Hypertensive Disorders in Pregnancy

Up to 10% of pregnancies in the United States are impacted by high blood pressure. Known medically as “hypertension,” elevated blood pressure can be a serious condition capable of impacting your pregnancy and the birth of your baby, putting you at risk for several negative outcomes and complications.

Your OBGYN or Midwife will regularly monitor your blood pressure in order to detect hypertension as early as possible. If elevated blood pressure is detected, your OBGYN or Midwife can help you manage symptoms. That way, you’ll be able to focus your energy on looking forward to a healthy and successful birth. 

What is Hypertension?

Every time your heart beats, it’s pushing blood through your veins, arteries, and other blood vessels. This is a good thing! It’s supposed to happen. The force of that movement is what we call blood pressure. 

Typically, blood pressure values look like this:

• Low Blood Pressure: Less than 90 / 60

• Normal Blood Pressure: Less than 120 / 80

• Elevated Blood Pressure: 121 – 129/ 80

• Stage 1 High Blood Pressure: 130 – 139 / 80 – 89

• Stage 2 High Blood Pressure: Higher than 140 / 90

For physicians, blood pressure is an important indicator of overall health–even when you aren’t pregnant. If your blood pressure drops too low, your vital organs won’t get enough oxygen, which can cause shock–requiring immediate medical attention.

Blood pressure that’s too high, on the other hand, can result in hardening of your arteries or weakened blood vessels. Hypertensive disorders in pregnancy can result in more severe and immediate complications as well.

What Can Cause Elevated Blood Pressure?

There are a great many variables that can cause your blood pressure to rise a bit. Some of the most common include:

• Stress: Sometimes this manifest just inside the doctor’s office (some physicians call it “white coat hypertension”). 
• Diet: A diet high in sodium can cause your blood pressure to increase.
• Genetics: Some people just have naturally higher blood pressure than others.
• Lack of exercise: A sedentary lifestyle has also been linked to a rise in blood pressure.

For some women, pregnancy will also cause a rise in blood pressure. This is what’s known as Gestational Hypertension. Your OBGYN or Midwife will regularly monitor you for either pre-existing hypertension or gestational hypertension.

Types of Hypertensive Disorders in Pregnancy

The type of hypertension you present with will determine the best therapies and treatments to pursue. While physicians and researchers have classified a wide variety of hypertension types, pregnant individuals will likely need to pay the most attention to the following two types of hypertension.

Pre-Existing Hypertension

Chronic or pre-existing hypertension is elevated blood pressure that is not caused by your pregnancy. If your hypertension presents prior to the 20 week mark or persists for more than 6 weeks after you give birth, it will be classified as chronic hypertension.

It’s possible you may not be aware of your high blood pressure when you become pregnant. Pre-existing hypertension may still be detected during your regular screenings (as long as you have your blood pressure taken before the 20 week mark).

Chronic or pre-existing hypertension still has the potential to cause negative outcomes and complications during your pregnancy. As a result, your OBGYN or Midwife will:

• Regularly monitor your blood pressure
• Keep a close watch on fetal growth
• Routinely assess you for worsening hypertension (i.e. preeclampsia) or other possible complications

Gestational Hypertension

When your blood pressure is directly linked to your pregnancy, it’s called gestational hypertension. This is hypertension that develops after the 20th week of pregnancy and typically goes back to normal before your 6th week post-birth. When you are diagnosed with gestational hypertension, your OBGYN or Midwife will continue to monitor fetal growth until birth, just as they would with chronic hypertension.  You may also have blood work done more frequently to evaluate how your organs are functioning. Your providers will discuss with you other procedures to monitor your baby’s health and well-being until birth including more prolonged monitoring of the baby’s heart rate by performing non-stress tests in the office.

Your OBGYN or Midwife will also continue to monitor your blood pressure. That’s because gestational hypertension can still lead to complications, especially if it presents after the 34th week. If you have gestational hypertension you will be monitored weekly to ensure:

• Your blood pressure does not rise too high
• The first signs of possible preeclampsia are detected

Your providers may also discuss with you recommendations to induce labor sooner than your due date if there is concern the gestational hypertension is worsening. 

High Blood Pressure and Preeclampsia

The precise cause of preeclampsia is not completely understood, though most experts believe it begins in the placenta. However, what is well known is that one of the first indications of preeclampsia is high blood pressure. As a result, your OBGYN or Midwife will check your blood pressure often and screen your urine for marker proteins that present with preeclampsia.  

Other concerning symptoms may also occur, including a severe, persistent headache that does not respond to repeat doses of acetaminophen or sudden onset of a severe headache characterized as “worst headache of my life.” Additionally, visual disturbances including blurred vision or seeing spots in front of your eyes, pain experienced in the right upper quadrant or epigastric area suggesting impairment in liver function. 

Preeclampsia can develop due to either gestational or chronic hypertensive disorders in pregnancy. Left untreated, preeclampsia can lead to possibly life threatening complications, both for you and for your baby. Other complications could include seizures (a condition known as eclampsia) or organ damage. Many of these complications can be life-threatening or have lifelong implications for your health.

For that reason, your OBGYN or Midwife will carefully monitor your blood pressure to ensure preeclampsia can be detected at the earliest stages. Treatment for preeclampsia includes:

• Inducing labor: Typically, the best way to treat preeclampsia is to deliver your baby as quickly as possible. For this reason labor may be induced.
• Medications: If your baby is not yet ready to be born, your OBGYN or Midwife may try to give them more time to mature and develop. In these cases, you may be prescribed medications that can help lower your blood pressure. 
• Corticosteroids and anticonvulsants: If your preeclampsia has already presented at moderate or severe levels, your OBGYN or Midwife may prescribe medications that help alleviate symptoms.

Preeclampsia is a serious condition that impacts roughly 1 in 25 pregnancies. When detected early, your OBGYN or Midwife will be able to help you manage the condition, monitor your baby, and provide the best opportunity for a positive birth experience.

Can You Keep Your Blood Pressure Low?

Hypertensive disorders in pregnancy can have a dramatic impact on your overall experience. So it makes sense that you’d want to know if there’s any way to keep your blood pressure on the healthy side. Here are a few ways you can:

• Overall wellness: Try to be as healthy as you can before you become pregnant. This will provide the best opportunities to manage hypertension challenges should they occur.
• Vitamin supplements: There’s some evidence to suggest that taking calcium supplements can be beneficial, especially if you have a calcium deficiency before you are pregnant. But there’s less evidence that other vitamin supplements help manage your blood pressure. Be careful about taking supplements while pregnant, and make sure you talk to your OBGYN or midwife about what you should or should not be taking. 
• Aspirin: There’s some evidence to suggest that small doses of aspirin can help prevent high blood pressure and preeclampsia, but, again, you should double check with your OBGYN or Midwife before taking any medication, even if it’s over-the-counter.

The best way to keep your blood pressure low and prevent preeclampsia is to check in with your OBGYN or Midwife often. 

To talk to an OBGYN or Midwife about your high blood pressure concerns, contact our Wilmette or Glenview locations to schedule an appointment!