Elevation in blood pressure or hypertension is the most common medical problem in pregnancy which can lead to various health issues for the mother and the baby. Being informed of the signs and symptoms, risk factors, prompt diagnosis, and appropriate management are essential in preventing life-threatening complications.
A blood pressure of > 140/90 mmHg taken on two separate occasions, more than four hours in between BP measurements is defined as hypertension.
Hypertensive disorders in pregnancy are classified according to the onset of increase in blood pressure. Some women already have hypertension prior to pregnancy, which develops only during pregnancy, and or continues after birth or resolves after delivery.
The four categories are as follows:
- Preeclampsia is the most serious form of high blood pressure in pregnancy. Timely diagnosis and treatment are essential for improved outcomes for both the fetus and the mother. Diagnosis is made when the onset of elevated blood pressure is after 20 weeks of pregnancy until 6 weeks after giving birth, associated with protein in the urine and or evidence of end-organ diseases in the liver, kidneys, eyes or brain. Eclampsia occurs if the elevation in blood pressure is severe enough to cause seizures. The only cure is delivery but medicines are given to keep the blood pressure in the normal range and prevent serious adverse outcomes. Close monitoring of both the mother and the baby is highly important. This condition is life-threatening and sometimes leads to death if not managed properly and promptly.
- Chronic hypertension with superimposed preeclampsia happens when blood pressure becomes uncontrollable in a woman diagnosed with hypertension before pregnancy occurred, associated with laboratory evidence of protein in the urine and end-organ damage.
- Gestational hypertension also called pregnancy-induced hypertension is diagnosed when a pregnant woman with no history of hypertension suddenly have a blood pressure of more than 140/90 mmHg on two separate occasions, taken four hours in between measurement, after 20 weeks of pregnancy without spilling protein in the urine and resolves after pregnancy. Some of the cases progressed to pre-eclampsia.
Chronic essential hypertension occurs before pregnancy or before 20 weeks and persists 12 weeks postpartum. Some women are not aware they have it until their prenatal check-up when their blood pressure is measured.
Causes of hypertension in pregnancy
Preeclampsia is the result of abnormal placental development. The placenta is the organ connecting the mother to the fetus through the umbilical cord. It provides the fetus with oxygen and nutrients and in return takes away waste products. In this condition, the blood vessels supplying the placenta do not develop properly, limiting blood flow to the fetus, as a response, the placenta releases inflammatory substances in the maternal circulation that eventually leads to high blood pressure and other issues
The cause of gestational hypertension is not well-understood.
Who is at risk?
- Women with multiple pregnancies or multi-fetal pregnancies
- Preexisting illnesses such as diabetes, chronic hypertension, or kidney disease
- Obesity
- Maternal age > 40 years old
- Family history of preeclampsia
- Family history of preeclampsia in previous pregnancies or other pregnancy complications
- First pregnancy
- Pregnancy through in vitro fertilization (IVF)
If you feel that you have any of these risk factors, consult your doctor before getting pregnant to discuss ways to lower your risk. It is highly recommended to have a regular prenatal check-up during pregnancy to monitor signs and symptoms including your blood pressure.
Signs and symptoms:
Elevations in blood pressure alone do not cause symptoms. Indications of gestational hypertension and preeclampsia with uncontrolled blood pressure include:
- Swelling of hands, feet, and face
- The difficulty of breathing from pulmonary edema
- Blurring of vision
- Intense abdominal pain on the right upper part
- Nausea
- Vomiting
- Severe headache
Having any of these signs is considered a medical emergency and may require hospitalization.
Hypertensive drugs in pregnancy
Not all BP-lowering medications are safe for pregnant women. Upon diagnosis, affected women need immediate treatment to prevent the significant risk of developing complications. The goal is to manage the condition to get as close to the due date as possible.
Prompt consultation is vital for the proper and safe use of anti-hypertensive drugs. The first line of oral drugs used are methyldopa, nifedipine, and labetalol.
Common BP-lowering drugs such as ace-inhibitor and angiotensin receptor blockers are not given in pregnancy. Women with chronic hypertension on medications not acceptable for pregnancy may be given alternative blood pressure-lowering medication.
Serious complications that can endanger the life of the mother and the fetus arise when blood pressure is not well controlled and not treated quickly.
Complications to the fetus include:
- Placental abruption that can lead to stillbirth
- Intrauterine growth restriction
- Premature birth
- Death
While maternal complications include:
- Stroke
- Kidney failure
- Heart attack
- Death
Monitoring closely the well-being of both the mother and the baby through regular visits to the doctor is essential for a healthy mother and baby.
How can Eva Teleconsult help in the management of Hypertension during Pregnancy
Here at EVA Teleconsult, we have expert doctors like our Primary care physicians and our OB-GYN who can give the appropriate advice if you have hypertension while pregnant.
Furthermore, our doctors are always ready to address any questions or concerns you may have about hypertension during pregnancy or almost any other related condition. Here is how EVA works, EVA our patients are guaranteed to experience the following:
- Timely appointments – No more time wasted while waiting outside a doctor’s office. With us, appointments begin right when they’re supposed to, even if they’re made on the same day.
- Guaranteed 30-minute consultation times – No rushing or quickly dashing off prescriptions with no explanations. Our doctors take the time needed to give you information about your concerns and are open to answering all your questions.
- 5-star ratings for our doctors – Because our doctors know how to explain things in a way patients can understand, we frequently get positive feedback from them.
If you are pregnant and may have symptoms of high blood pressure, it is always best to seek medical advice from a healthcare professional. Get the treatment you or your loved ones need and book an online consultation today.
