Hypertension and Pregnancy

Blood pressure usually fluctuates during pregnancy. During the middle part of pregnancy, blood pressure tends to be low. For this reason, it is important to know what your pre-pregnancy or early pregnancy blood pressure readings were.

There are two types of hypertension. The first is chronic hypertension which is long lasting, may require treatment with medications, and affects both men and women. The second is a group of conditions characterized by hypertension that occurs during pregnancy. You may experience only elevated blood pressure, which is called gestational hypertension or you may have preeclampsia which is elevated blood pressure with puffiness or swelling of the hands, feet, or face with or without protein in your urine.

Hypertension during pregnancy may affect the development of your baby. Hypertension causes decreased blood flow to the placenta, which results in less nutrients and oxygen reaching your baby, and growth may be slowed.

Warning Signs

There are certain warning signs associated with the worsening of hypertension during pregnancy. A sudden weight gain can be a result of your body retaining fluid because of the effects of high blood pressure on the kidneys. This weight gain is usually accompanied by swelling which is called edema. It is usually most noticeable in the fingers, face, and above the ankles. As a result of improper kidney function, protein may spill into the urine. Severe headaches, blurred vision, and pain in the upper abdomen are also signs that may indicate the progression of hypertension during pregnancy.

Self-Assessment

Learn the to recognize signs and symptoms hypertensive complications that could result from hypertension during your pregnancy. Your self-assessment of these signs and symptoms is very important. It is your responsibility to pay close attention to your body and know what is "normal" for you. Only by knowing what is "normal" can you recognize what is "abnormal". If you experience any of these signs and symptoms, you should call your doctor/midwife.

The following should help you understand how to recognize possible problems and what to report.

Edema

Most women have some swelling of their feet during pregnancy. However, any swelling of the face, hands, or feet early in the morning should be reported to our office.

Each morning, remember to conduct a "self-assessment" by checking the following:

  • Look in the mirror at your face, particularly the areas around your eyes and nose. Are you more "puffy" than normal?
  • Do your shoes and rings fit today? Put your finger on the front of your ankle and push down for a few seconds. Remove your finger and notice whether or not a dent was left. If the area was indented, how long did it take to return to being flat?
  • After you have looked at yourself, try to remember if you ate any food during the last 24 hours that may have made you retain fluid. Food such as potato chips, processed meats, Chinese food, popcorn, etc. has a lot of salt and might have made you more puffy than normal.

Headache

Most headaches are not a symptom of hypertension during pregnancy. Headaches can be caused by stress, too much reading, close-up work, or not eating. However, a headache that is not relieved by simple physician prescribed medicine is a cause for concern. Any severe headache should be reported.

Visual Disturbances

Visual disturbances may also indicate a serious complication of hypertension during pregnancy. A sudden onset of blurry vision or seeing "spots" could signal a problem and your doctor/midwife should be notified immediately.

Epigastric Pain

Pain in the upper right abdominal area can also signal significant complications. With severe prolonged hypertension, your liver can become swollen. Pain in the liver area (upper right abdominal area) should be reported immediately.

Abdominal Cramping and/or Vaginal Bleeding

Severe pain with or without bleeding from the vagina could indicate a problem. If you experience these symptoms, contact your provider immediately.

Evaluation of Mother and Baby

Since hypertension during pregnancy may affect both you and your baby, your doctor/midwife may choose to periodically evaluate and/or monitor you and your baby with one or more of the following:

  • Fetal movement counting: This is a simple technique of having you count your baby's movements for a designated time period several times a day. Your baby's activity can be an important indicator of well being.
  • Ultrasound or Sonogram: This method of evaluation is performed in the office or the hospital. Most examinations take between 5 and 30 minutes to perform and are not uncomfortable or painful.

    Ultrasound allows your doctor/midwife to determine if the size of the baby is appropriate for the number of weeks of pregnancy. It can also show whether or not there is enough amniotic fluid and looks at the placenta as well. The size of the baby and the amount of amniotic fluid can indicate whether or not your elevated blood pressure has interfered with the growth of your baby.

  • Nonstress test (NST): A test in which the baby's heart rate is monitored by an ultrasound transducer, which is placed on your abdomen. It records the baby's heart rate and looks for increases in heart rate that occur when the baby moves. The test is easy to administer and is neither uncomfortable nor painful. It may be performed in your doctor's office, the hospital, or perhaps your home.

Reprinted with permission from Her Healthcare.