High blood pressure is one of the most common issues that impacts pregnant women. It may occur before, during, or after pregnancy and needs special attention at each stage to prevent poor outcomes in mother and baby. Women may have Chronic Hypertension (elevated blood pressures before 20 weeks of pregnancy); Gestational Hypertension (elevated blood pressures after 20 weeks of pregnancy); Preeclampsia/Eclampsia (elevated blood pressures with changes that can affect the eyes, brain, heart, lungs, kidney, and nervous system); and Preeclampsia Superimposed on Chronic Hypertension. Uncontrolled high blood pressure during and after pregnancy, can have significant short- and long-term effects on the health of mother and baby. Therefore, all forms of hypertension should be carefully screened for and managed by you and your medical provider. In addition, your doctor may request help from a high-risk pregnancy doctor to help take care of you and your baby.
Effects on Mother: Although some symptoms may naturally occur during pregnancy, high blood pressures may come along with headaches, changes in vision (“seeing spots” or blurriness), pain in the middle or right upper side of the stomach, changes in reflexes (automatic actions that the body does to protect itself), sudden change in leg swelling, rapid weight gain, seizures, and significant changes in major organs seen on blood and urine tests.
Effects on Baby:The baby will be examined regularly with ultrasounds and fetal monitoring to look for poor growth, changes in heart rate, low levels of amniotic fluid, and changes in blood flow in the placenta that can occur as a result of hypertension.
Effects on Delivery:Your healthcare provider will consider your health status and that of your baby to decide if it will be necessary to change the timing of delivery (before full-term vs. at term), and route of delivery (vaginal vs. cesarean) to ensure the best outcome for both of you. In the event that baby needs to be delivered much earlier than expected, you may need to be hospitalized for an extended period and receive additional treatments to help ensure that baby’s lungs and nervous system develop before birth.
Talk with your healthcare provider about risk factors that may increase your risk for complications of elevated blood pressures (history of high blood pressures in a previous pregnancy, diabetes, family history of preeclampsia, multiple gestation (twins, triplets, etc.), first pregnancy, obesity, being over the age of 40, history of chronic hypertension or renal disease, and blood work that shows you have anti-phospholipid antibodies). Your plan to manage your blood pressure may include additional urine tests and blood work, medications to control blood pressure, dietary changes (avoid foods high in salt, increase calcium intake), and more frequent office visits with additional ultrasounds and fetal monitoring. Please take this plan seriously. Please take your medications faithfully. Please learn the signs that your blood pressure may be out of control. Improperly controlled blood pressures can lead to very serious events, like stroke or blindness in mom, and even death of the baby.
Your blood pressure and associated symptoms are important signals that your body uses to help you and your providers recognize that your treatment plan may need to be adjusted to ensure a happy and healthy – mom, baby, and family. Whether you develop blood pressure issues before, during, or after pregnancy, please seek and listen to the advice recommended to prevent poor outcomes. There are many treatment options available, so do not hesitate to talk with your healthcare provider to find the best one for you.
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Written By: Keisha R. Callins, MD, MPH