Hypertension & Pregnancy: What to Expect With Chronic High Blood Pressure

High blood pressure has been called the "silent killer" for good reason. Its symptoms, if any at all, are so generalized it can be attributed to just about anything. According to womenshealth.com, some of the symptoms of hypertension (high blood pressure) include: headaches, dizziness, blurred vision, and low libido. On a personal note, I have dealt with hypertension for nearly 10 years and discovered a few other symptoms: nausea, odd flutterings from my heart, and shakiness. Most people would think they just need a better night's sleep, less stress in their lives, or a better diet.

Hypertension, though deadly in every day life, is even more dangerous in pregnancy. Those women who have been diagnosed with high blood pressure prior to pregnancy need to be aware of several things in dealing with a pregnancy.

Chronic Hypertension versus Preeclampsia

There is a marked difference between these two conditions. Chronic hypertension, in pregnancy, refers to the woman's general health both before and after pregnancy. Any reading over 140/90 is considered high and will be re-checked in a doctor's office. If the numbers are consistently high over a longer period of time, the patient is usually put on some form of medication to control the pressure. In pregnancy, there are safe medications you can take to continue controlling blood pressure. Aldomet, or methyldopa, is commonly prescribed in pregnancy as there seems to be no effect on the baby. But be aware that it is secreted in breast milk if you are thinking of breastfeeding.

If you have chronic hypertension you are more likely to develop preeclampsia. Preeclampsia is defined by the Preeclampsia Foundation (http://www.preeclampsia.org/about.asp) as, "a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms." In your third trimester, you obstetrician will most likely see you more regularly than other patients. Often, you will be going in for check ups once a week in an effort to catch preeclampsia. It can happen very suddenly so be sure to let your doctor know about symptoms, no matter how small.

Ways to help yourself: Invest in a good blood pressure cuff. Something simple like an electronic wrist cuff, so all you have to do is press a button. Take it with you to your doctor's office and calibrate it there. The nurses can help. Once calibrated, you can chart your own blood pressure at home which will help the doctor assess your situation better. Also, keep notes on your health. Do you have more "floaters" appearing in your eyes? Do you have swelling that came on quickly or a sudden jump in weight? By keeping good notes, you will be able to focus and give clear answers to your doctor when he or she asks.

High Risk OB/GYN

The day I found out I was pregnant I was so excited. But then reality set in when I went to make my first obstetric visit. I was diagnosed with chronic hypertension when I was 23 years old, thanks to a strong familial history with heart disease. My ob/gyn, thankfully, had qualifications to handle high risk pregnancies. His privileges were at an excellent women's hospital that also had a level 3 neonatal intensive care unit. When you have chronic hypertension, you are at a greater risk of preeclampsia and you must be monitored very closely during your pregnancy. The important thing to remember is to communicate your health issues with your obstetrician. If you are considering a midwife or doula assisted birth, you may need to find one who works with a doctor or at a hospital. The danger can arise quickly and you need to be able to get medical help/medication that may not be available through someone other than a medical doctor.

Because of chronic, uncontrolled hypertension, your baby's growth can be restricted. Seizures and stroke are also serious risks. Plan ahead and hope for the best. If you are trying to get pregnant, talk to your ob/gyn now to make sure your hypertension is controlled prior to pregnancy. Also make sure your doctor is able to handle emergent situations and your hospital has a good neonatal intensive care unit.

Ways to help yourself: Once you find a good obstetrician, read and educate yourself further on hypertension and pregnancy. Your doctor will have good resources and the March of Dimes also has good literature. Ask about and follow a good diet and exercise regimen. (Be sure to discuss all of it with your doctor first.) Keeping active and eating healthy can help keep your blood pressure controlled.

Preterm Delivery and Other Risks

Preterm delivery is a very real risk in chronic hypertensive mothers. Because the blood vessels are constricted in the uterus due to the hypertension, growth of the baby can be restricted. Most likely you will receive ultrasounds regularly to monitor the baby's growth.

Thanks to a wonderful staff at the hospital where I delivered my daughter, I was well informed of what would and could happen. I was hospitalized prior to delivery for a hypertensive episode and was given steroids to help aid in my daughter's lung development. Steroids are given, if possible, when a preterm delivery is looking more and more likely. At 32 weeks, I went into preeclampsia and was taken in for an emergency caesarian section. If you do wind up having to deliver prior to 37 weeks, you will most likely be looking at spending extra time in the hospital. Your baby will also probably need to spend time in the neonatal intensive care unit (NICU).

Ways to help yourself: Sometimes the early delivery is unavoidable. Pack your maternity bag earlier than normal and keep it with you in the car. If you go in for a routine check up and your blood pressure is too high, your doctor may admit you to the hospital on the spot. Being prepared for that possibility will make you more comfortable in the long run.

Another thing to keep in mind is that you may not recuperate on the maternity floor should you have a preterm delivery and your baby is in the NICU. Often hospitals will separate full-term/"normal" deliveries from the emergent or early deliveries. Once you have recovered enough, feel free to insist on trips to the NICU.

As with any chronic condition, the key to a healthy pregnancy is communication with your doctor. And particularly with hypertension, remember that no symptom is too small or insignificant. Alert your doctor and you can avoid potentially serious risks.

Sources:

http://womenshealth.about.com/cs/highbloodpressur/a/highbldprssympt.htm

http://www.preeclampsia.org/about.asp

http://www.marchofdimes.com/professionals/14332_1222.asp