Managing High Blood Pressure During Pregnancy

High blood pressure is very common. According to the Centers for Disease Control about half of Americans have high blood pressure. And many of them may not know it. That’s why it’s known as the silent killer. If you’re pregnant and have high blood pressure, you need to know you have it, so you can take steps to manage it.

It can happen both ways. Some women have chronic high blood pressure which is high blood pressure prior to pregnancy. Some women develop high blood pressure during pregnancy. 

Some people have chronic high blood pressure and are already being treated for it by a primary care provider and others don’t know they have it. That’s why it’s important to go to your prenatal visits and have your blood pressure checked. Some women can acquire high blood pressure during pregnancy, especially towards the end of pregnancy.  It’s important to know if your blood pressure is high and if it’s getting worse, because this could become dangerous for the pregnancy and ultimately the baby.

Technically, a woman is considered to have chronic hypertension if the high blood pressure is diagnosed before 20 weeks of pregnancy. Alternatively, if it’s diagnosed after 20 weeks of pregnancy we call this gestational hypertension.

Risk factors for high blood pressure during pregnancy include:

• First pregnancy
• Young age at first pregnancy
• Advanced maternal age
• Obesity
• Decreased physical activity
• Smoking or drinking alcohol
• Diabetes
• Autoimmune disease
• Engaging in assistive reproductive technology such as IVF
• Carrying multiples (like twins or triplets)

A super-fit, healthy young woman can have hypertension too. High blood pressure doesn’t discriminate. It can affect anyone.

Many people have no symptoms at all. That’s why it’s even more important that women come in for their prenatal visits. Worsening hypertension can cause headaches, blurry vision, floaters in the eyes. In severe cases people may experience shortness of breath or chest pain, or abdominal right upper quadrant or epigastric pain.

Identifying whether your symptoms are due to pregnancy, hypertension or COVID-19 can be confusing. Talk to your provider about any concerns.

Complications from hypertension can be very serious and include:

• Preeclampsia, when high blood pressure can lead to organ damage in the mother and ultimately cause problems with the baby
• Eclampsia, when the mother can have seizures
• A stroke due to very high blood pressure. 
• Decreased blood flow to the placenta can lead to baby receiving less oxygen and fewer nutrients, causing low birth weight 
• Sometimes a recommendation is made for a preterm delivery

It’s often during the third trimester when symptoms can get worse and high blood pressure can become preeclampsia, but it can happen before this as well.

If you’re doing some of your prenatal appointments virtually, there are ways to have your blood pressure checked remotely. Talk to your OB or midwife. You may need to do in-person visits more frequently than other patients without high blood pressure.

Some high blood pressure medications are safe during pregnancy and some are not, so check with your primary care provider and your OB or midwife if you already have high blood pressure. It’s good  to talk about it with them before you’re thinking getting pregnant. 

If you already had hypertension, before you got pregnant, you provider may need to adjust your medication to something different. If you’re taking a medication for your high blood pressure that is not considered safe in pregnancy and this wasn’t changed for you prior to getting pregnant, you may need some closer follow ups and ultrasounds to make sure there was no danger caused to the baby.

Diet and exercise are important for overall health and are somewhat helpful in controlling regular hypertension, but not as helpful at controlling it during pregnancy. It’s recommended however to stay active and eat a well-balanced diet during pregnancy. Medication can be an important way to control high blood pressure.

If you have high blood pressure when you’re pregnant, blood tests may be done to make sure it’s not progressing. Depending on your diagnosis, additional monitoring may be recommended, including checking on the baby as through non-stress tests, fluid checks or growth scans.

Ultimately, the treatment for hypertension is delivery. In some cases, you may need to deliver your baby early to keep you and your baby safe. Sometimes gestational hypertension doesn’t resolve after delivery and can lead to chronic hypertension, but this does not happen often.

Since early delivery can occur, babies can be found to be a small birth weight due to the decreased blood flowing through the placenta. Sometimes babies have low platelet counts and low while blood cell counts, and it’s usually not treated if babies aren’t symptomatic. There can be a risk that the lungs are not fully developed if you delivered prematurely. If your obstetrician can anticipate this, we give you a medicine called betamethasone which is a steroid to help accelerate the lung maturity in your baby.

• American Collage of Obstetrics and Gynecology - High Blood Pressure and Preeclampsia

• Intermountain Healthcare – Preeclampsia