Special Care for High Blood Pressure & Pregnancy

Pregnancy puts new demands on a woman’s body. It can alter the course of some medical conditions a woman may have before pregnancy, and some conditions can affect the course of pregnancy. A woman with such a medical condition can have a healthy baby. An extra effort will be required, however, so that the woman’s general health and her pregnancy can be followed more closely.

If you have a condition that could complicate your pregnancy, your doctor may order additional tests and ask you to make extra prenatal visits or attend special clinics. You may need to stay in the hospital or to monitor your condition yourself at home. Your doctor may work with a team of experts to provide any special care you may need.

High Blood Pressure

Hypertension, or high blood pressure, occurs when the pressure of the blood in the arteries reaches levels that are greater than normal. This condition can be preexisting (before pregnancy) and chronic (long-term), or it can arise during pregnancy. High blood pressure that arises during pregnancy can be a sign of a condition called preeclampsia (also known as toxemia). These two conditions – chronic high blood pressure and preeclampsia affect pregnancy and its outcome in different ways. Depending on how severe these conditions are, both the mother and fetus can be affected.

The heart pumps blood rich in oxygen through the arteries (light blood vessels) to all parts of the body. Blood returns to the heart through the veins (dark blood vessels).If a blood pressure reading is 110/80, 110 is the pressure in the arteries when the heart is contracting, or the systolic pressure. The lower number, 80, is the pressure in the arteries when the heart is relaxed, or the diastolic pressure.

Measuring Blood Pressure

Blood pressure is checked with a stethoscope and an instrument made of an inflatable cuff and a pressure gauge (sphygmomanometer). A blood pressure reading is made up of two numbers separated by a slash, for example, 110/80. (You may hear this referred to as”110 over 80”). The first number is the pressure in the arteries when the heart contracts. This is called the systolic pressure. The second number is the pressure in the arteries when the heart is relaxed between contractions. This is the diastolic pressure.

Blood pressure changes often during the day. It can rise if you are excited or if you exercise. It usually falls when you are resting. These temporary changes in blood pressure that occur in response to some activity or event are normal. It is only when a person’s blood pressure stays high for some time that it requires attention.

Because of the normal ups and downs in blood pressure, if your doctor finds one high reading, he or she will want to see whether it is your normal level by taking another reading. Your normal blood pressure can be an average of several readings taken at rest.

Blood pressure varies from person to person, so everyone’s blood pressure is different. In nonpregnant adults, readings less that 130/80 are usually normal, and become abnormal when pressures reach above 140/90.

Some blood pressure levels that may see normal could be too high in a pregnant woman. For instance, a reading of 120/85 would be considered too high for a pregnant woman whose normal reading was 90/70. As a rule, any increase of 30 or more in the systolic reading or 15 or more in the diastolic reading can be a sign of high blood pressure in pregnancy.

It is normal for blood pressure to drop slightly during the middle part of pregnancy and then return to pregnancy levels during the latter part of pregnancy. Because of these changes, it is important to have your blood pressure measured before pregnancy or in early pregnancy so your doctor will know what is normal for you. As a part of prenatal care, a woman’s blood pressure is checked at each visit.

Chronic High Blood Pressure

High blood pressure can be present when a woman becomes pregnant. Diet, life style, and heredity con tribute to chronic high blood pressure. Over the course of her life, a woman with untreated high blood pressure is more likely to have a heart attack or stroke. She is also at higher risk for having problems during pregnancy. These include having a baby that is too small or separation of the placenta from the wall of the uterus before the fetus is born.

Before you get pregnant chronic hypertension should be brought under control with diet, weight loss, and possibly medication. During pregnancy, regular checkups are important to detect any changes in your condition that may signal a problem.

What is Preeclampsia?

High blood pressure that occurs for the first time in the second half of pregnancy along with protein in the urine and, usually, fluid retention is called preeclampsia. It affects about 7 out of every 100 women who become pregnant. It is not known what causes preeclampsia, although women who have chronic high blood pressure are more likely to develop it. Most women with preeclampsia, however, have never had high blood pressure before. Preeclampsia usually occurs with first pregnancies and often does not recur in later pregnancies except in women who have chronic hypertension or other diseases affecting the blood vessels. With preeclampsia, blood pressure returns to normal levels after pregnancy, whereas chronic hypertension remains after delivery.

The blood vessels in the uterus supply blood to the placenta, through which the fetus is nourished and given oxygen. When a woman has preeclampsia, the blood flow through these vessels is reduced. The severity of the condition and the time in pregnancy when it occurs determines the degree of risk to the fetus.

When blood pressure increases during pregnancy, your doctor may recommend bed rest. Frequently, the blood pressure will improve or return to normal with rest. When resting the woman may be advised to lie on her side-this position improves the flow of blood to the uterus and kidneys. Some doctors hospitalize women as soon as there is a slight increase in blood pressure; others wait until there is evidence that bed rest at home has not helped to reduce blood pressure.

Caption:Bed rest may be prescribed for a woman with preeclampsia.

Preeclampsia occurs in degrees, from mild to severe, and can gradually worsen or improve. If preeclampsia is detected in mild stages and controlled by bed rest and medication, the effects on the baby can be reduced. The goal, all other factors permitting, is to allow the pregnancy to continue until the fetus is old enough to be born.

When preeclampsia occurs early and is severe, early delivery may be necessary. A premature body is underweight and may have trouble breathing because the lungs are not fully developed. When preeclampsia is associated with chronic hypertension, the placenta can separate from the uterus and result in stillbirth. Preeclampsia can also be linked to poor fetal growth. Severe preeclampsia can also be linked to poor fetal growth. Severe preeclampsia affects almost all of the mother’s organs, such as the blood system, liver, kidneys, and brain. Convulsions can occur without warning with preeclampsia. When this occurs, the disease is called eclampsia. The treatment for very severe preeclampsia or eclampsia is to deliver the fetus, either by inducing labor or performing a cesarean birth.