High blood pressure, or hypertension, is a common condition that can raise the risk of heart disease, heart attack or stroke. In pregnant women, high blood pressure can also cause major complications for both mother and baby.
High blood pressure and related conditions, such as obesity and diabetes, are on the rise in the general population, so it makes sense that high blood pressure would also be increasing among pregnant women. This can lead to several significant problems that affect the heart, lungs or brain. The main concern is preeclampsia, a condition that can develop during pregnancy or up to six weeks after delivery.
Preeclampsia, also called toxemia or pregnancy-induced hypertension (PIH), may or may not be severe:
In preeclampsia without severe features, blood pressure is typically between 140-159/80-109 mmHG (normal is 120/80). These women typically have no symptoms and their blood test results are normal.
In preeclampsia with severe features, blood pressure is typically over 160/110 mmHg and women tend to have severe headache or visual problems, as well as blood test abnormalities, such as elevated liver enzymes and low platelets. Pregnant women whose severe preeclampsia is not treated could develop eclampsia, which is a seizure disorder.
High blood pressure during pregnancy is also potentially harmful for the baby, who may suffer from restricted growth or a life-threatening condition called placental abruption, where the placenta separates from the uterine wall.
“The treatment for preeclampsia and eclampsia is delivery, but it depends on what risk we are willing to take on mom’s health, and how early we want to deliver the baby,” says Dr. Daneshmand. “If a patient has high blood pressure or preeclampsia without severe features, we’d like to push the pregnancy as far along as we can, typically up until about 37 weeks of gestation.”
Women may have a higher risk of preeclampsia if they:
- Have had preeclampsia in a previous pregnancy
- Have not been pregnant before
- Are over 40 years old or under 18 years old
- Had high blood pressure prior to becoming pregnant
- Are obese and/or have diabetes
- Are pregnant with twins or triplets
High blood pressure that develops during pregnancy and abnormally high protein levels in urine are the main symptoms of preeclampsia. Other signs include:
- Swelling in your hands or face
- Rapid weight gain within one to two days
- Severe headaches
- Pain in the upper right side of your abdomen
- Severe shortness of breath
- Changes in vision
- Continuous nausea or vomiting
Pregnant women usually have no way of knowing if they have high blood pressure or protein in their urine. So, it’s critical to keep all prenatal appointments. An obstetrician can identify warning signs that would otherwise go unnoticed. Women may consider getting a home blood pressure monitor to check blood pressure between prenatal visits.
It’s also important to get high blood pressure under control before pregnancy, if possible.
“Before you get pregnant, address any health issues with your physician,” says Dr. Daneshmand. “Not only do you want to make sure you fine-tune the elevations in your blood pressure, but also that you’re taking medications that are safe in pregnancy.”
He adds that pregnant women who develop high blood pressure or other conditions that create a high-risk pregnancy should seek specialized care. The maternal fetal medicine specialists at Scripps Clinic Perinatology Program provide expert care for pregnant women with hypertension and other issues.
“We want to provide excellent clinical care to our high-risk moms, and we also want to make sure our patients have the best experience,” Dr. Daneshmand says. “We want them to know that we care about them, because these can be tough times for some of these parents.”