Pregnancy and high blood pressure

Having high blood pressure (hypertension) during pregnancy — whether you develop the condition before or after conception —requires special care. Here's what you need to know about high bloodpressure and pregnancy.

Sometimes high blood pressure is presentbefore pregnancy. In other cases, high bloodpressure develops during pregnancy. Forexample:• Gestational hypertension. Women with

gestational hypertension have high bloodpressure that develops after 20 weeks ofpregnancy. There is no excess protein in theurine or other signs of organ damage. Somewomen with gestational hypertensioneventually develop preeclampsia.

• Chronic hypertension. Chronic hypertensionis high blood pressure that was presentbefore pregnancy or that occurs before 20weeks of pregnancy. But because high bloodpressure usually doesn't have symptoms, itmight be hard to determine when it began.

• Chronic hypertension with superimposedpreeclampsia. This condition occurs inwomen with chronic high blood pressurebefore pregnancy who then developworsening high blood pressure and protein inthe urine or other health complications duringpregnancy.

• Preeclampsia. Sometimes chronichypertension or gestational hypertensionleads to preeclampsia, a pregnancycomplication characterised by high bloodpressure and signs of damage to anotherorgan system — usually after 20 weeks ofpregnancy. Left untreated, preeclampsia canlead to serious — even fatal — complicationsfor mother and baby. Previously, preeclampsia

was only diagnosed if a pregnant woman hadhigh blood pressure and protein in her urine.However, experts now know that it's possibleto have preeclampsia, yet never have proteinin the urine.

Are there different types of high blood pressure during pregnancy?

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High blood pressure during pregnancy posesvarious risks, including:• Decreased blood flow to the placenta. If

the placenta doesn't get enough blood,your baby might receive less oxygen andfewer nutrients. This can lead to slowgrowth, low birth weight or preterm birth.Prematurity can lead to breathing problemsfor the baby.

• Placental abruption. Preeclampsia increasesyour risk of placental abruption, in which theplacenta separates from the inner wall of youruterus before delivery. Severe abruption cancause heavy bleeding and damage to the

placenta, which can be life-threatening forboth you and your baby.

• Premature delivery. Sometimes an earlydelivery is needed to prevent potentially life-threatening complications.

• Future cardiovascular disease. Havingpreeclampsia increases your risk of futureheart and blood vessel (cardiovascular)disease. The risk is even greater if you've hadpreeclampsia more than once or you've had apremature birth. To minimize this risk, afterdelivery try to maintain your ideal weight, eata variety of fruits and vegetables, exerciseregularly, and don't smoke.

Why is high blood pressure a problem during pregnancy?

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Preeclampsia sometimes develops without anysymptoms. High blood pressure might developslowly, but more commonly it has a sudden onset.Monitoring your blood pressure is an important partof prenatal care because the first sign ofpreeclampsia is commonly a rise in blood pressure.Blood pressure that is 140/90 millimeters of mercury(mm Hg) or greater — documented on twooccasions, at least four hours apart — is abnormal.

Other signs and symptoms of preeclampsiamight include:• Excess protein in your urine (proteinuria) or

additional signs of kidney problems.• Severe headaches.• Changes in vision, including temporary loss of

vision, blurred vision or light sensitivity.• Upper abdominal pain, usually under your ribs

on the right side.• Nausea or vomiting.• Decreased urine output.• Decreased levels of platelets in your blood

(thrombocytopenia).• Impaired liver function.• Shortness of breath, caused by fluid in your

lungs.• Sudden weight gain and swelling (edema) —

particularly in your face and hands — oftenaccompanies preeclampsia. But these thingsalso occur in many normal pregnancies, sothey're not considered reliable signs ofpreeclampsia.

What do I need to know about preeclampsia?

Taking good care of yourself is the best wayto take care of your baby. For example:• Keep your pre-natal appointments. Visit

your healthcare provider regularlythroughout your pregnancy.

• Take your blood pressure medication asprescribed. Your healthcare provider willprescribe the safest medication at the mostappropriate dose.

• Stay active. Follow your healthcareprovider's recommendations for physicalactivity.

• Eat a healthy diet. Choose foods low insodium.

• Know what's off-limits. Avoid smoking,alcohol and illicit drugs. Talk to yourhealthcare provider before taking any over-the-counter medications.

What can I do to reduce the riskof complications?

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Any medication you take during pregnancy can affect your baby. Although some medicationsused to lower blood pressure are considered safe during pregnancy, others are generallyavoided during pregnancy.

Treatment is important, however. If you need medication to control your blood pressureduring pregnancy, your healthcare provider will prescribe the safest medication at the mostappropriate dose. Take the medication exactly as prescribed. Don't stop taking themedication or adjust the dose on your own.

Is it safe to take blood pressure medication during pregnancy?

Your healthcare provider might suggest inducinglabour a few days before your due date to avoidcomplications. If you develop preeclampsia orother complications, induction might be neededeven earlier. If you have severe preeclampsia, youmight be given medication during labour to helpprevent seizures. In some cases, a Caesarian-section might be needed.

What about labour and delivery?

Breast-feeding is encouraged for most women whohave high blood pressure, even those who takemedication. Discuss any medication adjustmentsyou'll need to make with your healthcare providerahead of time. Sometimes an alternate bloodpressure medication is recommended. Yourhealthcare provider might also recommend that youavoid breast-feeding right after you take yourmedication.

Will I be able to breast-feed my baby?

As a Platinum Health member youhave the benefit of consulting with ahealthcare provider who will assistyou with making the right choicesduring your pregnancy. For moreinformation, kindly contact thePlatinum Health Client Liaisondepartment on 014 590 1700

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