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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 vessels’ walls is called blood pressure. High blood pressure, also known as hypertension, carries serious health risks, especially during pregnancy. Severe hypertension can threaten you and you’re baby’s health.

Hypertension can lead to a very dangerous complication called preeclampsia. Severe forms of preeclampsia may develop alongside 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, which can be fatal if left untreated.

Chronic Hypertension

Chronic hypertension is a condition that affects the patient throughout his or her life. Because most cases of high blood pressure have no outward symptoms, it can be hard to tell whether the condition is chronic.

Typically, a doctor will consider your hypertension chronic if:

  • You have high blood pressure during the first 20 weeks of pregnancy.
  • You were diagnosed with high blood pressure prior to your pregnancy.

If you have chronic hypertension, you need to keep an eye on your blood pressure throughout your pregnancy. You may need to get a special device so you can self-monitor at home.

Gestational Hypertension

Some women who had normal blood pressure prior to pregnancy, may develop hypertension in the latter half of pregnancy. This is called gestational hypertension, and it poses some risks for the mother and 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 growing baby.

  • Increased risk of kidney disease.
  • Increased risk of heart attack and stroke.
  • Fetal Growth Restriction – Hypertension can hinder the placenta’s ability to deliver nutrients to the baby, and as a result, the baby may develop more slowly.
  • 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 or she may need to be delivered early.
  • Cesarean birth – If conditions are worsening, and the doctor believes it would be unsafe to deliver naturally, a C-section will be recommended.
  • 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 that 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.

When you become pregnant, the placenta is the organ that develops to feed and send oxygen to the fetus to help it grow. New blood vessels must form in order to send nutrient-rich blood into the placenta.

But in women with preeclampsia, the new 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 slows 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. However, a pre-term delivery carries its own serious risks for the infant. In severe cases, this can pose a difficult decision for the mother, her family, and her doctor.

Risk Factors for Preeclampsia

Preeclampsia appears to affect some types of pregnancies more than others. Here are some conditions that come with an increased risk for preeclampsia.

  • First pregnancy
  • Over 40 years of age
  • Obesity
  • Family history of preeclampsia. Preeclampsia may have a genetic component.
  • New father. Each pregnancy from a new partner increases the risk of preeclampsia.
  • Multiple gestation. Women carrying twins, triplets, 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. A spike in blood pressure can be the first sign of preeclampsia, 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 (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 signs are considered less reliable, since both are also normal symptoms of pregnancy)

Diligently attend all of your prenatal care appointments, and keep a log of any symptoms that you notice. 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.

About 2% of women with eclampsia die from complications. Because the condition is so dangerous, women with severe preeclampsia are often given anti-seizure medications.

How is Preeclampsia Treated?

If you have a mild case of either gestational hypertension or preeclampsia, you can 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 should 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 need to 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 – only an estimated 15% of women with preeclampsia will develop HELLP syndrome.

Like preeclampsia, HELLP typically occurs in the later stages of pregnancy, or even after the baby is born.

HELLP stands 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 similar to preeclampsia. Expectant mothers need 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 complications can occur.  Fortunately, these can usually be prevented if the symptoms are identified early, and emergency medical attention is sought. If you’re experiencing these symptoms, please call your doctor or 911 immediately.

If you or your family has a 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 at your regular prenatal visits.

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