We have been seeing a rise on comorbidities prior to pregnancy. Chronic health issues are on the rise, such as obesity, baseline hypertension or essential hypertension or diabetes. These conditions lead to an increased risk for development of hypertension or high blood pressure in pregnancy.
Typically, the symptoms are headache, visual disturbances, epigastric pain, pain in the upper right region of the abdomen underneath your right rib cage, swelling, excessive weight gain. Those are typically the symptoms.
With mom, patients with severe high blood pressure, think about the brain. They could get something called eclampsia, which is a seizure disorder. They could have a stroke. Think about the lungs. They could go into fluid overload. Think about the heart. They could be at risk for myocardial infarction or heart attack. They could go into kidney failure.
With babies, we think about growth restriction. The baby is not growing as well. They could have something called placental abruption, where the placenta separates from the uterine wall. Babies can pass away from this.
Complications really depend on how severe the blood pressure is and how quickly we can address the elevation of the blood pressure and other organ damages.
Preeclampsia is an elevation in blood pressure in association with spillage of protein. Proteins are macromolecules. We usually don’t spill them, but in pregnancy there’s damage to these vessels and mom starts spilling more protein.
There’s also a condition called gestational hypertension where it’s elevation of the blood pressure without evidence of proteinuria or any spillage of protein. This typically happens after 20 weeks of gestation and typically resolves by about 6 to 12 weeks after delivery.
Unfortunately, the treatment for preeclampsia is delivery, but it depends on what kind of risks we want to take with mom's health and obviously the baby's. How early do we want to deliver this baby?
If a patient has high blood pressure or preeclampsia in pregnancy, we’d like to push the pregnancy as far along as we can, typically up until about 37 weeks of gestation if the patient has preeclampsia without severe features; that is if the patient does not have any neurologic abnormalities, or headaches that don’t resolve with taking a pain medication or laboratory abnormalities. If a patient has any of those and also has severe range in blood pressures - a systolic blood pressure 160, and diastolic blood pressure of 110 equal or above - these patients are typically delivered at 34 weeks or earlier.
Preeclampsia typically happens in the latter stages of the pregnancy, the latter stages of the third trimester. But it can happen at any time. I’ve delivered babies at 23 weeks at 24 weeks at 20 weeks with preeclampsia, unfortunately.
The time where we can make the most amount of difference in a patient’s care is really preconception. Before you get pregnant, seek care with your obstetrician, gynecologist, with your family medicine doctor, because not only do you want to make sure you fine tune the elevations in blood pressure, but also make sure that you’re taking medications that are safe in pregnancy.
Address your health prior to pregnancy if you have any comorbid issues, such as obesity or diabetes. Make sure you address those as much as possible. Make sure you’re on the right type of medication. When you get pregnant, we also do some baseline labs.
Also we recommend patients take low-dose aspirin when they’re pregnant because that has shown to reduce the risk of superimposed preeclampsia, which is preeclampsia on top of already existing hypertension. These patients get monitored much more frequently, as one can imagine.
Women who have preeclampsia during their pregnancy have an increased risk for ischemic heart disease. A lot of times I tell patients your pregnancy gives you a window as to what your health could look like. Patients who had preeclampsia and delivered prematurely have a significant higher risk for ischemic heart disease or heart-related issues, cardiovascular related issues.
It’s very important to listen to the pregnancy. Make sure you see your primary care physician. Make those frequent checkups. Check your lipid profile. Maintain a very healthy diet and exercise. Do all the things that go with making sure that you maintain your health.
You can purchase a blood pressure monitor. You want to measure your blood pressure sitting down, legs not crossed, not talking. Usually you want to make sure you avoid any caffeine prior to taking your blood pressure. Usually do it at a time when you’re relaxed, arm at the level of the heart.
During pregnancy, we want your systolic blood pressure to be less than 140 millimeters of mercury and your diastolic blood pressure to be less than 90 millimeters of mercury.
Scripps Perinatology was started in 2018. We’re very excited. We’re a team of maternal fetal medicine specialists. We’re physicians that have done a residency in OBGYN and then did a three-year fellowship in maternal fetal medicine.
We’re part of a team. We work with OB-GYNs. We work with family practitioners. We work with other clinicians ensuring moms and babies have the best outcome.
We want to provide excellent clinical care to our high-risk moms, and we also want to make sure the patients have the best experience. We want them to know that we care about them. That’s very important to us. The patient experience also matters significantly, because these are tough times for some of these parents.
A perinatologist is an internal medicine physician to pregnant moms. So any complications, whether it’s, for example, hypertension or diabetes, or cancer, or a stroke, or heart disease, or any fetal issues, we are involved in the care that a patient.
A lot of times we play as the quarterback, making sure that the patient is seeing all the specialists, whether it’s pediatric or adult. And again, making sure that we bring in full circle the care for that mom and child.
Lightly edited for clarity.