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Hypertension in pregnancy: How to prevent complications

High blood pressure during pregnancy can put baby at risk. Here’s what moms-to-be can do.

Doctor taking blood pressure from pregnant woman

Image source: Thinkstock

Hypertension or high blood pressure is a fairly common condition, affecting about 7 percent of all pregnancies. Many women have varying degrees of high blood pressure prior to becoming pregnant, and some women develop high blood pressure during pregnancy.

How do you tell if a woman has high blood pressure?

A woman is considered to have high blood pressure if she has multiple systolic blood pressure readings greater than 140 or diastolic readings greater than 90. Blood pressure is considered to be severely elevated if the systolic levels are greater than 160 or diastolic levels greater than 110.

How to prevent or reduce the risk of hypertension

The timing and the severity of these conditions will determine how they are managed. Although high blood pressure can not be completely prevented, there are several ways to reduce the risk of complications that can be associated with high blood pressure in pregnancy.

Manage high blood pressure before becoming pregnant.

If a woman has a known history of high blood pressure, she needs to focus on optimizing management, prior to becoming pregnant. Management should start with a pre-conception visit with her physician that is managing this condition. Sometimes blood pressure that is only mildly elevated, may not require medication during pregnancy, but will need to be followed closely.

Lifestyle changes

There are several lifestyle changes that can promote healthy blood pressure levels.

  • Diet and exercise — with the goal of maintaining a normal body mass index prior to pregnancy — can greatly decrease the risk of complications during pregnancy. Sometimes it can be helpful to consult a nutritionist or personal trainer to help make these changes safely. Certain exercise regimens, such as Yoga, can be modified, but continued throughout the pregnancy.
  • Smoking cessation and management of other medical conditions, that can aggravate high blood pressure, such as diabetes and kidney disease, can also decrease the risks associated with high blood pressure in pregnancy.

Medications

Sometimes medications are necessary to optimally control high blood pressure, before and during pregnancy. It is very important to make sure that these are appropriately dosed prior to pregnancy, and that medications that are safe in pregnancy are utilized in women considering pregnancy.

A few medications that are utilized to manage high blood pressure can have negative effects on a developing baby, so it is important to try to change to one of the medications that are safe in pregnancy. If you are on a blood pressure medication and become pregnant unexpectedly, you should contact your physician immediately to determine if the medication you are taking is safe to continue.

You should not wait until your first prenatal visit, which may not be until 6-8 weeks, to alert your physician about medications you are taking. At the same time, you should not abruptly discontinue any medications, without first consulting your physician.

What to do if you develop hypertension

Hypertension that is present prior to pregnancy, or that presents during the first 20 weeks, is termed “chronic hypertension.”

Sometimes women with no prior history of high blood pressure will develop hypertension in the second half of pregnancy. This can either be due to “gestational hypertension” or “preeclampsia.” These conditions require close monitoring to ensure both mom and baby’s health.

Although preeclampsia can be more common in women with chronic hypertension, sometimes it can develop with little or no warning. It is more common in women who are under 20 years old or over 40 and in women carrying more than one baby.

Regular prenatal care

In order to ensure prompt diagnosis of these conditions it is very important to get regular prenatal care. The frequency of these visits will be determined by your physician and is based on your history and unique set of risk factors.

High risk specialist

You may also be referred to a high risk specialist, who utilizes ultrasounds to monitor the well being and growth of your baby. Your blood pressure should be checked at each prenatal visit, and if you have a history of elevated blood pressure, it may also be beneficial to get a blood pressure monitor, to check your blood pressure between visits.

Watch for symptoms between visits

It is also important to be aware of possible symptoms of preeclampsia, in case they develop in between your routine appointments. Although not always associated with preeclampsia, if you develop headaches, that do not resolve with measures such as rest or Tylenol, you should alert your physician.

Sometimes these headaches can be mild. Sometimes they are associated with visual changes. Other possible symptoms are rapid swelling of the hands and face and significant weight gain in a short period of time, which can be due to abnormal fluid retention.

Unfortunately, sometimes preeclampsia can occur even in the healthiest of pregnancies and when severe, often requires delivery to manage. However, taking precautions prior to and during pregnancy will almost always allow for healthy babies and moms.

About the Author

Dr. Allison Devine is an OB/GYN with The Austin Diagnostic Clinic. She writes about women's health topics, including pre-conception counseling and pre-natal care. Dr. Devine sees patients at ADC's Main Clinic location in north Austin, TX.