Hypertensive disorders of pregnancy (HDP) are a group of conditions, defined as pre-pregnancy (chronic) or pregnancy-associated hypertension that commonly affect pregnant and postpartum women. HDP’s continue to be one of the leading causes of pregnancy-related death in the United States. High-blood pressure during pregnancy can place both the mother and her infant at risk and the risk to the mother can continue postpartum. Hypertensive disorders of pregnancy have become more common, affecting approximately 15% of women during their reproductive years.
Risk factors for HDP’s may include:
Risk increases when maternal age is greater than 35.
Higher body mass index is linked with greater risk.
Diagnosed before or during pregnancy.
Chronic hypertension or diagnosis during pregnancy.
Being pregnant for the first time increases risk.
History of preeclampsia raises the likelihood.
Greater risk for Non-Hispanic Black or American Indian/Alaska Native women.
Carrying twins, triplets, or more.
Additional lifestyle or genetic factors may contribute.
If you experience any of the following signs & symptoms you should contact your healthcare provider immediately:
High blood pressure during pregnancy may indicate complications.
Persistent or severe headaches are a warning sign.
Swelling in hands, feet, ankles, legs, or face.
Unexplained or rapid weight gain during pregnancy.
Blurred vision, double vision, or sensitivity to light.
Beyond typical morning sickness, especially later in pregnancy.
Pain in the right upper abdomen beneath the ribs.
Urinating in unusually small amounts.
Difficulty breathing or shortness of breath.
Convulsions, which may indicate eclampsia.
High blood pressure is traditionally defined in pregnancy as a blood pressure reading of 140/90 or greater, measured on 2 separate occasions at least 4 hours apart. During pregnancy, a rise in the upper number (systolic) of 30 degrees or more, or a rise in the lower number (diastolic) of 15 degrees or more can also be a cause for concern. It is important to know your baseline blood pressure before you get pregnant so you know when to contact your healthcare provider. Keep a log of your blood pressure at home and share with your provider. It is important to take your blood pressure at the same time each day and in the same position, sitting with the cuff positioned on the left arm at the level of your heart.
Ultimately, it is best to keep your blood pressure below the parameters previously mentioned. Your healthcare provider might order you to rest, avoid heavy lifting, and avoid stress, or they may order medications to decrease your blood pressure. For patients at moderate and high-risk for preeclampsia, low dose aspirin may be started during the second trimester to reduce risk. It is important to visit your healthcare provider regularly so that they can perform lab and urine testing and check on your baby. The best way to prevent high blood pressure is to maintain a healthy weight and eat a healthy diet.
When suspicion of preeclampsia exists, a thorough evaluation may include hospitalization, so healthcare providers can more closely monitor the mother, baby and placenta.
Delivery of the baby may improve preeclampsia, but it is no longer the “cure” as traditionally believed. If only mild preeclampsia exists and both baby and mother are doing well, delivery may be held off to 37 weeks or beyond. If there is a threat to either the baby's health or mother’s life, delivery is scheduled earlier.
The effects of preeclampsia do not necessarily end after pregnancy. Women who have had preeclampsia during pregnancy have a higher risk post-delivery for developing blood pressure problems, high cholesterol, diabetes, along with stroke and heart disease. Preeclampsia is an indication of impaired function of the blood vessels, and therefore carries a long term risk of cardiovascular disease.
Women who experienced preeclampsia during pregnancy are at nearly double the risk for heart disease or stroke in the 30 years post pregnancy. Women who have had severe preeclampsia may have a greater than six-fold risk.
It is important that women who have experienced preeclampsia embark on a healthy lifestyle path and follow preventive measures such as: screening for diabetes, high blood pressure, high cholesterol and premature heart disease. For recommendations specific to you, continue regular checkups with your primary care physician or cardiologist. A team-based approach and multi-specialty collaboration is needed to ensure appropriate care transition with the goal of optimizing cardiovascular preventive strategies across the life span.