The Maternal Fetal topic for today is High Blood Pressure in Pregnancy
Most women feel like they are on a Rollercoaster ride of emotional , physical, mental spiritual, and financial changes during pregnancy. Pregnancy hormones can have you crying, screaming and/or laughing within minutes then feeling an overwhelming exhaustion. You may feel as if these changes may cause your blood pressure to shoot through the roof.
Actually, many pregnant women have lower blood pressure during pregnancy. Especially in the first 24 weeks of pregnancy. This is most likely caused by the circulatory system, as blood vessels expand to let blood flow to the uterus. At times the blood pressure can even present as low; fluctuating hormones and changes in circulation can often lower the blood pressure, especially in the first and second trimester of pregnancy (https://www.medicalnewstoday.com/articles/320303).
Low blood pressure is also called hypotension, during pregnancy, does not usually cause significant health issues, and most women can treat it at home. However, please speak with your doctor regarding management (https://www.medicalnewstoday.com/articles/320303).
For this Maternal Fetal Medicine Monday Blog post, I want to focus on Hypertension otherwise known as high blood pressure.
Let’s start with the basics. What is blood pressure? Blood pressure is the force of blood pushing against the walls of blood vessels called arteries. The arteries bring blood from the heart to your lungs, where it picks up oxygen and then moves to your organs and tissues. The organs and tissues use the oxygen to power their activities. Blood vessels called veins return the blood to the heart (American College of Obstetrics and Gynecologist [ACOG],2021). When your blood pressure is taken, two (2) numbers will appear; a top and a bottom number. The top number is called the systolic blood pressure; this is the pressure against the artery walls when the heart contracts. The bottom number is called the diastolic blood pressure, it’s measures the force of blood against your artery walls as your heart relaxes and the ventricles are allowed to refill with blood.
The American College of Obstetricians and Gynecologists (ACOG), 2021 states that a pregnant woman’s blood pressure should also be within the healthy range of less than 120/80 mm Hg. If blood pressure readings are higher, a pregnant woman may have elevated or high blood pressure. If high blood pressure occurs during pregnancy, it may indicate serious complications such as preeclampsia.
If you have high blood pressure in pregnancy, you are not alone, it is very common. In the United States, 1 in every 12 to 17 pregnancies among women ages 20 to 44 have high blood pressure. The good news, is high blood pressure can be treated by your provider and you can be monitored closely through your pregnancy (Center for Disease Control [CDC],2021. The main goal is always #healthy mom # healthy baby
There are three types of elevated blood pressure in pregnancy (CDC,2021).
- Gestational hypertension is high blood pressure that you develop while you are pregnant, and do not have protein in your urine or other heart or kidney problems. It is typically diagnosed after 20 weeks of pregnancy or close to delivery. Gestational hypertension usually goes away after you give birth. However, some women with gestational hypertension have a higher risk of developing chronic hypertension in the future (https://www.cdc.gov/bloodpressure/pregnancy.htm).
- Chronic hypertension is when you have high blood pressures before you get pregnant or before 20 weeks of pregnancy. Women who have chronic hypertension can also get preeclampsia in the in the second or third trimester of pregnancy (https://www.cdc.gov/bloodpressure/pregnancy.htm)
- Preeclampsia is a sudden increase in blood pressure and protein in the urine after the 20th week of pregnancy, after having normal blood pressures. Preeclampsia can be serious or even life-threatening for both you and your baby(https://www.cdc.gov/bloodpressure/pregnancy.htm) .
Your prenatal visits should include blood pressure checks. Be sure to advocate for yourself, and make sure the providers and support staff check your blood pressure at each visit. Use your visit time to discuss if your blood pressure is within normal limits.
Elevated blood pressure in pregnancy can become problematic as it can cause:
- 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 growth (intrauterine growth restriction)
- low birth weight or premature birth. Prematurity can lead to breathing problems
- increased risk of infection and other complications for the baby (https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/basics/healthy-pregnancy/hlv-20049471).
- 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 (https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/basics/healthy-pregnancy/hlv-2004947).
- Intrauterine growth restriction
- slowed or decreased growth of your baby (intrauterine growth restriction(https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/basics/healthy-pregnancy/hlv-20049471).
- Injury to your other organs
- result in injury to your brain, heart, lungs, kidneys, liver and other major organs. In severe cases, it can be life-threatening (https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/basics/healthy-pregnancy/hlv-20049471)..
- Premature delivery
- Sometimes an early delivery is needed to prevent potentially life-threatening complications when you have high blood pressure during pregnancy(https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/basics/healthy-pregnancy/hlv-20049471)..
- Future cardiovascular disease
- Having preeclampsia might increase your risk of future heart and blood vessel (cardiovascular) disease.
These are scary facts, however, there is good news. The good news is that if you develop high blood pressure, you can be treated. You can also advocate for yourself. Ask your provider questions, discuss your concerns, and ask what is the plan.
My nurse tips I offer to patients with a history of high blood pressure are:
- Prior to getting pregnant you will need a preconception counseling visit to discuss plan of care once pregnancy is achieved
- Prior to getting pregnant, continue to get in the best health possible, including healthy diet, exercise, and mentally prepared
- Monitor your blood pressures with the goal of keeping them in a range that your doctor has recommended
- If you have been prescribed blood pressure medication, continue to take your medication until your provider tells you otherwise
- Avoid high sodium, smoking, alcohol
If you are pregnant with high blood pressure, my nurse tips are:
- Keep every prenatal visit
- Make sure your blood pressure is monitored at every visit
- Ask if you doctor wants you to monitor your blood pressure at home and submit to them to review
- Ask your healthcare providers what signs/symptoms to watch and report or go to the emergency room for evaluation
- Be kind to yourself. Having a pregnancy with high blood pressure can be stressful and worrisome. Remember , it is not your fault and you are amazing!
Finally, high blood pressure in pregnancy can be a scary uncertain journey to travel while pregnant. This does not mean you should have a pregnancy surrounded in fear, still take time to enjoy this pregnancy and feel joy. Keep an open communication with your doctor, understand the plan of care, speak with your provider on what is needed to keep you healthy and baby healthy. Keep a log book of your blood pressures to show your provider , and ask what blood pressure results are concerning and when to seek medical attention.
Most importantly , remember you are doing an Amazing Job. Pregnancy, especially one with medical concerns, is a lot of work and requires a lot of managing , you are doing a great job !