Understanding Hypertension and Pregnancy

Hypertension

What is hypertension? Can I have it in pregnancy? 

Hypertensive disorders in pregnancy are a major cause of maternal, foetal and neonatal morbidity as well as and mortality in both developing and developed countries. Women with hypertension in pregnancy have a higher risk of complications such as placental abruption, wherein the placental lining separates from the uterus of the mother, stroke, blood clots and abnormal bleeding as well as a premature birth or miscarriage.

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Hypertension
Hypertension

Hypertension in pregnancy includes:

  • Pre-eclampsia. This is the most serious form of hypertension during pregnancy. The only way to control this condition is to deliver the foetus, which can lead to complications, including death of the mother and/or child. Preeclampsia typically occurs after 20 weeks.
  • Gestational hypertension. This form of hypertension occurs only during pregnancy and usually isn’t a problem for the mother after delivery. Gestational hypertension can appear near the end of a pregnancy.
  • Chronic hypertension. This form of hypertension develops prior to pregnancy or in the early stages of pregnancy (before 20 weeks).


How do I know whether I am suffering from hypertension during my pregnancy? 

There are various symptoms that you may observe to ascertain whether you have hypertension during pregnancy. These include, severe headaches, blurred vision or flashing before the eyes, vomiting, severe gastric pain, breathlessness and sudden swelling of the face, hands or feet.


What can I do, if I am suffering from hypertension during my pregnancy? 

All pregnant women should receive antenatal education so that they are aware of the symptoms associated with hypertension and when to obtain medical advice.

Nevertheless, if you developed the above symptoms, it is best to seek your doctor’s advice immediately. Depending on your blood pressure, weeks of pregnancy and blood flow in the placenta, he will be able to advise you on the best management method.

In non chronic cases, the doctor will keep you under close observation, recommend that you reduce your daily activities and possible stress inducers and to get more bed rest. In cases of chronic hypertension and pre-eclampsia, you may be advised to take some medication to reduce the maternal and foetal risk factors. For example, if you are at risk of pre-eclampsia, the doctor may usually recommend that you take  75mg aspirin from he 12th week of pregnancy to delivery.

Some pregnant women who do not suffer from pre-eclampsia may also be advised to take 75mg aspirin daily from the 12th week of pregnancy, if they are in any two of the following categories :

  • having their first pregnancy at age 40 or older
  • last pregnancy was over ten years ago
  • obese women with a BMI of 35 or higher
  • family history of pre-eclampsia
  • having a multiple pregnancy
  • suffering from renal disease in pregnancy
  • experiencing psychological changes in pregnancy


How do I know if I am at a high risk of developing pre-eclampsia during my pregnancy? 

Generally, women who are at risk of developing pre-eclampsia are those who have had hypertension in a past pregnancy, suffered from chronic kidney disease or autoimmune diseases such as  systemic lupus erythematosus (SLE) or antiphospholipid syndrome, or women with diabetes.


How will my doctor help keep my pregnancy hypertension in check? 

Your doctor will first asses the severity of your hypertension before prescribing the most suitable treatment method for you.

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Generally this will include keeping you under close observation or to provide you with medication in order to help keep your blood pressure to under 150/100 mm Hg. In addition, he may also conduct ultrasound examinations to assess foetal growth and amniotic fluid volume  at 28-30 weeks and 32-34 weeks of your pregnancy if mild or moderate hypertension develops before this time.

Given that women with pre-eclampsia may suffer some complications during labour, the doctor will discuss the the management plan for delivery with you and your husband based on your health and the progress of your baby during the said pregnancy. For example, patients with mild or moderate pre-eclampsia are usually delivered between 34+0 to 36+6 weeks depending on assessment of risk and availability of a special care baby unit, with foetal monitoring and after a course of corticosteroids to reduce the risk of infant respiratory distress syndrome.


Will the hypertension go away once I have given birth? 

In mild or transient hypertension, this may well be the case. However, in more severe cases, your doctor may continue to measure your blood pressure after birth. He may also continue you on the medication until your blood pressure falls to a healthy range.


Is there anything I can do to prevent hypertension in pregnancy? 

  • Know your blood pressure level before getting pregnant. Make an appointment for a checkup with your primary care doctor or ob-gyn and make a note of your blood pressure. You can also monitor your blood pressure yourself with the home blood pressure monitor available at most pharmacies.
  • Kick the salt habit. High salt, or sodium, intake can raise blood pressure. If you typically sprinkle salt on every dish, now is the time to break the habit. Most adults should keep salt intake to 1 teaspoon per day — that includes what comes out of the shaker as well as the hidden sodium in processed foods.
  • Get off the couch. Get up and get moving before you conceive. If you’re already pregnant, ask your doctor about starting a regular exercise programme. Sedentary women are likely to gain weight, which can increase the risk of hypertension during pregnancy, as well as before and after. Try to start your pregnancy at a healthy body weight.
  • Pay attention to medication. Make sure you aren’t taking medication that can raise blood pressure levels — check with your doctor to see what’s safe. You may not realise that popping a decongestant, such as pseudoephedrine (Sudafed and others), for something minor like a stuffy nose can cause an increase in blood pressure. Think twice about using any medication unless your doctor approves. If you already have high blood pressure, talk to your doctor about medication use before and during pregnancy. It is very important to have your blood pressure under control and stable before becoming pregnant, as those nine months are not the best time to try new or additional medication. Work with your doctor to make sure that you are taking a medication that will be safe to continue during pregnancy.
  • Get regular prenatal checkups. If your blood pressure starts to rise during pregnancy, you want to catch it early. Make sure to keep all appointments and consider checking your blood pressure more frequently at home.
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