Hypertension in Pregnancy

What is Gestational Hypertension?

When the heart pumps blood through the body, the measure of the pressure against the vessels’ walls is called blood pressure. High blood pressure while pregnant (also known as Hypertension in Pregnancy) carries serious health risks. Severe hypertension can threaten you and you’re baby’s health. Some women have high blood pressure before they get pregnant. Others have high blood pressure for the first time during pregnancy.

Hypertension during pregnancy 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. Hypertensive disorders of pregnancy are common and remain a significant cause of maternal and fetal morbidity.

Chronic Hypertension in Pregnancy

Chronic hypertension in pregnancy 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. This is high blood pressure that you have before you get pregnant or that develops before 20 weeks of pregnancy. It doesn’t go away once you give birth. About 1 in 4 women with chronic hypertension have preeclampsia during pregnancy. If you’re at high risk for preeclampsia, your provider may treat you with low-dose aspirin to prevent it.

Typically, a doctor will consider your hypertension chronic if:

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

American College of Obstetrics and Gynecology (ACOG) defines chronic hypertension as a systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg on two occasions before 20 weeks of gestation. 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.

If you had a hypertensive disorder in a prior pregnancy, your doctor might recommend a daily low-dose aspirin beginning late in your first trimester.

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, also known as pregnancy-induced 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.

Chronic hypertension with superimposed preeclampsia occurs in women with chronic hypertension before pregnancy who develop worsening high blood pressure and protein in the urine or other blood pressure-related complications during pregnancy.

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.

• Decreased blood flow to the placenta. If the placenta doesn’t get enough blood, your baby might receive less oxygen and fewer nutrients. This can lead to slow fetal growth (intrauterine growth restriction), low birth weight, premature birth, or a small baby for its gestational age.
• Prematurity can lead to breathing problems, increased risk of infection, and other complications for the baby.
• Placental abruption. Preeclampsia increases your risk of this condition in which the placenta separates from the inner wall of your uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for you and your baby.
• Intrauterine growth restriction. Hypertension might result in slowed or decreased fetal growth (intrauterine growth restriction).
• Organ damage. Poorly controlled hypertension can result in injury to your brain, heart, lungs, kidneys, liver, and other major organs. In severe cases, it can be life-threatening.
• Premature delivery. Sometimes, an early delivery is needed to prevent potentially life-threatening complications when you have high blood pressure during pregnancy.
• Future cardiovascular disease. Having preeclampsia might increase your risk of future heart disease and blood vessel (cardiovascular) disease. Your risk of future cardiovascular disease is higher if you’ve had preeclampsia more than once or if you’ve had a premature birth due to having high blood pressure during pregnancy.
• Cesarean birth. If conditions are worsening, and the healthcare 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

Preeclampsia is a hypertensive disorder 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 narrower 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. Delivering the baby can often cure preeclampsia. When making a decision about treatment, your health care provider takes into account several factors. 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.

The risks include how severe it is, how many weeks pregnant you are, and what the potential risks to you and your baby are:

• If you are more than 37 weeks pregnant, your health care provider will likely want to deliver the baby.
• If you are less than 37 weeks pregnant, your health care provider will closely monitor you and your baby. This includes blood and urine tests for you.

Monitoring for the baby often involves ultrasound, heart rate monitoring, and checking on the baby’s growth. You may need to take medicines, to control your blood pressure and to prevent seizures. Some women also get steroid injections, to help the baby’s lungs mature faster. If preeclampsia is severe, your provider may want you to deliver the baby early.

The symptoms usually go away within 6 weeks of delivery. In rare cases, symptoms may not go away, or they may not start until after delivery (postpartum preeclampsia). This can be very serious, and it needs to be treated 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

If Hypertension in Pregnancy is 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 have 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.

Schedule a preconception checkup. This is a medical checkup you get before pregnancy to take care of health conditions that may affect your pregnancy, such as hypertension.Save