Moms-To-Be, Blood Pressure and Pregnancy

Tabassum Firoz, MD

Pregnancy is a time of changes for a woman’s body. Some are normal and expected, but others can be of more concern. That’s especially true for high blood pressure.

For some, high blood pressure may be first discovered during pregnancy. If found prior to the 20th week of pregnancy, it is considered chronic or pre-existing.

Other women can develop high blood pressure due to the pregnancy and that usually develops after the 20th week. There are two types of pregnancy-related high blood pressure: gestational hypertension and pre-eclampsia. Gestational hypertension is high blood pressure that develops after 20 weeks of pregnancy but does not involve any other organs.

Preeclampsia, unlike gestational hypertension, is a disorder of high blood pressure that affects other organs like the brain, eyes, heart, lungs, liver and kidneys.  Pre-eclampsia typically occurs after 20 weeks of pregnancy and can very rarely occur before that. Pre-eclampsia can also develop in the first weeks after delivery.  

Pre-eclampsia affects between five and eight percent of all pregnancies. If not recognized in time, it can progress rapidly and can affect both the mother and baby.

Who is at risk of pre-eclampsia?

While we cannot predict who will develop pre-eclampsia, some women are at higher risk due to:

  • Past history of pre-eclampsia
  • Chronic or pre-existing high blood pressure
  • Diabetes
  • Kidney disease
  • Inflammatory diseases like lupus
  • Obesity

The Warning Signs

There are some signs and symptoms of pre-eclampsia. If a mother-to-be experiences these symptoms, it’s important to report them to your doctor as soon as possible. The warning signs of pre-eclampsia are:

  • Headaches
  • Changes in vision
  • Nausea/vomiting
  • Chest pain
  • Pain in the abdomen
  • Swelling

What does it mean for future pregnancies?

Pre-eclampsia increases the risk of developing gestational hypertension and pre-eclampsia in future pregnancies. The degree of risk depends on when in the pregnancy pre-eclampsia developed, its severity and complications.

Can pre-eclampsia be prevented?

If a woman has had pre-eclampsia in a past pregnancy, having a consultation with specialists prior to the next pregnancy is ideal. Usually, women are cared for in a multi-disciplinary team, which may include obstetrics, obstetric medicine and maternal fetal medicine. Patient education and awareness are key in recognizing pre-eclampsia early. Baby aspirin and adequate calcium intake can also reduce the risk of pre-eclampsia and may be discussed during the consultation.

How is it treated?

Delivering the baby is considered the cure for pre-eclampsia. This, however, depends on the severity and timing of pre-eclampsia. Blood pressure control is critical. Magnesium sulfate may be used to prevent eclamptic seizures which can occur with pre-eclampsia.

Pre-eclampsia and long-term health?

Pre-eclampsia increases the risk of having several health problems in the future. These include high blood pressure, heart disease, stroke, diabetes and kidney disease. Women who have had pre-eclampsia have three to four times the risk of high blood pressure and double the risk for heart disease and stroke.

After giving birth, blood pressure should be checked to see if it has returned to normal. Your doctor may also check urine and other blood work if they were abnormal during pregnancy. If abnormalities persist, these should be followed regularly over time.

While it is unknown whether the risk of future health problems is caused by pre-eclampsia or if the woman was already predisposed, these health problems can occur as early as 10 to 12 years after a complicated pregnancy.

To minimize the risk of future health problems, women should maintain a healthy weight, stop smoking, exercise regularly and pursue a heart healthy lifestyle.  Blood pressure, blood sugar and cholesterol should be checked regularly.

Resources

At the Women’s Medicine Collaborative, my colleagues and I in the Multidisciplinary Obstetric Medicine Service specialize in caring for women who have conditions that could complicate their pregnancy, including gestational hypertension and pre-eclampsia.

Also, the Preeclampsia Foundation is a national not-for-profit patient advocacy organization that is committed to providing patient support and education, raising public awareness, catalyzing research and improving healthcare practices.

We all hope for a complication-free pregnancy for all women. But if complications arise, just know there is a team of specialists ready to help you through it.

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