High Blood Pressure in Pregnancy

One of the most common medical problems during pregnancy is high blood pressure or hypertension. Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and perinatal mortality globally.

There are four conditions that are classified under HDP.

Preeclampsia-eclampsia: Preeclampsia occurs when hypertension is detected after 20 weeks of pregnancy, accompanied with proteinuria (excess protein in urine) or other multi-systemic signs of organ damage. Preeclampsia can lead to eclampsia, which is a seizure attack or convulsive phase of the disorder which can lead to severe complications, including death.

Chronic hypertension: Pre-existing condition of hypertension or one that is detected before 20 weeks of pregnancy is classified as chronic hypertension.

Chronic hypertension with superimposed preeclampsia: Women with pre-existing hypertension are more likely to be diagnosed with preeclampsia. In this case, blood pressure will be worse and signs of preeclampsia will manifest during pregnancy.

Gestational hypertension: This condition occurs when hypertension is detected after 20 weeks of pregnancy, but without other signs related to preeclampsia such as proteinuria.

Who are at risk?

There are various types of pregnancy where you are most at risk to get HDP, such as the first pregnancy, when you are pregnant with multiple babies, or if you are over 40. The risk is also high if you are obese prior to pregnancy, have mother or siblings with a history of HDP, had previous HDP, or suffered from diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma.

Symptoms of HDP

Pre-existing chronic hypertension might be hard to identify except by monitoring your blood pressure, but there are other symptoms of preeclampsia.

At home

  • Severe headaches
  • Upper abdominal pain, usually under right side of ribs
  • Blurred vision, temporary loss of vision, or sensitivity to light
  • Excessive nausea or vomiting
  • Shortness of breath
  • Excessive swelling of feet or hands
  • Lack of urine

At the clinic

  • Blood pressure readings of 140/90 mm Hg, taken twice, at least four hours apart
  • Proteinuria or other signs of kidney problems
  • HELLP syndrome (haemolysis, elevated liver enzymes, or low platelet count)

Possible complications

  • Decreased blood flow to placenta, leading to slow growth, low birth weight, or premature birth
  • Placental abruption, which can cause heavy bleeding
  • Premature delivery might have to be induced to prevent life-threatening complications
  • Future cardiovascular diseases

Managing HDP

Your doctor may prescribe different ways of managing your hypertension depending on the type of HDP. Always refer to your doctor before taking any measures to deal with your condition.

Regular prenatal check-up: After being diagnosed with HDP, consult your doctor regularly and as scheduled to monitor HDP symptoms and any complications. Your weight and blood pressure will be measured, with frequent blood and urine tests. Your baby’s condition will be monitored to evaluate his growth and well-being. This confirms your condition for proper treatment and care to be given, as there is a possibility of preeclampsia arising even if the initial diagnosis is gestational hypertension.

Proper medications: If you already have pre-existing hypertension, consult your doctor to ensure your medication is safe for pregnancy. Some hypertension medications, like angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, and renin inhibitors, might not be suitable for pregnant women. Do not change, stop taking your drugs, or purchase over-the-counter drugs for other health issues without referring to your doctor.

Preventive measures: It is recommended for high-risk women to take low-dose aspirin or extra calcium supplement (CaCO3) as a preventive measure. To prevent eclamptic seizure and placental abruption in women diagnosed with preeclampsia, magnesium sulphate can be administered. These preventive measures should be taken after doctor’s recommendation and prescription.

Proper and healthy diet: Control your sugar, salt and fat consumption. Increase fruits and vegetables in diet to supply enough nutrients for you and your baby. Drink adequate water. Normally, you would reduce your salt intake to control hypertension, but pregnant women should not skip salt. Follow your doctor’s advice regarding this.

Healthy lifestyle: Overweight women with hypertension are advised to lose weight before getting pregnant. While pregnant, you should watch your weight and try not to gain too much. Avoid smoking, drinking, and illicit drugs, especially during pregnancy. These can worsen your blood pressure, contributing to various health problems, and harm you and your baby. Stay active by doing regular exercises that are suitable, such as brisk walking or gardening. However, do not exert yourself and be mindful of your pregnancy.

High blood pressure in pregnancy is a prevalent problem, especially in a country like Malaysia where there is a significant population with hypertension. Thus, it is crucial to know how to manage your condition. The most important step is to maintain regular prenatal check-ups with your doctor an to constantly monitor your blood pressure. Other steps mentioned should also be taken to regulate your blood pressure and keep you and your baby healthy.

An educational collaboration with Obstetrical and Gynaecological Society of Malaysia.

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