Hypertension During Pregnancy

Hypertension, or high blood pressure, does put the pregnancy at higher risk. Some women have preexisting high blood pressure meaning the blood pressure was high before the pregnancy started. This is what this video is about. Other women develop high blood pressure during pregnancy. This is called pregnancy induced hypertension (PIH) or preeclampsia. This is treated in the video here. High blood pressure in pregnancy can be treated so that the pregnancy can go smoothly and the baby will be healthy. If the high blood pressure is not treated, it can cause serious problems. If blood pressure gets really high, it can cause a placenta abruption which can be catastrophic: the baby can die. Even blood pressures that remain mildly elevated throughout pregnancy can cause problems with the placenta  putting the baby at risk. This is why it is very important to treat high blood pressure in pregnancy.

Most women who have high blood pressure do not have any symptoms. Unless the pressure gets very high, women with high blood pressure feel the same as women with normal blood pressure. Very high blood pressure can cause headaches, but it is unusual for high blood pressure to get to the point that it causes symptoms. That is why you can not rely on how you feel to judge if your blood pressure is OK.

Women with high blood pressure in pregnancy usually need to on medication to protect the baby. The medication that is used in pregnancy is typically different then the medication used in the non-pregnant woman. Women who are on medication for their blood pressure before being pregnant usually need to change to a different medication in pregnancy. The most common medication for high blood pressure in pregnancy is Aldomet. This is a very old medication. It is not often used in the non-pregnant state but in pregnancy it has a long track record of being safe. Aldomet usually needs to be taken 3-4 times per day, so it is not very convenient. Most women do not have many side effects from it; it is generally well tolerated. The main problem is the multiple dosing per day. Another class of medication that can be used is beta-blockers, Labetolol being the most common. This is also safe in pregnancy and is often only needed twice per day. It has more side effects then Aldomet, so most doctors use this as a second choice.

Blood pressure usually goes down in the second trimester but then rises in the third trimester. It is not unusual, and somewhat expected, to need to increase the dose of medication as the pregnancy gets near term. When the pressure starts to rise towards the end of pregnancy, it an sometimes be challenging to know if the rise in blood pressure is due to the expected elevation or if preeclampsia is developing. Tests on the urine as well as blood tests are often needed to distinguish these two issues.

Although medication is the main treatment for hypertension in pregnancy there are other things that may be helpful. A low salt diet can help control blood pressure in some women. It is important to keep weight gain down as much as possible. Depending on the pre-pregnancy weight, 15 pounds is usually a good goal in the hypertensive patient for total weight gain during pregnancy. Exercise can also help control high blood pressure. Ask your doctor because in some cases, especially towards the end of pregnancy, bed rest may be necessary.

Women with hypertension are often induced a few days before the due date.This will depend on many factors including how well the blood pressure has been controlled as well as certain parameters on ultrasound. Testing for fetal well-being is often done as the due date approaches. There are various types of testing available including NST and ultrasound.

In general, high blood pressure is controllable during pregnancy. Most pregnant patients with hypertension have normal, healthy babies.