Hypertension in Pregnancy: Everything You Need to Know
During pregnancy, it’s not uncommon for women to become ill and suffer from different health problems. These could even be life-threatening for the woman, the fetus, or both. One of the most common conditions is hypertension in pregnancy. Here we’ll bring you everything you need to know about this cardiovascular condition.
Pregnancy is a beautiful, complex, and delicate process in which the mother’s body undergoes several changes. This adaptive process can trigger serious conditions such as diabetes, hypertension, and infections. Studies estimate that hypertensive pathologies represent the most frequent complications of pregnancy, with up to 10% prevalence.
Early expert attention and continuous care from the beginning of pregnancy are essential in order to reduce the risk of complications. Timely medical treatment leads to a healthy delivery and increases the quality of life of the fetus and the mother.
Blood pressure changes during pregnancy
In general, during the first 13 to 20 weeks of gestation, blood pressure falls continuously and steadily. Research suggests that this is a result of increased dilation of the renal blood vessels and the mother’s hormonal activity. In this way, cardiac work is increased in order to improve the perfusion and nutrition of the uterus and the developing fetus.
Subsequently, blood pressure rises from the third trimester of pregnancy, reaching values even higher than those registered prior to pregnancy. During this period of changes, the mother may experience hypertensive complications that interfere with the pregnancy.
What is hypertension in pregnancy?
In adults, arterial hypertension is defined as values higher than 120/80 millimeters of mercury (mm Hg). However, it’s common for women to have high values during this period of their lives. Therefore, to speak of high blood pressure in pregnancy, other criteria must be followed.
Hypertension in pregnancy is defined as an increase in systolic pressure greater than or equal to 140 mm Hg and an increase in diastolic pressure greater than or equal to 90 mm Hg. Measurement should be performed in two or more measurements, separated by a minimum of 6 hours.
Hypertensive disorders of pregnancy are very varied and may be accompanied by other abnormal signs:
- A loss of protein in urine or proteinuria: the presence of more than 300 milligrams (mg) of protein in 24-hour urine.
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In some mothers, symptoms of high blood pressure may go unnoticed. The most common manifestations of gestational hypertensive disorders are as follows:
- Abdominal discomfort
- A decrease in urinary volume
- Swelling in feet, ankles, hands, and face
- Continuous nausea and vomiting
- Fatigue and extreme weakness
- Ringing in the ears
Several factors can increase the likelihood of hypertension in pregnancy. Research suggests the following as predisposing conditions:
- Advanced age
- Diabetes mellitus
- Multiple pregnancies
- Excess weight and obesity
- Chronic alcoholic habit
- Not having given birth before
- Cigarette or tobacco use
- A personal history of hypertension
- A family history of hypertension during pregnancy
Types of hypertension in pregnancy
Hypertensive disorders during pregnancy are classified based on the manner of onset and accompanying symptoms. We can find the following types of hypertension in pregnancy.
This is blood pressure greater than or equal to 140/90 mm Hg that’s present before pregnancy or that’s detected before 20 weeks of gestation. Chronic hypertension is also referred to as hypertension when it appears after 20 weeks, and then persists more than 12 weeks after delivery.
Read also: Diabetes During Pregnancy: Causes and Treatments
This is a form of hypertension without proteinuria that occurs late in gestation and clears up in the first 12 weeks postpartum. It’s usually masked in early gestation due to the normal reduction in blood pressure at this stage.
This is characterized by blood pressure greater than or equal to 140/90 mm Hg associated with proteinuria, occurring after 20 weeks of pregnancy. In some severe cases it may appear in the first 20 weeks.
In mild preeclampsia, there are usually no obvious clinical manifestations. Some of the most common symptoms include sudden weight gain and swelling of the face and hands.
Similarly, preeclampsia is severe when systolic blood pressure is greater than or equal to 160 mm Hg and diastolic blood pressure is greater than or equal to 110 mm Hg, accompanied by proteinuria. In addition, it’s also severe when the person presents proteinuria greater than or equal to 2 grams in 24 hours.
Preeclampsia together with chronic hypertension
This is the appearance of proteinuria greater than or equal to 300 mg in 24-hour urine in mothers whose blood pressure is greater than or equal to 140/90 mm Hg before pregnancy, or detected before the 20th week of gestation. It’s usually difficult to identify and requires urgent treatment.
This is characterized by the presence of seizures not attributable to other causes in a pregnant woman with preeclampsia. It most often appears in the second half of pregnancy, during delivery, or in the first 2 days postpartum.
Treatment of hypertension in pregnancy
The treatment for hypertensive complications depends on the form of presentation and the severity of the condition. In general, in mild to moderate hypertension, a conservative approach with reduced physical activity and lifestyle changes is preferred. However, in severe cases, antihypertensive drugs are necessary.
The first-line drugs in the management of hypertensive disorders of pregnancy are methyldopa, beta-blockers, and calcium channel blockers. Labetalol is the most commonly used beta-blocker, alone or in combination with methyldopa. Similarly, nifedipine is a calcium channel antagonist with great benefits in the management of this condition.
Diuretics are used in the management of chronic hypertension only when the benefits outweigh the risks to the fetus. In addition, several antihypertensive drugs should be avoided during pregnancy because of their risk:
- Aldosterone antagonists, such as spironolactone
- Angiotensin II receptor antagonists (ARA II), such as losartan
- Angiotensin-converting enzyme inhibitors (ACE inhibitors), such as captopril
Early diagnosis improves prognosis
There are several forms of hypertension in pregnancy. This complication can be detected early on through routine medical check-ups. In most cases, timely management with antihypertensive drugs allows the pregnancy to be carried to term.
If you suspect a complication, don’t hesitate to seek medical attention as soon as possible. Gynecology and obstetrics specialists are the only ones qualified to identify the problem and provide the best guidance.