High Blood Pressure During Pregnancy

Pregnancy causes hormonal 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.

WHAT IS BLOOD PRESSURE

Blood pressure is the pressure in the blood vessels in your body. It is the force with which the blood moves through the blood vessels. Doctors and nurses measure blood pressure by putting a cuff around your upper arm. Then they listen to your blood flow with a stethoscope. High blood pressure(also called hypertension) occurs when your blood moves through your blood vessels at a higher pressure than normal.

What are the different types of high blood pressure during pregnancy?

There are three types of high blood pressure in pregnant women:

• Chronic hypertension: High blood pressure that develops before the 20th week of pregnancy or is present before the woman becomes pregnant. Sometimes a woman has high blood pressure for a long time before she gets pregnant, but she doesn’t know it until her first prenatal check-up.

• Gestational hypertension: Some women just get high blood pressure near the end of pregnancy. They don’t have any other associated symptoms.

• Pregnancy-induced hypertension (PIH), also called toxemia or preeclampsia: This condition can cause serious problems for both the mother and the baby if left untreated. PIH develops after the 20th weeks of pregnancy. Along with high blood pressure, it causes protein in the urine, blood changes and other problems.

What are the risks of PIH to the baby and me?

PIH can prevent the placenta (which gives oxygen and food to your baby) from getting enough blood. If the placenta doesn’t get enough blood, your baby gets less oxygen and food. This can cause low birth weight and other problems for the baby.

Most women who have PIH still deliver healthy babies. A few develop a condition called eclampsia(PIH with seizures), which is very serious for the mother and baby, or other serious problems. Fortunately, PIH is usually detected early in women who get regular prenatal care, and most problems can be prevented.

Symptoms

What are the symptoms of PIH?

If you have any of the following symptoms of PIH, call your doctor right away:

• Severe headaches

• Vomiting blood

• Excessive swelling of the feet and hands

• Smaller amounts of urine or no urine

• Blood in your urine

• Rapid heartbeat

• Dizziness

• Excessive nausea

• Ringing or buzzing sound in ears

• Excessive vomiting

• Drowsiness

• Fever

• Double vision

• Blurred vision

• Sudden blindness

• Pain in the abdomen (tummy)

Does high blood pressure mean I have PIH?

Not necessarily. If your doctor sees that your blood pressure is high, he or she will watch you closely for changes that could mean you have PIH. In addition to high blood pressure, women who have PIH also have excessive swelling. They may also have protein in their urine. Many women who have high blood pressure during pregnancy don’t have protein in their urine or extreme swelling, and don’t get PIH.

Does swelling mean I have PIH?

Swelling alone doesn’t necessarily mean you have PIH. Some swelling is normal during pregnancy. For example, your rings or shoes might become too tight. Swelling is more serious if it doesn’t go away after resting, if it’s very obvious in your face and hands or if it’s a rapid weight gain of more than 5 pounds in a week.

CAUSES

Who is at risk for PIH?

PIH is more common during a woman’s first pregnancy and in women whose mothers or sisters had PIH. The risk of PIH is higher in women carrying multiple babies, in teenage mothers and in women older than 40 years of age. Other women at risk include those who had high blood pressure or kidney disease before they became pregnant. The cause of PIH isn’t known.

Diagnosis

What tests can show if I have PIH?

No one test diagnoses PIH. Your blood pressure will be checked during each doctor’s visit. A big rise in your blood pressure can be an early sign that you might have PIH. A urine test can tell if there is protein in your urine. Your doctor may order certain blood tests, which may show if you have PIH. If you have signs of PIH, your doctor may want to see you at least once a week and possibly every day.

Treatment

How is high blood pressure treated in pregnant women?

The treatment will depend on the type of high blood pressure:

• Chronic hypertension: If you are already taking medicine for high blood pressure, your doctor may want you to keep taking that medicine. If that medicine is not safe for the baby, your doctor might want you to change to another medicine or to stop taking medicine while you are pregnant. Your doctor will pay special attention to how your baby is growing. You might have ultrasound exams more often. You might have some other tests near the end of your pregnancy to make sure that your baby is healthy. Your doctor will monitor you closely for signs of PIH.

• Gestational hypertension: This condition doesn’t need any treatment. But it can be hard to tell this condition from early or mild PIH, so your doctor will monitor you very closely to make sure your high blood pressure does not turn into PIH. Your doctor might tell you to take aspirin or extra calcium to prevent PIH. Your doctor might also tell you to lie on your left side while you are resting. This will improve blood flow and take weight off your large blood vessels.

• PIH: How your doctor treats this condition depends on how close you are to your due date and how you and your baby are doing. The only treatment that stops PIH is to deliver the baby. If your baby is born very early, it may have serious health problems. But your doctor may want your baby to be delivered early if you or the baby are very sick. If your doctor thinks it is safe for the pregnancy to continue to full term, he or she will monitor you and your baby very closely until delivery. You will see your doctor often and get blood tests. Your baby will also get some tests to make sure he or she is healthy. You might need to stay home from work and rest in bed. In some cases, hospitalization may be necessary.

MEDICATION

Medication for high blood pressure during pregnancy

Some traditional blood pressure medications can cause problems in pregnant women.

According to Mayo Clinic, these medications for lowering blood pressure should be avoided when you are pregnant:

• ACE inhibitors

• renin inhibitors

• angiotensin receptor blockers

These drugs in particular will be passed through the bloodstream to the developing baby. They can negatively impact the baby’s health. These medications may also cause blood to thin, which can compromise the mother’s ability to carry the baby to term.

Methyldopa and labetalol are both drugs that have been deemed safe for use to manage blood pressure during pregnancy.

Talk to your doctor about how to control your blood pressure if you develop hypertension during pregnancy.

Next steps

High blood pressure during pregnancy doesn’t usually lead to serious problems. However, if it goes untreated, hypertension can become life-threatening for both mother and baby. Unfortunately, hypertensive disorders resulting from high blood pressure are the second-leading cause of U.S. maternal death during pregnancy.

Always talk to your doctor about your concerns. Plan to stay on top of your prenatal care to have the healthiest pregnancy outcome possible.

Take the time to understand the risk factors and possible causes of high blood pressure before you get pregnant — and take preventive measures to keep your blood pressure down during pregnancy.

How can you manage high blood during pregnancy?

Here’s what you can do:

• Go to all your prenatal care checkups, even if you’re feeling fine.

• If you need medicine to control your blood pressure, take it every day. Your provider can help you choose one that’s safe for you and your baby.

• Eat healthy foods. Don’t eat foods that are high in salt, like soup and canned foods. They can raise your blood pressure.

• Stay active. Being active for 30 minutes each day can help you manage your weight, reduce stress and prevent problems like preeclampsia.

• Don’t smoke, drink alcohol or use street drugs or abuse prescription drugs.

What can you do about high blood pressure before pregnancy?

Here’s what you can do:

• Get a preconception checkup. This is a medical checkup you get before pregnancy to take care of health conditions that may affect your pregnancy.

• Use birth control until your blood pressure is under control. Birth control is methods you can use to keep from getting pregnant.

• Get to a healthy weight. Talk to your provider about the weight that’s right for you.

• Eat healthy foods.

• Do something active every day.

• Don’t smoke. Smoking is dangerous for people with high blood pressure because it damages blood vessel walls.

Ways to lower blood pressure in pregnancy

Get moving.

Inactive women are at a higher risk of hypertension than those who exercise. So whether you are already pregnant or plan on conceiving, talk to your doctor about starting an exercise program.

• Try to exercise for at least 30 minutes a day or most days throughout the week.

• If you are a beginner, try low-intensity walking or swimming.

• Always talk to your doctor before starting an exercise program and ask if it is safe for you to do certain activities.

Monitor your weight.

Being overweight is a risk factor for hypertension and thus, you need to take caution to keep your pregnancy weight gain within healthy limits. A proper diet and regular exercise are ways to manage your weight gain during pregnancy.

• Preeclampsia is associated with hypertension and weight gain during pregnancy, so it is important to avoid gaining too much weight and to avoid gaining weight too quickly. Preeclampsia can lead to kidney and liver problems for the mother and complications for the baby.

• Being overweight also increases the risk of other health conditions during pregnancy, such as back aches, exhaustion, leg cramps, hemorrhoids, gestational diabetes, heartburn and aching joints.

Reduce stress.

Being stressed can cause elevated blood pressure whether you are pregnant or not. Try eliminating known triggers for stress if possible.

• Do not overwork when pregnant. If you work over 41 hours per week, this can increase your risk for high blood pressure.

• Try relaxation techniques such as meditation, visualization and yoga. These can bring serenity to your body and mind and help reduce your stress level.

Try controlled breathing.

Breathing techniques, such as diaphragmatic breathing, can help calm your body and mind and provide stress relief. In addition, by engaging the diaphragm (the muscle at the base of your lungs) you can make your breathing more powerful and reduce the strain to the other muscles in your neck and chest

• Lie comfortably on your back or sit on a chair. If lying down, place a pillow under your knees to keep them bent.

• To feel your diaphragm move, place your hands on the chest and below the rib cage.

• Slowly inhale through your nose so that you feel your stomach move up.

• Slowly exhale through your mouth by counting to five while tightening your abdominal muscles and letting them fall inward.

• Repeat and keep your breathing regular and slow.

Listen to music.

Studies have shown that listening to the right type of music while slowly breathing for at least 30 minutes a day can lower blood pressure.

• Listen to calming and relaxing music such as Celtic, classical, or Indian or if you have a favorite slow music that inspires and relaxes you, listen to that.

• Avoid loud and fast music, such as rock, pop and heavy metal, as these might have the opposite effect on you.

Take a closer look at your medications.

Hypertension is a side effect of some medications. Talk to your doctor about your medications and find out if they are safe to use while pregnant.

Stop smoking.

Besides being a danger to your baby, smoking can also raise your blood pressure. If you are pregnant, you should quit smoking immediately.

• Talk to your doctor about methods to stop smoking that are safe for you and your baby.

Avoid high-sodium foods (ask your physician about what is okay)

Although your body requires sodium in small amounts, consuming too much sodium is bad for you and can lead to hypertension, heart disease and stroke. If you suffer from high blood pressure, take steps to reduce your sodium intake:

• Do not add salt to foods when cooking but use other spices instead (cumin, lemon pepper, fresh herbs).

• Rinse canned foods to remove sodium.

• Buy foods that are labeled “low sodium” or “sodium free.”

• Avoid processed foods, such as crackers, fried items, and baked goods, that often are high in sodium.

• Also avoid eating fast food and ask for reduced sodium when ordering in restaurants.

Eat more whole grains.

Whole grains are high in dietary fiber and studies have shown that adding more fiber to your diet may reduce hypertension.

• Make sure you get at least six to eight servings of whole grains every day.

• Switch refined grains to whole grains, such as brown rice and whole wheat pasta and bread.

Add potassium-rich foods to your diet.

Potassium-rich foods should be a part of your hypertension management diet. Foods you should add include sweet potatoes, tomatoes, kidney beans, orange juice, bananas, peas, potatoes, dried fruits, melon and cantaloupe.

• Keep your target potassium levels moderate (around 2,000 to 4,000 mg a day).

Indulge with dark chocolate.

According to a clinical study, dark chocolate may actually assist in lowering blood pressure.

• Eat a half an ounce of dark chocolate that has at least 70% of cocoa per day.

• Because dark chocolate is high in calories, be sure not to overindulge.

Avoid alcohol and caffeinated drinks.

Besides being bad for blood pressure, caffeine and alcohol also have other negative health effects to you and your baby during pregnancy. Thus, you should avoid both, especially if you suffer from high blood pressure.

• Drinking caffeine during pregnancy has been linked to declined placental blood flow and a risk of miscarriage. Although more studies are needed to confirm the effects of caffeine, it is best to switch to decaf during your pregnancy.

• High alcohol consumption is known to raise blood pressure and it is also known to have negative effects on your unborn baby. Before drinking any alcohol, even just one glass of wine, consult your doctor.

Add soy and low-fat milk products to your diet if you have not done so already.

A clinical study demonstrated that systolic blood pressure can be lowered by adding these foods to your diet.

• Add low-fat or fat-free dairy products (such as milk, cottage cheese, yogurt) to your diet.

• If you are lactose intolerant, try a milk alternative, such as almond, coconut, or hemp milk. You can also try soy milk, but you may want to limit soy products during pregnancy since it may increase estrogen levels in your fetus.

• Go easy on the amount of cheese you eat (even low-fat) due to their high sodium content.

MANAGEMENT OF PREECLAMPSIA If your preeclampsia is severe, the first step to preventing complications is to deliver the baby as soon as possible. A drug known as oxytocin is typically used to start labor. It works by stimulating the uterus to contract. An epidural anesthesia or other types of analgesic drugs can be given to control pain. However, women with low platelet counts caused by the preeclampsia may not be able to have an epidural. Your doctor will help you decide which pain medication is best for you.

During labor, management of preeclampsia involves medications that help to stabilize your blood pressure and prevent seizures. Intravenous magnesium sulfate is given to prevent seizures. The hospital staff will continually monitor your knee reflexes after you receive magnesium sulfate. Loss of knee reflexes is the first sign of hypermagnesemia, or elevated magnesium levels in the blood, which can lead to respiratory paralysis and cardiac arrest if it’s not monitored. Anti-hypertension drugs such as hydralazine (Apresoline) and labetalol (Normodyne, Trandate) are given to lower blood pressure gradually. Oxygen is also given.

You and your baby’s condition will be monitored closely. If you begin to experience severe bleeding, anemia, or low platelet levels, you might need a blood transfusion.

Resources

Health Line March of Dimes WikiHow

Family Doctor.org

Health Line