High Blood Pressure in Pregnancy

Hypertension, or high blood pressure, is one of the leading causes of maternal and fetal complications worldwide.
In fact, according to the World Health Organization (WHO), hypertensive diseases during pregnancy are responsible for nearly 10% of maternal deaths globally, ranking second only to bleeding. This makes it a critical issue for both expectant mothers and their babies.
Understanding how high blood pressure can affect pregnancy, how to recognize the signs, and knowing how to prevent and treat it can be life-saving. Knowledge is truly power when it comes to managing this common but serious condition.
Let’s explore the types of high blood pressure in pregnancy, how to detect it early, and the best ways to keep both mom and baby healthy.

Types of High Blood Pressure in Pregnancy

There are four primary types of hypertension that can occur during pregnancy:

Gestational Hypertension High blood pressure that develops after 20 weeks of pregnancy, without protein in the urine or organ damage. While gestational hypertension doesn’t usually cause major complications, it can progress to preeclampsia if not carefully monitored.
Preeclampsia This condition is characterized by high blood pressure and the presence of protein in the urine. It often develops after 20 weeks and can cause damage to organs like the liver and kidneys, as well as serious complications for the baby. Preeclampsia requires close monitoring and timely treatment.
Preeclampsia with Severe Features A more severe form of preeclampsia, marked by very high blood pressure (above 160/110) and organ damage. This can lead to complications like seizures (eclampsia), liver and kidney failure, and even stroke.
Chronic Hypertension High blood pressure that exists before pregnancy or before 20 weeks of pregnancy. This type can continue after childbirth and requires ongoing management.
Preeclampsia on Top of Chronic Hypertension This occurs when a woman with pre-existing high blood pressure develops preeclampsia during pregnancy. It is a serious condition that can lead to severe complications for both mother and baby.

What Is Preeclampsia?

Preeclampsia is a pregnancy complication that causes high blood pressure and protein in the urine. It typically begins after the 20th week of pregnancy but can develop post-delivery as well. Though it often resolves after childbirth, women who experience preeclampsia are at a higher risk for heart problems and high blood pressure later in life.

Who Is at Risk for Preeclampsia?

Certain factors can increase the risk of developing preeclampsia, including:

First-time pregnancy
History of preeclampsia in previous pregnancies
Age (under 18 or over 40)
Pre-existing hypertension or kidney disease
Autoimmune diseases like lupus
Diabetes (pre-existing or gestational)
Carrying multiples (twins or more)
Overweight or obesity
Low socioeconomic status
History of miscarriage, fetal growth problems, or early delivery
Sleep disorders, such as sleep apnea
Fertility treatments like IVF

How Does Preeclampsia Happen?

Preeclampsia occurs when the placenta doesn’t develop properly, leading to poor blood flow and raising blood pressure. This can cause damage to the kidneys, liver, or other organs and can also restrict blood flow to the baby, resulting in growth problems or preterm birth.

Signs and Symptoms of Preeclampsia

In the early stages, preeclampsia may not present noticeable symptoms. Regular prenatal visits are crucial for early detection. However, if you experience any of the following symptoms, it's important to contact your healthcare provider immediately:

Severe headache that doesn't go away or worsens
Vision problems, such as blurry vision, seeing spots, or flashes of light
Shortness of breath or difficulty breathing
Abdominal pain, particularly in the upper-right abdomen (similar to heartburn or indigestion)
Swelling, especially in the hands and face
Sudden weight gain (more than 2 pounds a week)
Severe high blood pressure (above 160/110 mmHg)
Severe Signs of Preeclampsia:
Kidney problems (detected through blood tests)
Liver abnormalities
Fluid in the lungs, leading to shortness of breath
Seizures (known as eclampsia)

Impact of Preeclampsia on the Baby

Slowed growth: Detected through ultrasounds
Low amniotic fluid: Identified via ultrasound
Poor blood flow: Seen through Doppler tests during ultrasound

If left untreated, preeclampsia can cause preterm birth or serious complications for both mother and baby.

How Is Preeclampsia Diagnosed and Managed?

At your first prenatal visit, your healthcare provider will check for signs of preeclampsia, including blood pressure readings and protein levels in your urine. If you're at higher risk, your provider may recommend low-dose aspirin (usually starting at 12 weeks) to help reduce the risk of developing preeclampsia.
Regular prenatal visits are essential for monitoring your blood pressure and ensuring your health and the health of your baby. The earlier preeclampsia is detected, the more effectively it can be managed.

Treatment of Preeclampsia

Currently, the only way to cure preeclampsia is through delivery of the baby and placenta. However, there are various ways to manage the condition:

Medication: To control high blood pressure and reduce the risk of stroke.
Monitoring: Continuous monitoring of blood pressure, kidney function, and liver function.
Delivery: If preeclampsia is severe, delivery may be induced, especially if the baby is at a viable gestational age.

For women with preeclampsia before 37 weeks, doctors will monitor both the mother and baby closely. Steroids may be given to help mature the baby’s lungs if early delivery becomes necessary.

When is Delivery Recommended?
Before Term (less than 37 weeks): The decision to delay delivery before 37 weeks depends on several factors, including the gestational age, the baby’s weight, the severity of the condition, and the overall wellbeing of both the mother and the fetus. If it's possible to safely extend the pregnancy to allow for further fetal maturation, we will do so. However, if the risks to the mother or baby become too great, premature delivery may be necessary to ensure both their safety. At Term (37 weeks or more): Delivery is generally recommended to avoid complications for both mother and baby.

Eclampsia: A Life-Threatening Complication

Eclampsia is a severe complication of preeclampsia, marked by seizures that occur during pregnancy or shortly after childbirth.

Symptoms of Eclampsia

Seizures: Violent shaking and loss of consciousness
Severe headache
Blurred vision or seeing spots
Abdominal pain, nausea, or vomiting

Risks for Mom and Baby

For Mom: Eclampsia can lead to life-threatening complications like stroke, organ damage, or even death if untreated.
For Baby: Increased risk of premature birth, low birth weight, or reduced oxygen supply, which could even result in death.

Management of Eclampsia

Immediate medical care is required, often with hospitalization.
Medication: Magnesium sulfate is commonly used to prevent further seizures.
Delivery of the baby may be necessary to stabilize the condition.

Chronic Hypertension in Pregnancy

Chronic hypertension refers to high blood pressure that either existed before pregnancy or develops before 20 weeks of pregnancy.

Symptoms to Watch For

Chronic hypertension often has no clear symptoms, which is why regular blood pressure checks are crucial during pregnancy. Severe cases may cause:

Headaches
Blurred vision
Swelling

Risks for Mom and Baby

For Mom: Increased risk of developing preeclampsia, kidney damage, or heart problems later in life.
For Baby: Risk of growth restriction, low birth weight, or preterm delivery. There’s also an increased risk of placental abruption (bleeding before birth) or stillbirth if not well managed.

Management of Chronic Hypertension

Regular monitoring of blood pressure.
Medications may be prescribed to control blood pressure and reduce risks for both mother and baby.

Life-Saving Tips for Managing High Blood Pressure During Pregnancy

Managing high blood pressure is crucial for the health of both mother and baby. Here are some essential tips for staying on top of your blood pressure during pregnancy:

Regular Checkups: Early detection can help prevent complications. Never miss your prenatal appointments.
Monitor Your Blood Pressure at Home: Track your readings with a home cuff, especially if you have been diagnosed with high blood pressure.
Stay Active with Safe Exercise: Activities like walking or prenatal yoga can help manage blood pressure. Always check with your doctor before starting any new routine.
Eat a Healthy Diet: Focus on fresh fruits, vegetables, whole grains, and lean proteins while avoiding excessive salt and processed foods.
Avoid Stress: Practice relaxation techniques like deep breathing, meditation, or listening to calming music.
Get Plenty of Rest: Aim for 6-9 hours of sleep each night to help reduce strain on your heart.
Take Low-Dose Aspirin (if recommended): Low-dose aspirin can reduce the risk of preeclampsia in high-risk women. Talk to your doctor about this.
Know the Warning Signs: Be aware of symptoms like swelling, severe headaches, or blurry vision and contact your healthcare provider if they occur.
Avoid Smoking and Alcohol: Both can elevate blood pressure and harm the baby.
Take Prescribed Medication: If prescribed, follow your doctor’s instructions for managing blood pressure.
Know Your Risk Factors: Conditions like obesity, diabetes, and a history of preeclampsia increase your risk. Discuss these with your doctor.

Conclusion High blood pressure during pregnancy is a serious condition that requires vigilant monitoring and timely intervention. By understanding the risks, symptoms, and treatment options, expectant mothers can work with their healthcare providers to ensure the best possible outcome for both themselves and their babies. If you're pregnant, make sure to attend all your prenatal visits and reach out to your healthcare provider if you experience any concerning symptoms. Early detection and proactive management can help ensure a safer pregnancy and healthier future for both you and your baby.