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Hypertension in Pregnancy: Types, Risk Factors and Prevention

 Hypertension in pregnancy

Our pregnancy series continues, make sure you have read previous post on pregnancy, so that you may have get ultimate benefits of the series, our aim is healthy mother and healthy baby at the end of every pregnancy. So today im this post, we are going to talk on hypertension in pregnancy.

Hypertension or high blood pressure is common, occurring in about 15% of all pregnancies, that is one in every seven pregnancies. Hypertension also known as high blood pressure is very commonly seen in pregnancy. It is important that blood pressure be maintained at an appropriate level in order to perfuse the organs of the body. 

If blood pressure is too low, then organs won't be perfused and won't receive the oxygen and nutrients they need, and the waste products won't be removed. The same thing can happen to the placenta, that organ that supports the fetus throughout pregnancy. If the blood pressure is not high enough, the placenta won't get enough blood and the baby won't be able to grow and develop normally. 

On the other hand, if the blood pressure is too high, it can damage the placenta, leading to bleeding, which we call placental abruption. Normal blood pressure in pregnancy is less than or equal to 120/80mmHg. So abnormal blood pressure in pregnancy is regarded as a blood pressure where the systolic is greater than or equal to 140 or the diastolic pressure is greater than or equal to 90. 

The other important thing to note is, it shouldn't be based on a single blood pressure measurement. You need at least two blood measurements, more than four hours apart, in order to be able to make a diagnosis of high blood pressure in pregnancy. The correct way to take blood pressure, the standardized way, is in the sitting position, resting first for at least five minutes, using the right size cuff and measure it at the level of the heart. 

Risk Factors for Developing Hypertension in Pregnancy 

High blood pressure is a common condition in pregnancy. However, not all women are at equal risk of developing high blood pressure. Some people are at high risk because of underlying risk factors. 

Some of these include diabetes, chronic hypertension, which is high blood pressure before pregnancy, carrying twins and underlying medical conditions, or the fact that you had high blood pressure in a prior pregnancy. 

So high blood pressure in pregnancy can be dangerous and it can be dangerous both to the mother and to the developing fetus. It depends on, very importantly, what the cause of the high blood pressure is, it depends on how severe the high blood pressure is, when in the pregnancy it occurs, and whether you're able to control the blood pressure with medication. 

Types of Hypertension in Pregnancy 

There are four main types of high blood pressure in pregnancy and it's very important to distinguish which one of these conditions you have. The first is known as chronic hypertension. 

  1. Chronic Hypertension
  2. Chronic hypertension with superimposed preeclampsia
  3. Gestational hypertension
  4. Preeclampsia

1. Chronic hypertension refers to a condition in which a woman enters the pregnancy with a diagnosis of high blood pressure or she was diagnosed with high blood pressure before the pregnancy reaches 20 weeks of gestation, whether or not she's on treatment. In general, women should be followed closely and their blood pressure measured on a regular basis. 

They should continue their medications. These medications are generally safe both for the mother and for the baby in pregnancy. 

2. We have gestational hypertension, this is also called pregnancy-induced hypertension. It turns out this is a benign condition that is not dangerous either to the mother or the baby. 

3. Preeclampsia, by far, the most serious cause of high blood pressure in pregnancy is called preeclampsia, this condition is dangerous both to the mother and to the baby. This condition needs to be diagnosed in a timely fashion and if it is the one, you manage appropriately, the outcomes will be optimal. 

While preeclampsia has been around for decades and centuries, we still don't completely understand the cause, but there are a couple of things we do know. 

We do know that it only occurs in women during pregnancy and in the first few weeks after pregnancy, what we call the purperium We also know that it's a disease of the placenta.

Remember, the fetus is a thief, it is stealing oxygen and nutrients from the mother constantly throughout the day, throughout the weeks. If the placenta doesn't grow in right at the beginning of pregnancy in the first few weeks, if it doesn't establish a healthy blood supply, the placenta will begin to malfunction and produce a substance that then leaks into the mother's blood and circulates throughout her body and damages the blood vessels in various organ systems. For this reason, preeclampsia never gets better during pregnancy. It always gets worse. 

The good news is that after the pregnancy is delivered and especially the placenta is delivered, preeclampsia always gets better. Every organ system that has been damaged will improve and get healthy again with the one exception of stroke. 

How Preeclampsia is Diagnosed 

So how do you make a diagnosis of preeclampsia? It's based on a series of clinical criteria. So the first is you have to have elevated blood pressure, new onset hypertension. It needs to be after 20 weeks of gestation. 

We don't make a diagnosis of preeclampsia before 20 weeks. And the third criteria is evidence of organ system damage in the mother. 

The two types of preeclampsia are 

  1. Preeclampsia with severe features, we call that severe preeclampsia.
  2. Preeclampsia without evidence of severe features. 

Features of Severe Preeclampsia 

You can be severe by symptoms. Example include severe, unremitting headache despite analgesics. Pain in your abdomen that's severe, usually up in the right side of the abdomen close to the ribs. Problems with vision, flashes of light that don't go away, blurry vision. 

You can be severe by signs, meaning that you feel fine, but your provider picks up something abnormal. Very high blood pressure, fluid on the lung, or a seizure. 

The second type of preeclampsia is called non-severe preeclampsia. All that means is you're somebody who's been diagnosed with preeclampsia, but don't have any features of severe disease. It's really important that distinction between severe disease and non-severe disease be made as early as possible, because it's going to affect how you're going to be managed for the rest of the pregnancy from that moment on.

Treatment of Preeclampsia 

Once a diagnosis of preeclampsia has been made, the only cure is delivery. That is why when people have preeclampsia close to their due date, after 37 weeks, which is three weeks before your due date, it is typically recommended that you get delivered. However, earlier in pregnancy, it may be appropriate to continue the pregnancy and try and get the baby a little further along, a little bit stronger, especially help the lungs develop. 

So while I can't give you specific recommendations for any individual pregnancy, I can share with you some general recommendations. 

They need to be able to come in to see their provider at least twice a week, get testing on the baby twice a week, get blood tests twice a week. They need to have somebody with them at home in case they suddenly develop severe features and have to be rushed to the hospital. 

They need to be compliant with what we generally call modified bed rest, eight hours during the day off your feet and no heavy lifting is a reasonable conservative recommendation. If, however, somebody has severe disease, then they need to stay in hospital for the rest of the pregnancy. Then a decision will need to be made about when delivery should occur. 

If the blood pressure can't be safely managed, if the blood tests get worse, the recommendation would be to proceed with delivery immediately. So during labor, either if somebody presents in spontaneous labor or if their labor is being induced, they should be managed in a tertiary care setting where there are specialists around who can manage any complications in case they occur. 

The fetus should be continuously monitored. 

Their blood pressure should be very closely monitored. So once you are delivered, either vaginally or by cesarean section, you should remain in hospital at least for a few days to be closely monitored. But if you don't have symptoms, if your blood pressure is controlled and your blood tests are normal, you can go home within a matter of a few days. 

It is safe to breastfeed even if you're on medications to control your blood pressure. These medications are safe and it is not only safe to breastfeed, it is strongly recommended that you breastfeed. 

Prevention of Hypertension in Pregnancy 

For people who are at high risk, we do have some recommendations. 

1. You follow your symptoms closely. 
2. You see your provider on a regular basis.
3. Check your blood pressure regularly. 

One medication that is recommended for high-risk women is aspirin. Taking a baby aspirin every day, starting early on in pregnancy and continue all the way to 36 weeks can prevent preeclampsia in some women at high risk. 

Closing Thought 

In summary, high blood pressure or hypertension in pregnancy is very common. It can be serious both for the mother and for the baby. But if it's appropriately diagnosed and appropriately managed, the outcome for the pregnancy will be good. Thank you for joining us today. 


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