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Hypertension in Pregnancy

Hypertension in Pregnancy, Gestational Hypertension, Hypertension symptoms, Hypertension treatment

Overview

Hypertension (also known as high blood pressure) can be defined as having blood pressure more than or equal to 130/80 mm HG. Hypertension during pregnancy can be effectively managed with the proper treatment and care. It can also have serious consequences if left unchecked.

Types of Hypertension in Pregnancy

Based on when and how high blood pressure manifested, it is classified into several categories. These are:

  1. Gestational Hypertension – if you develop high blood pressure during your pregnancy (in most cases approximately 20 weeks into the pregnancy) then it is called gestational hypertension. It is mostly mild and you might not even show any symptoms. Typically your blood pressure should go back to normal in about 12 weeks after delivery and it should not have any impact on your child. In some cases, however, it can progress to a more severe form and hence should be monitored with care. 
  2. Chronic Hypertension – In case hypertension/ high blood pressure existed before the pregnancy, it can be termed as chronic hypertension. This pre-existing condition might have gone undetected till the first prenatal visit, so pinpointing the exact timeframe when one developed hypertension is next to impossible. Once diagnosed extreme care should be taken to monitor BP levels to avoid complications like miscarriage and preeclampsia
  3. Preeclampsia – Preeclampsia is a pregnancy disorder wherein there is a sudden surge in blood pressure after 20 weeks into the pregnancy. It is also characterised with signs of damage to other organ systems such as renal, Nero, liver, and blood. Preeclampsia can progress to seizures and can also be fatal to both mother and child. 

About The Condition

Blood pressure is the pressure exerted by blood on the walls of your blood vessels. While reading blood pressure, the top number is called systolic pressure (pressure in your arteries when the heart is pumping out blood) and the bottom number is diastolic (pressure in your arteries when the heart is resting)

Anything below 120/80 mm Hg (higher than 90/60 mm Hg) is considered normal BP according to the American Heart Association. 

High blood pressure during pregnancy can be detrimental to the development of the placenta which in turn limits the supply of nutrients and oxygen to the baby, it can also lead to early and/or complicated delivery, placental separation, and other complications if left unchecked. 

Risk factors for Hypertension in Pregnancy

There are several risk factors that are factored in to identify if someone is more likely to develop hypertension during pregnancy. These are: 

  1. If the expectant mother is over 40 years of age or below 20 years of age
  2. If she had high blood pressure prior to the pregnancy
  3. In the case of multiple babies
  4. Has a history of gestational hypertension in previous pregnancies
  5. Has gestational diabetes/diabetes
  6. Is overweight 
  7. Has any kidney disease
  8. If conception was via in vitro
  9. If there exist any preexisting medical conditions such as diabetes, autoimmune disorders, etc.
  10. Has a family history of hypertension/gestational hypertension/preeclampsia 

Symptoms

Symptoms for high blood pressure during pregnancy can vary with each individual. In the case of gestational hypertension, symptoms may include:

Hypertension in Pregnancy, Gestational Hypertension, Hypertension symptoms, Hypertension treatment
  • Chronic headache
  • Excessive swelling (edema)
  • Rapid/sudden weight gain 
  • Blurry/double vision 
  • Insufficient  urination

Diagnosis of Hypertension in Pregnancy

Monitoring blood pressure forms a vital part of prenatal care. If there is an increase in your blood pressure over the course of your pregnancy, you may also have to undergo additional tests to rule out preeclampsia. These are:

  • Blood pressure readings 
  • Urine testing for the presence of protein  
  • Routine weight recording 
  • Liver and kidney function tests 
  • Blood clotting tests

Treatment of Hypertension in Pregnancy

If you  are diagnosed with chronic hypertension (high blood pressure prior to pregnancy) then it is advised to take medical advice while planning the pregnancy,    

Once diagnosed with this condition, the way forward is to manage it right and stop it from becoming worse. The treatment depends on the severity of the condition, your general health, and disposition. The course of action will include:

  • A routine check of blood pressure 
  • Fetal monitoring – Keeping a track of your baby’s movements, your baby’s heart rate in response to his/her movements, biophysical profile and measuring the flow of your baby’s blood through a blood vessel (doppler flow studies)
  • Urine and blood testing at every prenatal visit
  • In case a premature delivery is expected or advised, corticosteroids would be prescribed to hasten fetal lung development
Hypertension in Pregnancy, Gestational Hypertension, Hypertension symptoms, Hypertension treatment

Prevention

While many of the risk factors that increase our propensity towards hypertension can’t be controlled (such as ethnicity or age), factors such as weight, diets, etc can be managed quite easily and also significantly reduce the risk of developing hypertension:

  • In case the pregnancy is planned, it is advised to check blood pressure levels beforehand. If in case chronic hypertension is diagnosed, seek medical advice, and map out the pregnancy. 
  • Reduce salt intake – The average adult requires only one teaspoon of salt a day (including what is present in processed foods), the average intake however is much higher. Reduce the overall sodium consumption to reduce the risk of developing hypertension both before and during pregnancy
  • Exercise – Incorporating a minimum of 30 minutes of physical activity into your daily routine is a must. A sedentary lifestyle can lead to weight gain which in turn results in a higher risk of developing gestational hypertension 
  • Be mindful of medication – Keep a close eye on the medications you’re consuming and ensure that none of the side effects include elevated blood pressure. Consult your doctor and take approval for any and every medication that you consume especially during your pregnancy
  • Have routine prenatal checkups – Catching rising blood pressure as early as possible is key to efficiently managing it. Routinely monitoring your blood pressure levels during your prenatal checkup can significantly aid in having a smooth pregnancy

FAQs

1. What is the difference between chronic hypertension, gestational hypertension and preeclampsia?

Chronic hypertension is high blood pressure that developed prior to the pregnancy, gestational hypertension on the other hand develops around 20 weeks into the pregnancy and if not carefully controlled can progress into preeclampsia which is a sudden surge in blood pressure. Preeclampsia can affect multiple organ systems and can prove to be fatal to both mother and child.

2. What is HELLP syndrome?

Preeclampsia can result in this syndrome. It stands for hemolysis, elevated liver enzymes, and low platelet count (H.E.L.L.P). In this progression of preeclampsia, red blood cells are damaged/destroyed, there can be internal bleeding in the liver (manifests as chest or abdominal pain)and blood clotting is impaired. This is an extremely serious condition and can prove to have long-lasting health problems if not fatal.

3. Can preeclampsia occur post pregnancy?

In extremely rare cases, preeclampsia can occur in the postpartum period.

4. What are the risks to my baby in case of preeclampsia?

Preeclampsia can lead to preterm labour. Premature birth holds a number of risks to the baby ranging from developmental problems to even death in severe cases. With good medical care, however, these risks can be minimised. Seek medical help and map out your pregnancy with your doctor.  

 
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