High blood pressure, also called “hypertension”, can pose problems during pregnancy whether you had it before pregnancy or it’s new in pregnancy
High blood pressure you have before pregnancy is called chronic hypertension. High blood pressure that you develop during pregnancy is gestational hypertension. Both of these conditions can get worse with pregnancy and may progress to a pregnancy-related condition called “preeclampsia”.
See also: Know Your Blood Pressure Numbers
Complications of high blood pressure for mom and baby
Pregnant women with high blood pressure have a higher risk for premature separation of the placenta (placental abruption), cesarean and hemorrhage after delivery. You have a higher risk of having heart and kidney disease later in life. Your baby is at risk to be born early, grow smaller than normal, be stillborn or die soon after birth. If you have very high blood pressure, as sometimes occurs with preeclampsia, you can have complications including seizures, stroke, kidney or liver complications, and even death.
How do I know if I have preeclampsia?
Currently, there is no screening method for preeclampsia. If you have chronic or gestational hypertension expect your providers to closely monitor you for symptoms (see box). They’ll check for signs you may be developing preeclampsia, including high blood pressures and changes in laboratory values. Some women who develop preeclampsia have risk factors (see below) but many women with preeclampsia have no risk factors.
Symptoms to Report to your Provider (some women have no symptoms until their blood pressure is dangerously high)
- Changes in your vision (spot in eyes, blurry vision, etc)
- Puffiness (edema) in your feet, legs, hands or face
- Especially edema that doesn’t resolve with rest
- Sudden weight gain
- New nausea or vomiting in the second half of pregnancy
- Difficulty breathing
- Epigastric pain (below ribs in area of the upper belly) or shoulder
- Your baby moves less than usual (talk with your nurse about doing daily fetal “kick counts”)
Risk factors for Preeclampsia:
- Preeclampsia in a previous pregnancy
- Being pregnant with twins, triplets or more
- Chronic hypertension
- Type 1 or 2 Diabetes
- Kidney disease
- Autoimmune diseases
- Never being pregnant before (Nulliparity)
- Pre-pregnancy body mass index greater than 30
- Mother or sister who had preeclampsia
- Maternal age 35 years or older
- Being African American
Chronic hypertension is high blood pressure diagnosed before pregnancy or before the 20th week of pregnancy. If you have this condition before pregnancy, work with your care providers to treat your blood pressure. Ask for counselling about healthy weight, nutrition, and activity to begin your pregnancy as healthy as possible. Let your provider know you’re thinking about getting pregnant so they can prescribe antihypertensive medications that are safe in pregnancy. Avoid excessive salt and caffeine intake and ask for help to stop smoking. After 12 weeks of pregnancy, your provider may recommend you take low-dose aspirin daily to help prevent preeclampsia.
Gestational hypertension is high blood pressure diagnosed after the 20th week of pregnancy. If you have gestational hypertension your provider will check your blood pressure more often and may place you on blood pressure-lowering medication if your blood pressure continues to increase. Depending on risk factors, your provider may recommend low-dose aspirin daily after 12 weeks of pregnancy to prevent preeclampsia.
Monitoring high blood pressure in pregnancy
When you have high blood pressure in pregnancy you’re considered “high-risk”. You and baby will be monitored more often. Your provider will regularly check your blood pressure and order lab tests to measure your kidney and liver function. Your baby’s growth and well-being will be checked with ultrasounds and fetal heart monitoring. At any time in pregnancy if your blood pressure rises high enough you may be admitted to the hospital for closer monitoring. If needed, your provider may place you on a medication called magnesium sulfate to help prevent you from having a seizure (eclampsia) or other complications. Your provider may recommend delivering your baby early if your condition becomes dangerous for either you or your baby.
Remember high blood pressure can be “silent”. You know your body better than anyone else, so if you’re concerned about any symptoms or just don’t feel “right”, let your provider know so you and your baby can be checked.