January 1, 2020

Hypertension and pregnancy: What are the dangers?

by

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

Vanderbilt Women’s Health experts answer questions on what to know about the the risks that hypertension can present in pregnancy to help take care of you and your baby.

What is hypertension in pregnancy?

Hypertension, or high blood pressure, and other related high blood pressure disorders complicate up to 10% 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% 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, as well as increased testing of the well-being of the baby later in pregnancy.

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 preeclampsia 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% risk for developing preeclampsia during the current pregnancy. A history of preeclampsia in the past can bring 25-30% 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% 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.

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.