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Did you know that up to 10-15% of pregnancies are affected by hypertension? About 5% of those cases are in women previously known to have hypertension (termed ‘chronic hypertension’), prior to pregnancy. Another 5-8%, develop hypertension within the pregnancy (termed ‘gestational hypertension’ or ‘pregnancy-induced hypertension’.)
Hypertensive disorders are characterized by blood pressures consistently ranging 140/90 or greater. Women with chronic hypertension (existing before pregnancy, or diagnosed before 20 weeks of gestation) may require blood pressure medications to control their blood pressure, even throughout the pregnancy. Those medications should be reviewed with your healthcare provider, to assess their safety in pregnancy, even before conception.
Most women with hypertension in pregnancy do well, without significant complications. However, there are concerns for complications involving the mother (worsening blood pressure, with a subsequent risk for stroke with severely high pressures,) and for the fetus (small size/restricted growth, placental abruption.) Women with pre-existing chronic hypertension are at an increased risk for pre-eclampsia in the pregnancy, where in it’s severe form, a risk for maternal seizure (and other organ dysfunction) exists. (Most of which, resolve after delivery.)
The causes for pre-eclampsia are unknown, though risk factors for it’s development include, first pregnancy, early or late maternal age, and a history of pre-existing hypertension. Pre-eclampsia usually presents with rising blood pressures, excessive protein in the urine, most commonly occurring in the latter half of pregnancy. Pre-eclampsia can occur in any pregnant woman (without risk factors,) so all pregnant women should be aware of warning signs (and contact their healthcare provider):
--Headaches or blurred vision
--Pain in the right upper/mid quadrant of your abdomen (where your liver is located)
--elevated blood pressures at home
--(as well as any baby/labor concerns, decreased fetal movement, vaginal bleeding, or any other sign of labor, pain or discomfort)
Because of the increased maternal and fetal risks in pregnancies with high blood pressure, delivery is usually recommended to occur by the due date. If labor does not ensue on it’s own, this may mean a recommendation for induction of labor near the due date.
Dr. Suzanne Hall