Types Of High Blood Pressure In Pregnancy
There are three main types of high blood pressure that women experience in pregnancy:
Chronic hypertension is high blood pressure that existed before pregnancy or is diagnosed before 20 weeks. If you have a high blood pressure reading early in your pregnancy, it’s likely you had hypertension before you became pregnant. Chronic hypertension is also the diagnosis for women who have high blood pressure for longer than 12 weeks after delivery.
Having chronic hypertension can put you at risk for preeclampsia later in pregnancy. About 1 in 4 women with chronic hypertension will develop preeclampsia.
A new study suggests that women with pre-pregnancy hypertension should be treated with blood pressure medication during their pregnancy to keep their blood pressure below 140/90. Previous conventional wisdom encouraged treatment only for those with readings above 160/110. Women who were treated more promptly in the study had fewer severe complications, and their babies grew just as well as those in the non-treatment group.
Gestational hypertension is high blood pressure that usually occurs for the first time at 20 weeks of pregnancy or later. It’s diagnosed if you have new onset high blood pressure during pregnancy but not preeclampsia. Women with gestational hypertension usually have just a small increase in blood pressure, but 10 to 25 percent of women with the condition may show signs of preeclampsia later in pregnancy.
Evidence Backs 37 Weeks’ Induction For Mild Preeclampsia
Women who develop high blood pressure during pregnancy may have fewer associated complications if obstetricians routinely induce labor once the pregnancy has exceeded 37 weeks gestation, according to Dutch researchers.
HYPITAT, a multicenter study of 756 pregnant women who developed gestational hypertension or mild preeclampsia, found that 31% of the women who were induced had a poor outcome versus 44% of the women who had expectant monitoring.
The difference of 49 women was significant , wrote Corine M. Koopmans, MD, of University Medical Centre in Groningen, and colleagues. The findings were published online in The Lancet.
Action Points
- Explain to interested patients that this report suggests that inducing labor at 37 weeks or later may improve outcome for women with gestational hypertension or preeclampsia.
- Note that the benefit in this trial was driven by reduction in risk of severe hypertension. There was no mortality benefit.
We believe that induction of labor should be advised for women with gestational hypertension and a diastolic blood pressure of 95 mmHg or higher or mild preeclampsia at a gestational age beyond 37 weeks, Koopmans wrote.
The authors said the finding underscored the importance of frequent blood pressure monitoring during the concluding weeks of pregnancy.
The women were randomized 1:1 to induction of labor or expectant monitoring. The primary endpoint was a composite measure of poor maternal outcome.
Primary Source
The Lancet
After An Induced Delivery
After delivery, when my doctor checked in on me, we mildly joked about how terrible my babies are at handling labor and how unlucky I am with those damn umbilical cords . Im thankful I had a wonderful care team with both my deliveries or the circumstances could have been vastly different. Just goes to show how important it is to have an OB you love and trust and to talk to them about your concerns. Make sure you have a whatever it takes plan in place and they are aware of it.
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Preventing High Blood Pressure During Pregnancy
Common risk factors for high blood pressure, such as obesity, can be minimized through diet and exercise.
During pregnancy, its normal to gain some weight. If youre concerned, talk to your doctor about a target weight gain and ways to stay within a range thats healthy for you.
Dietary guidelines for pregnant women vary from person to person. A nutritionist can help create a meal plan thats designed for your specific height and weight.
Avoid smoking and drinking alcohol. Both are known to raise blood pressure and to cause other complications during pregnancy.
Salt is important during pregnancy and its usually not necessary to limit salt intake, even for women with high blood pressure. Restricting salt too much is harmful for pregnant women and can impact fetal growth and development.
Pregnancy causes hormone shifts as well as psychological and physical changes. This can bring on stress, which can make high blood pressure harder to manage. Try stress reduction techniques such as yoga and meditation.
Some traditional blood pressure medications can cause problems in pregnant women.
These medications for lowering blood pressure are typically not recommended during pregnancy:
Who Is At Risk For Preeclampsia
You are at higher risk of preeclampsia if you:
- Had chronic high blood pressure or chronic kidney disease before pregnancy
- Had high blood pressure or preeclampsia in a previous pregnancy
- Damage to your kidneys, liver, brain, and other organ and blood systems
- A higher risk of heart disease for you
- Eclampsia, which happens when preeclampsia is severe enough to affect brain function, causing seizures or coma
- HELLP syndrome, which happens when a woman with preeclampsia or eclampsia has damage to the liver and blood cells. It is rare, but very serious.
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Prepping For Induced Labor + Planning For Toddler Care
Over the next 2 days, I ordered allllll the Amazon next-day shipping and 2-day shipping Target items I had been putting off like tiny diapers, breast milk storage bags, everything for my hospital bag and breastfeeding basket, and all the postpartum care essentials I was sure to need. I also cleaned and organized the house from top to bottom because there is nothing worse than coming home to a messy/dirty house!
I called my mom to plan out our toddlers possible early vacation at Grandmas house and packed everything they would need for a smooth couple of days. Our toddler gear included his pack n play, sound machine, music machine, baby monitor, clothes, snacks, and 2-year-old toys. Thankfully my mom babysits 2 days a week so she has experience with his daily routine, food, sleeping, etc. If not, I would have also included a daily schedule and food suggestions to make life easier for her.
Last but not least, we installed the infant car seat base! They suggest you not install it too early in case, God forbid, youre in an accident and you have to replace the seat before even using it. But in this case, and as you get close to your due date, its better safe and have it with you than sorry and not be able to take the baby home!
High Blood Pressure When Pregnant At 37 Weeks Check #2
So, 2 days later my mom came over to our house for her normal babysitting schedule knowing it might be extended a few days. My husband and I went to the OB clinic in our hospital with the infant car seat and hospital bag in tow.
I was on the verge of tears the moment we parked the car. I was obviously worried about our new baby , scared about induced labor, and sad for how our toddler would react to no longer being an only child. PLUS, and I dont recommend this, but it was our first night away from our toddler and that + the hormones really got me going. A word to the wise, do a trial run at grandmas house before the big event. They did great but it would have saved me a lot of stress.
After getting weighed in, I gained exactly 30lbs, same as my first pregnancy, they took my blood pressure and we all held our breath. As youve probably guessed, it was even higher. The nurse gave me the pitying aw, crap look and went to get my doctor.
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Treatment Options For Preeclampsia
Your doctor will treat your preeclampsia based on how severe your symptoms are, how far along you are, and how well your baby is doing. When monitoring your preeclampsia, your doctor may recommend regular blood pressure and urine testing, blood tests, ultrasounds, and non-stress tests. He may also recommend:
- Treatment with betamethasone, a steroid that will help mature your baby prior to delivery if youre still early in your pregnancy
- Delivery of your baby if your symptoms are severe or if youre at 37 weeks or more.
- Modified bed rest at home or in the hospital if youre not yet at 37 weeks, and if your and your babys conditions are stable.
Preeclampsia generally worsens as pregnancy goes on, so your doctors recommendations may change, depending on your health and the health of your baby.
Can High Blood Pressure During Pregnancy Be Prevented Or Avoided
It cant be prevented. However, you can lower your chances of getting it by making necessary adjustments before getting pregnant. These include getting or maintaining a healthy weight, eating a healthy diet, and exercising regularly.
If you have chronic hypertension before you get pregnant, talk with your doctor. He or she will look at how well your hypertension is being managed and let you know if you need to make any changes before getting pregnant.
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High Blood Pressure During Pregnancy Treatment
If you have chronic hypertension, you may have been taking medicine for it before you became pregnant. Tell your doctor which medicine youre taking. He or she may say its okay to continue that medicine. But if the medicine isnt safe for your baby, you may need to switch to another medicine during your pregnancy. Like with all pregnancies, your doctor will check your blood pressure and urine during your regular appointments.
If you have gestational hypertension, your doctor will monitor your blood pressure and urine more closely. He or she will do this to watch for signs of preeclampsia. Your doctor may also monitor your baby. One way to do that is with an ultrasound. This is a painless test that lets your doctor see your baby inside your body.
High Blood Pressure And Pregnancy
High blood pressure, or hypertension, does not usually make you feel unwell, but it can sometimes be serious in pregnancy.
Your midwife will check your blood pressure at all your antenatal appointments.
If you are pregnant and have a history of high blood pressure, you should be referred to a specialist in hypertension and pregnancy to discuss the risks and benefits of treatment.
If you develop high blood pressure for the first time in pregnancy, you will be assessed in a hospital by a healthcare professional, usually a midwife, who is trained in caring for raised blood pressure in pregnancy.
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When To Call The Doctor
- Have swelling in your hands, face, or eyes
- Suddenly gain weight over 1 or 2 days, or you gain more than 2 pounds in a week
- Have a headache that does not go away or becomes worse
- Are not urinating very often
- Have nausea and vomiting
- Have vision changes, such as you cannot see for a short time, see flashing lights or spots, are sensitive to light, or have blurry vision
- Feel lightheaded or faint
Hypertension And Diabetes Before And During Pregnancy
Using all available blood pressure measurements, preeclampsia was defined using the International Society for the Study of Hypertension in Pregnancy definition as SBP at least 140mmHg and/or DBP at least 90mmHg as well as proteinuria of 1+ or more on urine dipstick testing on two occasions after 20 weeks gestation in a woman who was not known to be hypertensive prior to pregnancy . Women who responded to a questionnaire administered during pregnancy that they had previously had hypertension outside of pregnancy were considered to have essential hypertension. Women who responded that they had previously had diabetes outside of pregnancy were classed as having existing diabetes, and for those without existing diabetes, any diagnosis of gestational diabetes was obtained from obstetric records.
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Tips To Relieve Normal Pregnancy Swelling
Sometimes, swelling may be as inevitable as that supersonic sense of smell and burning indigestion that you take in stride with the pure joys of pregnancy. However, here are a few things that you can do to help prevent or ease it.
- Elevate your feet at a level above your heart throughout the day, as this helps the fluid circulate back to your heart.
- Drink more water to flush extra fluid and sodium out of your body.
- Wear compression stockings to improve circulation, especially if youre taking a long flight.
We know every mama bear wants to know when to panic. The answer? Never. Panicking only boosts your emotional and physical stress. Instead, feel empowered by learning when to call your OB-GYN or midwife about swelling.
The two most concerning conditions during pregnancy that can cause swelling are preeclampsia and a blood clot.
First thing to remember: These conditions arent common, but the risk is real during pregnancy. Therefore, its important to be aware of them.
Secondly, swelling associated with these conditions is different than the normal, gradual swelling you may experience over the course of your pregnancy.
Heres how the swelling is different.
Normal Blood Pressure In Pregnancy
The American College of Obstetricians and Gynecologists state that a pregnant womans blood pressure should also be within the healthy range of less than 120/80 mm Hg.
If blood pressure readings are higher, a pregnant woman may have elevated or high blood pressure. If high blood pressure occurs during pregnancy, it may indicate serious complications such as preeclampsia.
It is important to track and manage blood pressure throughout pregnancy.
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High Blood Pressure When Pregnant At 37 Weeks
At my 37 week appointment, everything changed. My high blood pressure during pregnancy had jumped to the concerning level. My doctor ran a urine test to check for preeclampsia which thankfully came back normal. Since my blood pressure had been gradually increasing she was still concerned and scheduled another check for 2 days later. She let me know that if it was still high we would schedule an induction, possibly immediately. Oh. My. Word. That meant I had 2 days to do everything I had been putting off
In a panic, I asked my local mom group for induction stories that werent horrific and had several wonderful mommas assure me it wouldnt be a big deal. My doctor also reassured me that induced pregnancy is completely safe, normal, and not at all the horror story that everyone hears about. Of course, everyone is different and every pregnancy is different so I was still completely terrified.
Not to mention the concerns of high blood pressure when pregnant at 37 weeks. Most of them affected the mother, the worst being seizures during and after labor, the more common being high or low blood pressure after delivery.
If You Are Already Taking Medicine For High Blood Pressure
If you’re already taking medicine to lower your blood pressure and want to try for a baby, talk to your GP or specialist first. They may want to switch you to a different medicine before you get pregnant.
If you find out you’re already pregnant, tell your doctor immediately. They may need to change your medicine as soon as possible.
This is because some medicines that treat high blood pressure may not be safe to take when you’re pregnant. They can reduce the blood flow to the placenta and your baby, or affect your baby in other ways.
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Types Of High Blood Pressure Disorders During And After Pregnancy
If you have high blood pressure before pregnancy, it will need to be managed during and after pregnancy.
In addition, some women who have a healthy blood pressure develop high blood pressure during or after pregnancy.
- Gestational hypertension is blood pressure greater than or equal to 140/90 that develops during pregnancy. Its typically diagnosed after 20 weeks of pregnancy or close to delivery.
- Preeclampsia is a combination of high blood pressure during pregnancy and signs that your organs are not working well, such as high protein levels in your urine. This can lead to life-threatening seizures or coma, a condition known as eclampsia. Women who have had preeclampsia have a higher risk of developing high blood pressure and heart disease later in life.
- HELLP syndrome is a more severe type of preeclampsia or eclampsia.
- High blood pressure disorders may continue after the baby is born. Some women may continue to have high blood pressure problems, including preeclampsia, eclampsia, or HELLP syndrome, after the birth of their child, or their high blood pressure may get worse.
- A sudden spike in blood pressure can also happen during pregnancy or after the baby is born. This is a medical emergency.
High Blood Pressure In Pregnancy
High blood pressure also called hypertension can lead to serious problems when youre pregnant. But people with high blood pressure in pregnancy can have healthy pregnancies and babies with treatment and help from a doctor or nurse.
There are a few kinds of hypertension in pregnancy:
Chronic hypertension:Chronic hypertension is high blood pressure that started before your pregnancy, or during the first 20 weeks of your pregnancy. You also have chronic hypertension when youre diagnosed with high blood pressure for the first time during your pregnancy, and it doesnt go away after you give birth.
Gestational Hypertension :Gestational hypertension is high blood pressure that starts after 20 weeks of pregnancy. Gestational hypertension usually goes away after you give birth, but it makes you more likely to have chronic hypertension in the future.
Preeclampsia:Preeclampsia is a serious blood pressure disorder that can happen in pregnancy. Preeclampsia in pregnancy can damage organs in your body and can cause health risks for your baby. Preeclampsia tends to happen in the last trimester, but can happen earlier. It can also happen after pregnancy . If you have preeclampsia, you may need to deliver your baby early. Preeclampsia can lead to something called HELLP syndrome, which affects your organs and blood and can be life threatening. Preeclampsia can also lead to eclampsia, which causes seizures.
Signs of preeclampsia include:
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