A Complicated Duo Part 2: Hypertension and Pregnancy

Important Questions for Managing Hypertension during Pregnancy Hypertension during pregnancy can result in serious complications for mother and

Important Questions for Managing Hypertension during Pregnancy

Hypertension during pregnancy can result in serious complications for mother and baby.  It is therefore very important that you and your provider keep a close watch on your blood pressure.

These are some of the most common hypertension related complications:

  • Fetal growth restriction, resulting in a lower birth weight baby
  • Preterm delivery, resulting in a lower birth weight baby
  • Placental abruption
  • Cesarean section delivery
  • Complications with your organs such as lungs, heart, kidneys, liver
  • Changes in your blood count, which can put you at increased risk for bleeding
  • Neurological changes in you

No matter what health condition or complication you face, always start with the basic knowledge about the condition and then ask questions to help you partner with your provider in your health care.

If you are thinking yes, but are wondering what you need to know and what to ask your provider, I thought it would be helpful to split the topic into two parts.

The first section is hypertension prior to pregnancy and the second section is hypertension during pregnancy.  These sections are primers that touch the surface of a condition that can be very complex and cause serious complications.  I cannot urge you enough to speak to your provider about how this condition can affect you.

 

Hypertension Prior to Pregnancy

What should I know if I am hypertensive before I become pregnant?

Anyone with high blood pressure, whether treated or untreated before becoming pregnant or before the 20th week of gestation is considered chronic hypertensive.

You can have preeclampsia with the pregnancy as well, if other symptoms occur along with hypertension.  This condition is called superimposed preeclampsia.

Prepare yourself to talk to your provider by knowing your hypertension history including any medications you take currently or have taken in the past for the condition.

No matter what health condition you are facing, your relationship with your care provider is strengthened by clear and consistent communication.  If talking to health providers brings you up short, here are some questions to get your conversation on hypertension and pregnancy started.

Ask your provider:

Is hypertension during pregnancy life threatening?

How does hypertension affect pregnancy?

How does pregnancy affect hypertension?

How would hypertension affect the baby?

How would hypertension affect the options for labor?

How would hypertension affect the options for delivery?

Would I be at risk for preeclampsia?

What other conditions along with hypertension create preeclampsia?

Does having hypertension or preeclampsia increase risk of a cesarean delivery?

How would hypertension medication affect my baby?

What long term risks or complications should I be aware of regarding hypertension and pregnancy?

What do I need to do now to prepare for a healthy pregnancy with hypertension?

How does hypertension medication affect a potential pregnancy?

Remember the only bad question is the one you did not ask.

 

Hypertension during Pregnancy

What should I know since I have become hypertensive during my pregnancy?

All women with any form of hypertension are at increased risk for complications during pregnancy and after delivery.

Your medical team will keep a very close watch on you and your baby including monitoring results of tests and other assessments, including how the baby is growing.  These assessments will help them to determine the best treatment plan for optimum outcomes.

Hypertension that develops during pregnancy is usually diagnosed as gestational hypertension or preeclampsia.

Gestational hypertension means no other symptoms such as proteinuria or abnormal organ functions are found.

Preeclampsia includes findings of abnormal urine or organ functions along with hypertension.

Hypertension during pregnancy is not uncommon.  There several things you can do to help yourself stay as healthy as possible during this time.

Keep all care provider appointments or scheduled tests. Your clinically trained team knows what to watch for and how best to intervene if there are abnormal findings.

Ask your care team to learn more about the condition.

Here are some questions to get the conversation started.

Ask your provider:

Is hypertension during pregnancy life threatening for me or my baby?

How does hypertension affect my pregnancy?

How does hypertension affect my baby?

How does hypertension affect my options for labor?

How does hypertension affect my options for delivery?

Does having hypertension increase my risk for having a cesarean delivery?

What signs should I report to you if I suspect there are changes?

What, if any, medications should I take for hypertension?

How does this medication affect my baby?

How does my diet affect this condition?

What risks or complications should I be aware of because of hypertension after my pregnancy?

What are the signs that gestational hypertension is not preeclampsia?

What can we do to reduce the risk of preeclampsia?

Will the hypertension go away after I deliver?

Will I get hypertension with my next pregnancy?

What signs or symptoms should I look for that indicate I need to seek immediate care due to the hypertension or preeclampsia?

What do I need to do to stay as healthy as possible during my pregnancy?

 

Hypertension and Postpartum Care

Depending on when the hypertension began and the effects of it on your body during your pregnancy, hypertension can cause some complications and require further assessments and treatment after delivery.

After delivery of your baby, the healthcare team will continue to monitor your vital signs closely, as well as lab values on your blood counts and your urinary output.  Based on those results they will create an ongoing plan of care for you.

If you have received a special medication – magnesium sulfate – during your labor period, you may continue on that medication for some time following delivery.  You can provide breastmilk for your baby, even if receiving magnesium sulfate.  Ask for support if your newborn has had to go to a “special” nursery for care.

If you had hypertension prior to your pregnancy, make sure you ask your provider about the best care management for you throughout the postpartum period, after delivery.

When you leave the hospital it is very important to monitor your blood pressure and other vital signs like temperature as well as watch for signs of post-partum preeclampsia.

Sometimes preeclampsia can develop or worsen after delivery, even when you did not have an issue while pregnant.

Headache, a change in vision, high blood pressure, shortness of breath and swelling are just a few of the symptoms of preeclampsia.  Check with your provider for a full list of symptoms.

As always check with your care provider or go to the nearest emergency department for care if you are experiencing these symptoms.

There is a 10-25% risk of reoccurring preeclampsia with additional pregnancies.  Don’t forget to include hypertension and preeclampsia in your discussion with your provider during your postpartum care visits.

Postpartum care follow-up with your provider is just as important as your prenatal care.  Your health is central to the health and well-being of your baby.  Your baby is depending on you to be as healthy as possible.

 

Resources

https://www.acog.org/~/media/Task%20Force%20and%20Work%20Group%20Reports/public/HypertensioninPregnancy.pdf

https://www.preeclampsia.org/

Hypertension Related Complications
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