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Hypertension in Pregnancy

Pregnancy Induced Hypertension, High Blood Pressure During Pregnancy, Gestational Hypertension, Menopause Center of Los AngelesWhen the heart pumps blood through the body, the measure of the pressure against the blood vessel walls is called blood pressure. High blood pressure, also known as hypertension, carries serious health risks, especially during pregnancy. Severe hypertension can compromise you and you’re baby’s health and safety.

Hypertension can lead to a very dangerous complication called preeclampsia. Severe forms of preeclampsia may manifest with even more dangerous conditions, such as eclampsia (seizures during preeclampsia) and HELLP syndrome. All pregnant women need to understand the warning signs of these conditions, as they could be life-threatening if left untreated.

Chronic Hypertension

Chronic hypertension is a condition which will affect the patient throughout life. Because high blood pressure often has no outward symptoms, it’s often hard to tell if the condition is chronic. When a woman has high blood pressure in the first 20 weeks of pregnancy, or if she had hypertension prior to pregnancy, her doctor will consider her hypertension to be chronic.

If you have chronic hypertension, you need to monitor your blood pressure carefully throughout your pregnancy. You may need to get a special device so you can monitor yourself at home.

Gestational Hypertension

Some women who did not have problems with blood pressure before getting pregnant will develop hypertension in the latter half of her pregnancy. This is called gestational hypertension, and it may pose some risks for the mother and the baby. Gestational hypertension usually subsides after the baby is born, but in some cases, the mother still has an increased risk of high blood pressure for the rest of her life.

Complications of Hypertension in Pregnancy

Both types of hypertension during pregnancy strain your kidneys, heart, and other systems. They can also cause problems for your developing baby.

  • Increased risk of kidney disease
  • Increased risk of heart attack and stroke
  • Fetal Growth Restriction –Hypertension can hinder the placenta’s ability to get nutrients to the baby, and as a result, the baby may not develop as quickly as expected.
  • Placental abruption – Hypertension increases the risk that the placenta will detach from the uterine wall while the baby is still growing. This is a severe medical emergency for you and the baby and must be treated immediately.
  • Pre-term delivery – Women with hypertension have an increased chance of a pre-term delivery. If the condition is preventing the placenta from nourishing the baby, he/she may need to be delivered early.
  • Cesarean birth – If conditions are worsening and the doctor deems a vaginal delivery unsafe, the baby may need to be delivered via Cesarean section.
  • Preeclampsia – Women with hypertension have an increased chance of developing preeclampsia.

Hypertension and Preeclampsia

High-Risk Obstetrics, Gestational Hypertension, Menopause Center of Los AngelesPreeclampsia is a severe health condition affecting pregnant women that threatens both the mother and the baby. Preeclampsia affects roughly 5-8% of pregnancies in the U.S. Researchers are still studying the exact causes for preeclampsia, but it appears that the problem begins in the placenta.

The placenta is the organ that grows to feed and send oxygen to the fetus during its development. New blood vessels must form in order to send nutrient-rich blood to the placenta, but in women with preeclampsia, the blood vessels are more narrow than usual and don’t seem to react as well to the mother’s hormones. They’re unable to carry enough blood, which affects the baby’s development, causes hypertension, and damages other organ systems in the mother, especially the kidneys.

Preeclampsia can be fatal to the mother and baby if left untreated. The only way to cure the condition is the deliver the baby. This might pose a difficult decision for both the mother and her doctor. Early delivery before the pregnancy has reached its full term carries its own serious risks for the infant.

Risk Factors for Preeclampsia

Preeclampsia appears to affect some pregnancies more than others. Here are some conditions that have an increased risk for preeclampsia.

  • First pregnancy
  • Over 40 years old
  • Obesity
  • Family history of preeclampsia. Preeclampsia may have a genetic component.
  • New father. Each pregnancy with a new partner increases the risk of preeclampsia.
  • Multiple gestation. Women carrying twins or more are more susceptible to preeclampsia.
  • Period of time between pregnancies. If your last pregnancy was either less than two years ago, or more than 10 years ago, your current pregnancy carries a higher risk of preeclampsia.
  • Medical conditions. Women with a history of chronic hypertension, migraines, diabetes (type 1 or type 2), blood clots, kidney disease, or lupus have a higher chance of developing preeclampsia.

Symptoms of Preeclampsia

Preeclampsia usually manifests after the first 20 weeks of pregnancy. The first sign of preeclampsia is typically a rise in blood pressure, which is why monitoring your blood pressure during pregnancy is so important. Other symptoms include:

  • Severe headaches
  • Sensitivity to light, blurry vision, or temporary loss of vision
  • Nausea
  • Vomiting
  • Proteinurea, or excessive protein in the urine
  • Decrease in urination
  • Pain in the upper abdomen, especially on the right side
  • Difficulty breathing, due to fluid in the lungs
  • Sudden weight gain or edema (swelling) in the hands and face – these are less reliable signs, since both are also normal symptoms of pregnancy

You should be diligently attending all of your prenatal care appointments so that your doctor can monitor your blood pressure. If you’re experiencing severe abdominal pain, severe headaches, vision problems, and shortness of breath, you must contact your doctor immediately or go to the emergency room.

Nausea, vomiting, swelling, and other aches and pains are fairly common during pregnancy, and may not necessarily be cause for concern. However, if you’re worried about your symptoms, please don’t hesitate to contact us with questions.

Eclampsia

Eclampsia is another life-threatening condition associated with preeclampsia. Eclampsia is the onset of seizures in a woman with severe preeclampsia. It may cause muscle aches and pains, severe agitation, and a loss of consciousness. Eclampsia has a mortality rate of 2%. Women with severe preeclampsia are often given anti-seizure medications, also called anticonvulsants, to prevent eclampsia.

How is Preeclampsia Treated?

If you have a mild case of either gestational hypertension or preeclampsia, you may be able to manage your health on an outpatient basis by keeping track of your blood pressure at home and performing a daily kick count to monitor your baby’s movement. You’ll need to see your doctor once or twice a week. Depending on your baby’s development and your health, your OB-GYN may recommend delivery at 37 weeks or earlier.

Severe preeclampsia must be treated in the hospital. Women who are 34 weeks pregnant are typically recommended to deliver the baby as soon as medically feasible. Any earlier than that, and the decision to deliver early might be a difficult one that you and your doctor must make together.

The doctor may be able to give the baby corticosteroids in utero to help the lungs to develop more quickly and prepare for life outside the womb. You will likely need blood pressure and anti-seizure medication to stay as healthy as possible. If either you or your baby’s condition gets worse, you may need to deliver the baby right away.

HELLP Syndrome

HELLP syndrome is a variation of preeclampsia and a life-threatening pregnancy complication. It is rare – an estimated 15% of women with preeclampsia will develop HELLP syndrome. Like preeclampsia, it typically occurs in the late stages of pregnancy, or may even occur after the baby is born. HELLP is an acronym for:

  • Hemolysis – the breaking down of red blood cells
  • Elevated Liver enzymes – indicates damage to the liver
  • Low Platelet count – blood may be unable to clot properly, also called thrombocytopenia

Symptoms of HELLP

The symptoms for HELLP are often very similar to those of preeclampsia. It’s critically important for mothers to be aware of the symptoms of HELLP, as the condition can be fatal in up to 25% of cases worldwide.

  • High blood pressure
  • Proteins in the urine
  • Headaches
  • Changes in vision (temporary loss of vision, blurry vision)
  • Nausea
  • Vomiting
  • Indigestion or pain after a meal
  • Pain in the abdomen, particularly in the upper right side
  • Bleeding
  • Swelling

If left untreated, severe consequences can occur.  They can usually be prevented when the symptoms are identified and emergency medical attention is sought. If you’re experiencing these symptoms, please call your doctor or 911 immediately.

If you have hypertension or a family history of hypertension, it’s critically important for you to fully understand the risks and symptoms associated with hypertension in pregnancy. These issues can be scary to talk about, but it’s never too early to discuss your concerns with your doctor. Be sure to ask your doctor any questions you may have about hypertension at your regular prenatal visits.

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