HEALTH MATTERS: Mothers-to-be can learn to manage high blood pressure while pregnant

By Samih A. Ibrahim, M.D.
   High blood pressure during pregnancy can be a dangerous condition for mother and baby, especially if left untreated. However, with special care most women with high blood pressure have successful pregnancies and healthy babies.
   Problems with high blood pressure occur in 6 percent to 8 percent of all pregnancies in the United States, according to the National Heart, Lung and Blood Institute, making it one of the most common pregnancy complications.
   In the most dangerous cases, the mother develops preeclampsia, a condition characterized by high blood pressure and protein in the urine after 20 weeks of pregnancy. Untreated preeclampsia can be fatal for both the mother and the fetus.
   Blood pressure measures the amount of force exerted by the blood against the walls of the arteries. Blood pressure is high when the top number (the systolic) of the blood pressure reading is greater than 140 mm Hg or the bottom number (the diastolic) is greater than 90 mm Hg.
   The most common types of high blood pressure during pregnancy are chronic hypertension, gestational hypertension and preeclampsia.
   • Chronic hypertension is high blood pressure that develops before pregnancy. Compared to women with normal blood pressure, women with pre-existing, or chronic, hypertension are more likely to have difficult pregnancies.
   • Gestational hypertension is high blood pressure that develops after 20 weeks of pregnancy. This form of hypertension usually goes away after delivery.
   • Preeclampsia typically starts after the 20th week of pregnancy. The condition is related to increased blood pressure and protein in the mother’s urine (caused by kidney problems).
   High blood pressure can have mild to dangerous effects on pregnancy. Women with preeclampsia experience the most severe effects, including harm to the placenta and the mother’s kidney, liver, and brain. Preeclampsia may also lead to fetal complications like low birth weight, premature birth and stillbirth.
   Untreated preeclampsia can become eclampsia. In some cases this rare, potentially fatal condition can cause seizures and coma in the mother. Eclampsia is the second leading cause of maternal death in the nation, according to the National Heart, Lung and Blood Institute.
   Fortunately, eclampsia is rare in women who routinely receive prenatal care.
   The most common risk factor for preeclampsia is chronic hypertension prior to pregnancy. In addition, preeclampsia is more common among women who:
   • Developed hypertension or preeclampsia during a prior pregnancy, especially during early pregnancy.
   • Become pregnant under the age of 20 or over the age of 40.
   • Are obese prior to pregnancy.
   • Are pregnant with more than one baby.
   • Have diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma.
   There is no single test to predict or diagnose preeclampsia. However, key warning signs include:
   • Persistent headaches.
   • Blurred vision or sensitivity to light.
   • Abdominal pain.
   These symptoms may be associated with other disorders and may even be present in healthy pregnancies.’
   There is no “tried-and-true” way to prevent preeclampsia. Delivery of the baby is the only cure for the condition. Fortunately, most women can minimize or avoid problems related to preeclampsia by keeping their regularly scheduled prenatal appointments.
   Your doctor can closely watch your blood pressure readings and level of protein in urine. Your doctor can also order and analyze blood tests that detect signs of preeclampsia.
   Moreover, you can help reduce your risk for pregnancy complications associated with high blood pressure with the following actions:
   • Control your blood pressure through lifestyle changes prior to becoming pregnant. Limit salt intake. Exercise regularly. Lose excess weight.
   • Schedule a preconception appointment and meet with your family doctor or cardiologist if you currently have high blood pressure.’
   • Check with your doctor if you are currently on medication for your blood pressure. Your doctor may tell you that some medications are still OK to take. In other cases, your doctor may take you off of angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II (AII) receptor antagonists. Do not adjust or stop any medications without first talking to your doctor.
   • Keep a regular schedule of prenatal medical visits.
   • Refrain from alcohol and tobacco use.
   • Consult with your doctor about any over-the-counter medications you are taking.
   High blood pressure and related disorders during pregnancy can be dangerous, threatening the lives of both the mother and the baby. Even so, many women with high blood pressure have successful pregnancies. Early and regular access to prenatal care is key. Close monitoring before and during pregnancy by health care providers ensures your long-term health and the well being of your baby.
   To find a physician with Princeton HealthCare System, call (888) 742-7496 or www.findadr.com.
Samih A. Ibrahim, M.D, F.A.C.O.G. is board certified in obstetrics and gynecology and a fellow of the American College of Obstetricians and Gynecologists. He is a member of the medical staff at University Medical Center of Princeton at Plainsboro.