Causes of high blood pressure when pregnant

High Blood Pressure During Pregnancy: Symptoms and Treatments

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Lifestyle

Unhealthy lifestyle choices may lead to high blood pressure during pregnancy. Being overweight or obese, or not staying active are major risk factors for high blood pressure.

Type of pregnancy

Women experiencing their first pregnancy are more likely to have high blood pressure. Fortunately, there’s a lower chance of this condition in subsequent pregnancies.

Carrying multiples can make it more likely for a woman to develop hypertension, because the body is working harder to nourish more than one baby.

According to the American Society for Reproductive Medicine, using assistive technologies (such as IVF) during the conception process can increase chances of high blood pressure in a pregnant woman.

Age

Age can also be a factor. Pregnant women over the age of 35 are at higher risk.

Women who had high blood pressure before pregnancy are at higher risk for related complications during pregnancy than those with normal blood pressure.

High blood pressure during pregnancy can be divided into three different conditions.

Chronic hypertension

Sometimes a woman has preexisting high blood pressure, or hypertension, before she gets pregnant. This may be referred to as chronic hypertension, and is usually treated with blood pressure medication.

Doctors also consider hypertension that occurs in the first 20 weeks of pregnancy to be chronic hypertension.

Gestational hypertension

Gestational hypertension develops after the 20th week of pregnancy. It usually resolves after delivery. When diagnosed before 30 weeks, there’s a higher chance it will progress to preeclampsia (see below).

Chronic hypertension with superimposed preeclampsia

Women who have chronic hypertension before becoming pregnant can develop preeclampsia. This occurs when they experience protein in their urine or additional complications as the pregnancy progresses.

A blood pressure reading is a fraction: your systolic blood pressure over your diastolic blood pressure.

The top number is your systolic pressure, which is a measurement of the pressure on your arteries when the heart is beating or squeezing blood forward through your body.

The diastolic pressure, or the lower number, is a measurement of the blood pressure in your arteries when the heart is at rest.

To determine what your “normal” blood pressure is during pregnancy, your doctor will likely take a baseline blood pressure measurement at your first visit. Then they will measure your blood pressure at every visit that follows.

Normal blood pressure is anything less than 120/80 mm Hg.

What is considered high blood pressure during pregnancy?

A blood pressure that is greater than 130/90 mm Hg or that is 15 degrees higher on the top number from where you started before pregnancy may be cause for concern.

High blood pressure during pregnancy is defined as 140 mm Hg or higher systolic, with diastolic 90 mm Hg or higher.

Early in pregnancy, usually from 5 weeks to the middle of the second trimester, a pregnant woman’s blood pressure may actually decrease. This is because pregnancy hormones can stimulate blood vessels to widen. As a result, the resistance to blood flow isn’t as high.

What is considered low blood pressure during pregnancy?

While there isn’t a definitive number that is too low, there are symptoms that are associated with low blood pressure:

headache
dizziness
nausea
feeling faint
cold, clammy skin

As a woman progresses in her pregnancy, her blood pressure may change or return to pre-pregnancy levels. There are a few possible reasons for this.

The amount of blood in a woman’s body increases. According to the journal Circulation, a woman’s blood volume increases by as much as 45 percent during pregnancy. This is extra blood that the heart must pump throughout the body.

The left ventricle (left side of the heart that does a significant amount of pumping) becomes thicker and larger. This temporary effect allows the heart to work harder to support the increased blood volume.

The kidneys release increased amounts of vasopressin, a hormone that leads to increased water retention.

In most cases, high blood pressure during pregnancy will decrease after the baby is delivered. In cases where blood pressure remains elevated, your doctor may prescribe medication to get it back to normal.

Tips for tracking blood pressure during pregnancy

There are ways to track your blood pressure between doctor visits.

You can buy a blood pressure monitor from a pharmacy or online medical goods store. Many of these devices will go on your wrist or upper arm. To check the monitor’s accuracy, take it to your doctor’s office and compare the readings on the monitor to those from your doctor.

Visit a grocery store, pharmacy, or other store that has a machine that takes blood pressure readings.

For the most accurate readings, take your blood pressure at the same time every day. Take it while seated with your legs uncrossed. Use the same arm each time.

Notify your doctor immediately if you have repeated high blood pressure readings that are four hours apart or symptoms of high blood pressure.

If you have high blood pressure during pregnancy, there can be complications.

Preeclampsia

This condition can cause serious damage to your organs, including your brain and kidneys. Preeclampsia is also known as toxemia. Preeclampsia with seizures becomes eclampsia. If left untreated, it can be fatal.

Symptoms of preeclampsia include:

abnormal swelling in hands and face
persistent headaches
seeing spots or having changes in vision
upper abdominal pain
nausea or vomiting later in pregnancy
difficulty breathing

Because preeclampsia can be dangerous for both you and your baby, you should call your doctor if you have any of these symptoms.

Keeping regular doctor visits and letting your doctor know about any changes can help them catch and treat preeclampsia early.

HELLP syndrome

HELLP is an acronym that stands for hemolysis, elevated liver enzymes, and low platelet count. This condition is severe and life-threatening, and can be a complication of preeclampsia.

Symptoms associated with HELLP include:

nausea
vomiting
headache
upper abdominal pain

Because HELLP syndrome can severely damage organ systems vital to life, emergency medical care is aimed at reducing blood pressure for the health of the mother and the baby. In some cases, a premature delivery is required.

High blood pressure during pregnancy can also have an effect on the baby’s growth rate. This can result in low birth weight. According to the American Congress of Obstetricians and Gynecologists, other complications include:

placental abruption, a medical emergency during which the placenta detaches from the uterus prematurely
preterm delivery, defined as delivery prior to 38 weeks of pregnancy
cesarean delivery, commonly known as C-section

Common risk factors for high blood pressure, such as obesity, can be minimized through diet and exercise.

During pregnancy, it’s normal to gain some weight. If you’re concerned, talk to your doctor about a target weight gain and ways to stay within a range that’s healthy for you.

Dietary guidelines for pregnant women vary from person to person. A nutritionist can help create a meal plan that’s 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 it’s 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:

ACE inhibitors
renin inhibitors
angiotensin receptor blockers

These drugs in particular will pass through the bloodstream to the baby and negatively impact the developing baby’s health.

Methyldopa and labetalol are both drugs that are considered safe to use to manage blood pressure during pregnancy.

If high blood pressure goes untreated during pregnancy, it can become life-threatening for both mother and baby.

Hypertensive disorders resulting from high blood pressure are the second-leading cause of U.S. maternal death during pregnancy, so it’s important to talk to your doctor about any symptoms or concerns.

In general, careful monitoring and some lifestyle changes can lower your risk of developing complications from high blood pressure.

High Blood Pressure During Pregnancy

What are high blood pressure complications during pregnancy?
What should I do if I have high blood pressure before, during, or after pregnancy?
What are types of high blood pressure conditions before, during, and after pregnancy?
More Information

Some women have high blood pressure during pregnancy. This can put the mother and her baby at risk for problems during the pregnancy. High blood pressure can also cause problems during and after delivery.^1,2 The good news is that high blood pressure is preventable and treatable.

High blood pressure, also called hypertension, is very common. In the United States, high blood pressure happens in 1 in every 12 to 17 pregnancies among women ages 20 to 44.³

High blood pressure in pregnancy has become more common. However, with good blood pressure control, you and your baby are more likely to stay healthy.

The most important thing to do is talk with your health care team about any blood pressure problems so you can get the right treatment and control your blood pressure—before you get pregnant. Getting treatment for high blood pressure is important before, during, and after pregnancy.

What are high blood pressure complications during pregnancy?

Complications from high blood pressure for the mother and infant can include the following:

For the mother: preeclampsia, eclampsia, stroke, the need for labor induction (giving medicine to start labor to give birth), and placental abruption (the placenta separating from the wall of the uterus). ^1,4,5
For the baby: preterm delivery (birth that happens before 37 weeks of pregnancy) and low birth weight (when a baby is born weighing less than 5 pounds, 8 ounces).^1,6 The mother’s high blood pressure makes it more difficult for the baby to get enough oxygen and nutrients to grow, so the mother may have to deliver the baby early.

Discuss blood pressure problems with your health care team before, during, and after pregnancy.

Learn what to do if you have high blood pressure before, during, or after pregnancy.

What should I do if I have high blood pressure before, during, or after pregnancy?

Before Pregnancy

Make a plan for pregnancy and talk with your doctor or health care team about the following:
- Any health problems you have or had and any medicines you are taking. If you are planning to become pregnant, talk to your doctor.⁷ Your doctor or health care team can help you find medicines that are safe to take during pregnancy.
- Ways to keep a healthy weight through healthy eating and regular physical activity.^1,7

During Pregnancy

Get early and regular prenatal care. Go to every appointment with your doctor or health care professional.
Talk to your doctor about any medicines you take and which ones are safe. Do not stop or start taking any type of medicine, including over-the-counter medicines, without first talking with your doctor.⁷
Keep track of your blood pressure at home with a home blood pressure monitor. Contact your doctor if your blood pressure is higher than usual or if you have symptoms of preeclampsia. Talk to your doctor or insurance company about getting a home monitor.
Continue to choose healthy foods and keep a healthy weight.⁸

After Pregnancy

Pay attention to how you feel after you give birth. If you had high blood pressure during pregnancy, you have a higher risk for stroke and other problems after delivery. Tell your doctor or call 9-1-1 right away if you have symptoms of preeclampsia after delivery. You might need emergency medical care.^9,10

What are types of high blood pressure conditions before, during, and after pregnancy?

Your doctor or nurse should look for these conditions before, during, and after pregnancy:^1,11

Chronic Hypertension

Chronic hypertension means having high blood pressure* before you get pregnant or before 20 weeks of pregnancy.¹ Women who have chronic hypertension can also get preeclampsia in the second or third trimester of pregnancy.¹

Gestational Hypertension

This condition happens when you only have high blood pressure* during pregnancy and do not have protein in your urine or other heart or kidney problems. It is typically diagnosed after 20 weeks of pregnancy or close to delivery. Gestational hypertension usually goes away after you give birth. However, some women with gestational hypertension have a higher risk of developing chronic hypertension in the future. ^1,12

Preeclampsia/Eclampsia

Preeclampsia happens when a woman who previously had normal blood pressure suddenly develops high blood pressure* and protein in her urine or other problems after 20 weeks of pregnancy. Women who have chronic hypertension can also get preeclampsia.

Preeclampsia happens in about 1 in 25 pregnancies in the United States.^1,13 Some women with preeclampsia can develop seizures. This is called eclampsia, which is a medical emergency.^1,11

Symptoms of preeclampsia include:

A headache that will not go away
Changes in vision, including blurry vision, seeing spots, or having changes in eyesight
Pain in the upper stomach area
Nausea or vomiting
Swelling of the face or hands
Sudden weight gain
Trouble breathing

Some women have no symptoms of preeclampsia, which is why it is important to visit your health care team regularly, especially during pregnancy.

You are more at risk for preeclampsia if:¹

This is the first time you have given birth.
You had preeclampsia during a previous pregnancy.
You have chronic (long-term) high blood pressure, chronic kidney disease, or both.
You have a history of thrombophilia (a condition that increases risk of blood clots).
You are pregnant with multiple babies (such as twins or triplets).
You became pregnant using in vitro fertilization.
You have a family history of preeclampsia.
You have type 1 or type 2 diabetes.
You have obesity.
You have lupus (an autoimmune disease).
You are older than 40.

In rare cases, preeclampsia can happen after you have given birth. This is a serious medical condition known as postpartum preeclampsia. It can happen in women without any history of preeclampsia during pregnancy.¹⁴ The symptoms for postpartum preeclampsia are similar to the symptoms of preeclampsia. Postpartum preeclampsia is typically diagnosed within 48 hours after delivery but can happen up to 6 weeks later.⁹

Tell your health care provider or call 9-1-1 right away if you have symptoms of postpartum preeclampsia. You might need emergency medical care.^9,10

*In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) updated the definition of chronic stage 2 hypertension to mean having blood pressure at or above 140/90 mmHg.¹⁵ The American College of Obstetricians and Gynecologists’ recommendations on hypertension in pregnancy predate the 2017 ACC/AHA’s guideline and definition of hypertension and stage 2 hypertension.

Hypertension in pregnancy

High blood pressure during pregnancy

Changes in blood pressure (BP) in women during pregnancy are observed quite often, which can adversely affect the mother and fetus. Blood pressure is one of the most important indicators of the functioning of the circulatory system in the body. During pregnancy, all organs and systems of the mother work with increased stress, especially the cardiovascular system. Therefore, it is necessary to regularly measure blood pressure to prevent the development of severe complications. At the beginning of pregnancy, blood pressure, as a rule, decreases slightly, which is associated with the action of hormones. In later pregnancy, as the fetus grows and blood flow increases to feed it, blood pressure may increase relative to pre-pregnancy physiological values. Hypertension is said to occur when a pregnant woman's blood pressure exceeds 140/9.0 mmHg However, in women with low blood pressure before pregnancy, arterial hypertension may be at blood pressure levels that are usually considered normal. Therefore, it is important to know your normal blood pressure.

Why is high blood pressure dangerous during pregnancy?

High blood pressure during pregnancy poses a great danger to the mother and fetus. Against this background, vasoconstriction occurs and the blood supply to all vital organs, including the placenta, is disrupted. Due to the lack of essential nutrients and oxygen, the process of growth and development of the fetus slows down. There is a serious danger of placental abruption, which is accompanied by bleeding and threatens the life of the mother and fetus. High blood pressure during pregnancy can lead to the development of a dangerous pregnancy complication - preeclampsia. Edema, large weight gain, and the presence of protein in the urine can also be a manifestation of preeclampsia. Very dangerous symptoms of preeclampsia are: headache, blurred vision ("flies", "veil" before the eyes), pain in the upper abdomen. Deterioration of the general condition may be accompanied by dizziness, tinnitus, nausea, vomiting. Pre-eclampsia can provoke a formidable complication - eclampsia. In this condition, the pregnant woman loses consciousness and convulsions occur.

Register for pregnancy at the antenatal clinic as early as possible!

A very important feature of arterial hypertension during pregnancy is that often even with high blood pressure numbers, the patient feels normal. High blood pressure is detected by chance, at the next appearance in the antenatal clinic. The absence of clinical manifestations of elevated blood pressure does not exclude the development of dangerous complications.

In order to detect unwanted deviations during pregnancy in time and prevent the development of complications in the mother and fetus, pregnant women need to regularly monitor their blood pressure. It is very important to register for pregnancy in a antenatal clinic in a timely manner. The doctor will promptly detect changes in blood pressure and prescribe the optimal therapy to maintain blood pressure in the normal range. If a woman had high blood pressure before pregnancy, and she is taking medications, it is necessary to adjust the treatment and individually select the drugs that can be taken during pregnancy. To prevent high blood pressure, a pregnant woman should eat a healthy and balanced diet, observe a drinking regimen, and monitor weight gain. The correct recommendations on these issues will also be given by the doctor of the antenatal clinic. A pregnant woman must follow the recommendations and not violate the prescribed therapy.

What to do if a pregnant woman has high blood pressure?

If a pregnant woman regularly monitors blood pressure on her own and notices even a slight increase with good health, she should visit the doctor of the antenatal clinic as soon as possible (before the scheduled next visit). Self-administration of drugs in this case is strictly prohibited. Before visiting a doctor, you can lower blood pressure by taking a mild sedative based on motherwort or valerian.

If necessary, you can consult with an obstetrician-gynecologist of the remote medical advisory panel of the Ambulance and Emergency Medical Care Station. A.S. Puchkov, Moscow by phone: (495) 620-42-44.

When is it necessary to call an ambulance?

If blood pressure rises suddenly, you feel unwell, urgent hospitalization is necessary, and it is advisable for the patient to immediately call an ambulance team. Such signs as: headache, feeling of flashing dots or "flies", a veil before the eyes, pain in the upper abdomen, nausea, vomiting, agitation or depression, along with this - an increase in blood pressure should alert. There may be a high convulsive readiness, which is manifested by twitching of the muscles of the face, neck, upper limbs, loss of consciousness, convulsions are possible.

What to do before the ambulance arrives?

First of all, go to bed, if possible, eliminate all unwanted irritants (turn off all sources of noise, close the curtains), do not leave the pregnant woman alone, as convulsions may occur and help will be needed. Give it a position with a raised head end. It is possible to take pressure-lowering drugs prescribed by a doctor. If a woman has not previously taken antihypertensive drugs, then drugs should not be taken on the advice of others.

If an attack of convulsions occurs, the pregnant woman should be laid on a flat surface, turn her head to the side (to prevent aspiration of vomit), protect from damage (cover with a blanket), do not hold physically. After an attack, clean the oral cavity with a napkin from vomit, blood and mucus. Wait for the ambulance to arrive!

The ambulance will arrive quickly and provide the necessary assistance. Hospitalization in this condition is mandatory. Only in a hospital is it possible to fully monitor the condition of the mother and child, complete therapy and determine the delivery plan.

We wish you health and happy motherhood!

Chief Specialist

in Obstetrics and Gynecology Arkhipova N.L.

High blood pressure during pregnancy

But its meaning is not always correctly controlled and interpreted. Let's see how to properly control blood pressure during pregnancy , what kind of blood pressure is considered elevated, why it can rise and what should be done with it, and what should not be done.

Blood pressure measurement

Blood pressure is monitored using a tonometer: electronic, semi-automatic or mechanical. You can buy any that you can handle and the cuff of which suits you in diameter. The only thing to consider is that the blood pressure cuff should be worn on the upper arm, carpal blood pressure monitors are too inaccurate and cannot be relied upon.

Measurement of blood pressure is best done in a sitting position, and after you have spent about fifteen minutes in this position, in a state of physical and emotional rest, you do not need to talk while measuring blood pressure.

The cuff is worn on the shoulder freed from clothing, its lower edge should be a few centimeters above the elbow. The arm on which blood pressure is measured should be in a relaxed position, the cuff should be located approximately at the level of the heart. Measurement is performed on one arm, measurement on two arms, which was previously required for all pregnant women, is now excluded from all clinical recommendations.

When measuring with a mechanical sphygmomanometer , air is inflated into the cuff to the digits, approximately twenty to thirty mm. rt. Art. higher than expected blood pressure. The air from the cuff is released slowly, the appearance of sound marks the numbers of systolic blood pressure, the disappearance of the sound - diastolic. This is not "cardiac" and "renal" pressure, but - systolic and diastolic.

Measurement of blood pressure is carried out at each visit to the obstetrician-gynecologist - office measurement of blood pressure, at home of the pregnant woman herself or her relative - outpatient measurement of blood pressure. If necessary, the doctor may recommend that the patient keep a blood pressure diary - measure blood pressure several times a day for some time, writing down the numbers. Ceteris paribus, more reliable information is obtained from outpatient (at home) measurements.

If there is doubt about the correctness of the patient's blood pressure measurement or if there is a suspicion of an increase in blood pressure at night, the doctor may prescribe the patient 24-hour blood pressure monitoring (ABPM), in which blood pressure is measured automatically at certain intervals within one day.

In general, during pregnancy, blood pressure in the first trimester is lower than normal for the patient, in the second or third it returns to her usual numbers, by the third trimester it may be slightly higher, but within the normal range. Blood pressure below 140/9 is considered normal during pregnancy.0 mm. rt. Art.

If the patient is prone to arterial hypotension (low blood pressure), elevated blood pressure is still considered to be blood pressure above 140/90 mm. rt. Art., lower figures do not require any additional examination or treatment, even if they are higher than usual for the patient. None of the clinical guidelines for the treatment of arterial hypertension during pregnancy indicate the need for treatment with higher blood pressure than usual, but not reaching a value of 140/90 mm. rt. Art.

AD 140/90 mm. rt. Art. and above must be recorded 2 or more times with an interval between measurements of at least 4 hours to be considered hypertension.

Causes of high blood pressure

There are three causes of high blood pressure during pregnancy: chronic arterial hypertension, gestational arterial hypertension and preeclampsia.

Chronic arterial hypertension is the general name for all cases of high blood pressure that existed before pregnancy. Chronic arterial hypertension is not divided into primary (due to unknown causes) and secondary (resulting from a disease), in contrast to arterial hypertension detected outside of pregnancy. Also, chronic arterial hypertension includes situations when a woman did not control blood pressure before pregnancy, and for the first time an increase in blood pressure was detected only in the first half (up to 20 weeks) of pregnancy.

Gestational hypertension occurs from the twentieth week until the end of the term, and is not accompanied by the excretion of protein in the urine.

Pre-eclampsia, in contrast to gestational hypertension, also develops after the 20th week of pregnancy, and is accompanied by the release of protein into the urine (proteinuria). Preeclampsia can also occur after delivery. Signs of an increase in the severity of preeclampsia are the appearance of a headache, dizziness, visual disturbances, pain in the solar plexus and / or in the right hypochondrium, pain under the right shoulder blade, respiratory failure, and some changes in blood tests. These signs require urgent hospitalization.

The extreme case of preeclampsia - eclampsia - is characterized by the occurrence of convulsions and threatens the life of both the mother and the child, therefore, it requires an emergency delivery, regardless of the gestational age, only in this way it becomes possible to save the life of the mother and child.

Since an increase in blood pressure may occur before proteinuria in preeclampsia, it is possible to distinguish gestational arterial hypertension from preeclampsia only in retrospect - if blood pressure increased, and no protein appeared in the daily urine, it can be said with certainty that this increase in blood pressure was due to specifically gestational hypertension.
Preeclampsia may be associated with chronic arterial hypertension that existed before pregnancy.

Treatment of Hypertensive Disorders

Hypertensive disorders are an important cause of maternal and perinatal death, increase the rate of preterm birth, and are indeed a serious problem and should not be ignored.

The only one to date proven effective in preventing preeclampsia drug is acetylsalicylic acid. It is prescribed from the 13th week of pregnancy at a low dose and at this dosage does not lead to fetal developmental disorders, unlike high doses.

Treatment of any arterial hypertension during pregnancy is prescribed only by a doctor.

In case of chronic arterial hypertension uncomplicated by damage to other organs, treatment is started at a blood pressure of 150/90 mm. rt. Art. and more, with gestational arterial hypertension and preeclampsia - with blood pressure 140/90 mm. rt. Art. and more.

BP should be maintained at 130-150/80/95 mmHg during treatment. rt. Art., since a more radical decrease in blood pressure is fraught with impaired blood supply to the fetus and is not recommended.

There are several groups of antihypertensive drugs, the use of which during pregnancy can lead to impaired fetal development or death, so they should not be used during pregnancy. These are angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. Do not use during pregnancy and diuretics (drugs with a diuretic effect).
Treatment is usually initiated with methyldopa, but it is also possible to use certain drugs from the group of beta-blockers and some drugs from the group of calcium antagonists, which are best studied from the point of view of safety in pregnancy. It is possible to use combinations of these drugs.

Separately, a few words should be said about magnesium sulfate (magnesium sulphate). This drug has practically no antihypertensive effect, and its use during pregnancy is limited only to preeclampsia, which threatens the development of eclampsia. It is needed to prevent the development of seizures (neuroprotective effect). It should not be used to influence elevated blood pressure.

Hypertension during pregnancy, delivery is usually through the natural birth canal, except in cases of severe pre-eclampsia, eclampsia and their complications, requiring emergency delivery by caesarean section, regardless of the gestational age for health reasons.

Chronic arterial hypertension that persists during lactation and is not complicated by damage to other organs does not require medical treatment for blood pressure less than 150/95 mm. rt. Art. Arterial hypertension after childbirth does not require stopping breastfeeding; on the contrary, the protective effect of lactation in arterial hypertension has been proven.

If it is necessary to prescribe drug therapy , drugs are selected that are the least likely to be excreted into breast milk, the use of which has not been recorded serious side effects in the child.