above 150/100 to prevent kidney, heart and other organ damage for the mom. However, high blood pressure can also affect the growth of the fetus, so regularly scheduled ultrasounds are performed and increased testing of the well-being of the baby later in pregnancy is performed.

How do they treat preeclampsia in pregnancy?

Preeclampsia is dangerous and can develop gradually or come on quite suddenly. There are mild and severe forms of preeclampsia, depending on the severity of the signs and symptoms. The only cure for pre-eclampsia is delivery of the baby, and specifically the placenta. Women with severe preeclampsia are at higher risk for developing seizures known as eclampsia. These women usually receive magnesium sulfate during labor as well as 24 hours after delivery to decrease the chance of seizures.

If I have newly diagnosed hypertension this pregnancy, can I have it in future pregnancies?

The concern with chronic hypertension is that those patients can have at least a 20 percent risk for developing preeclampsia during the current pregnancy. A history of preeclampsia in the past can bring 25-30 percent increased risk of having preeclampsia in a next pregnancy. It is important to know that if you have a history of severe preeclampsia earlier in pregnancy, you can have an increased risk of up to 70 percent in future pregnancies. Therefore, it is recommended to discuss these risks with your obstetrician when considering future pregnancies.

What can be done to prevent preeclampsia?

While all pregnant patients should lead healthy lifestyles, it is even more important for patients with high blood pressure. Continue to eat a healthy diet (decrease the amount of fried foods and junk food and increase your veggies, whole grains and lean meat, avoid beverages containing caffeine), limit your sodium (salt) intake and exercise regularly. Try to build relaxing breaks into your day to reduce stress and fatigue while pregnant.

If you work with your doctor, then you can catch any problems early on. So, as soon as you might be pregnant, see your doctor. Keep all of your prenatal appointments (including ultrasounds and antenatal testing). If you need medication to control your blood pressure you doctor can prescribe the safest medication, and you will need to take the medication exactly as prescribed.

This post was written by Emad Elsamadicy, M.D. Raised in Tuscaloosa, Ala., he earned his undergraduate degree in Biomedical Engineering and Mathematics from the Vanderbilt University. Elsamadicy graduated from UAB School of Medicine in 2013 and completed his OB-GYN residency at Vanderbilt in 2017. He is an Assistant Professor of Obstetrics and Gynecology at Vanderbilt University Medical Center, and runs the Vanderbilt Hypertension in Pregnancy Clinic along with Sarah Osmundson, M.D.

Need help?

Vanderbilt Women’s Health provides care for women at all stages of their lives at locations across Middle Tennessee. Learn more here or call 615-343-5700.

Sarah Osmundson, M.D.

Sarah Osmundson, M.D., is assistant professor of Maternal-Fetal Medicine at Vanderbilt University Medical Center. In addition to opioid use after C-section, her research interests include screening and treatment of women with prediabetes in pregnancy, advanced maternal age and obesity in pregnancy.