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High blood pressure and Pregnancy

High blood pressure and Pregnancy

When you have high blood pressure, pregnancy requires special care. Here's what you need to know to take care of yourself — and your baby.

Perhaps you control your high blood pressure (hypertension) through diet and exercise. Or maybe you manage your condition with medication. In either case, is pregnancy safe? For most women, the answer is yes. But proper prenatal care is essential. If you have high blood pressure and are considering pregnancy, here's what you need to know. Why is high blood pressure a problem during pregnancy?
High blood pressure can decrease blood flow to the placenta, which affects your baby's supply of oxygen and nutrients. This may slow your baby's growth and increase the risk of preterm delivery. High blood pressure also increases the risk of placental abruption, in which the placenta prematurely separates from the uterus. Rarely, high blood pressure poses life-threatening complications.

Later risks may be a concern, too. High blood pressure during pregnancy may increase your risk of diabetes, heart disease and kidney disease later in life.

Are there different types of high blood pressure during pregnancy?
Sometimes high blood pressure is present before pregnancy. In other cases, high blood pressure develops during pregnancy.
  • Chronic hypertension. If high blood pressure develops before 20 weeks of pregnancy or lasts more than 12 weeks after delivery, it's known as chronic hypertension. Often, chronic hypertension was present — but not detected — before pregnancy.
  • Gestational hypertension. If high blood pressure develops after 20 weeks of pregnancy, it's known as gestational hypertension. Although it usually goes away after delivery, gestational hypertension may increase the risk of developing chronic high blood pressure in the future.
  • Preeclampsia. Sometimes chronic hypertension or gestational hypertension leads to preeclampsia, a serious condition characterized by increased blood pressure and protein in the urine after 20 weeks of pregnancy. Left untreated, preeclampsia can lead to serious — even fatal — complications for both mother and baby.
What do I need to know about preeclampsia?
Warning signs of preeclampsia — which can develop gradually or strike suddenly, often in the last few weeks of pregnancy — may include:
  • Severe headaches
  • Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
  • Upper abdominal pain, usually under the ribs on the right side
  • Nausea or vomiting
  • Decreased urine output
  • Sudden weight gain, typically more than 2 pounds a week
Swelling (edema), particularly in the face and hands, often accompanies preeclampsia as well. Swelling isn't considered a reliable sign of preeclampsia, however, because it also occurs in many normal pregnancies.

If you develop signs of preeclampsia, you and your baby will be closely monitored. Sometimes bed rest or hospitalization is recommended. If your health care provider is concerned about your health or your baby's health, early delivery may be needed — either through induction or a C-section.

Is it safe to take blood pressure medication during pregnancy?
Any medication you take during pregnancy can affect your baby. Although some medications used to lower blood pressure are considered safe during pregnancy, others — such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and renin inhibitors — are not.

Treatment is important, however. The risk of heart attack, stroke and other problems associated with high blood pressure doesn't go away during pregnancy. And high blood pressure can be dangerous for your baby, too. If you need medication to control your blood pressure, your health care provider will prescribe the safest medication at the most appropriate dose. Take the medication exactly as prescribed. Don't stop taking the medication or adjust the dose on your own. What should I do to prepare for pregnancy?

Before you try to conceive, schedule an appointment with the health care provider who'll be handling your pregnancy. Also meet with other members of your health care team, such as your family doctor or cardiologist. They'll evaluate how well you're managing your high blood pressure and consider any treatment changes you may need to make before pregnancy begins. If you're overweight, your health care provider may recommend losing the excess pounds before you try to conceive.

What can I expect during prenatal visits?
During pregnancy, you'll see your health care provider often. Your weight and blood pressure will be checked at every visit, and you may need frequent blood and urine tests.

Your health care provider will closely monitor your baby's health as well. Frequent ultrasounds may be used to track your baby's growth and development, particularly during the last trimester. Nonstress tests may be used to monitor your baby's heartbeat and movements, and ultrasound may be combined with fetal heart rate monitoring to evaluate your baby's well-being. As your pregnancy progresses, you may be asked to keep track of your baby's movements.

What can I do to prevent complications?
Taking good care of yourself is the best way to take care of your baby.
  • Keep your prenatal appointments. Visit your health care provider regularly throughout your pregnancy.
  • Take your blood pressure medication as prescribed. Your health care provider will prescribe the safest medication at the most appropriate dose.
  • Get plenty of rest. Take a daily nap, if you can. Follow your health care provider's recommendations for exercise and activity. If you develop signs of preeclampsia, bed rest may be recommended.
  • Eat healthy foods. Limit the amount of sodium in your diet, and remember to take your prenatal vitamins.
  • Monitor your weight. Gaining the right amount of weight supports your baby's growth and development, but gaining too much weight places additional stress on your heart.
  • Know what's off-limits. Avoid smoking, illicit drugs and ...
In early trials, preventive aspirin treatment appeared to reduce the risk of preeclampsia — but large-scale studies haven't confirmed the results. The possible benefits of preventive aspirin treatment are still being evaluated.

What about labor and delivery?
Your health care provider may suggest inducing labor a few weeks before your due date to avoid complications. If you develop preeclampsia or other complications, induction may be needed even earlier. If you have severe preeclampsia, you may be given medication during labor to help prevent seizures. In some cases, a C-section may be needed. Depending on the timing, you may be given an injection of potent steroids to enhance your baby's lung maturity before birth.

Will I be able to breast-feed my baby?

Breast-feeding is encouraged for most women who have high blood pressure, even those who take medication. Discuss any medication adjustments you'll need to make with your health care provider ahead of time. Sometimes an alternate blood pressure medication is recommended.

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