How common is hypertension in pregnancy? According to Dr. Priti Arora Dhamija, “Approximately 10-15% of women have high BP during pregnancy. But with proper management, this typically does not pose a grave risk to mother or baby.”
“Very often, high BP in pregnancy appears in the last trimester. That’s why you need to be very regular with your visits and monitoring.”
High BP (blood pressure) during pregnancy manifests in 3 different forms. It is important to learn how to control this condition in each of these situations.
Here are some urgent queries three to-be mothers brought to our attention during their consultations –
1. High Blood Pressure During Pregnancy (Pregnancy Induced Hypertension)
Aanchal Sharma, 32, was expecting her first baby. Aanchal noticed some swelling on her feet, toes, and fingers. Aanchal’s high BP in pregnancy was picked up on a routine check-up at 34 weeks.
She was asked to get some blood and urine tests.
Her high blood pressure was not accompanied with proteins in urine, which was a good sign, and she was diagnosed with pregnancy-induced hypertension.
Why is Hypertension a Problem During Pregnancy?
Aanchal wanted to know how hypertension could pose a problem for her and her baby’s health.
“High blood pressure causes pressure changes in the body, affecting the blood volume and blood flow to both the mother’s vital organs and the baby,” explained Dr. Priti.
High BP during pregnancy can lead to the baby remaining weak, or experiencing growth retardation (IUGR) due to depleted blood flow.
How to Manage High BP During Pregnancy?
“Most mothers with pregnancy-induced hypertension, like Aanchal, have isolated hypertension and require only regular-checkups, blood and urine tests and serial ultrasounds to keep a check on the baby’s well-being,” explained Dr Priti.
“In such situations, the blood pressure usually returns to normal after the delivery.”
Aanchal’s blood pressure did not rise significantly, even though she was not on any medications, and all her tests remained normal as well.
“Eventually Aanchal went into spontaneous labour, had a normal delivery and her BP resolved within 6-12 hours of giving birth,” recalls Dr Priti.
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2. High BP with Proteins in Urine During Pregnancy (Pre-eclampsia)
When Anu Bhutani came in for an antenatal check-up at 32 weeks, her BP registered on the higher side. At 34 weeks, when she had her BP checked again, it was 150/100.
Her initial investigations revealed significant amounts of protein in urine.
“She was diagnosed with pre-eclampsia and we decided to admit her and recommended a few investigations. She was started on medicines to lower her BP and to protect her baby.”
“We advised her regarding her diet and explained the importance of regular treatment and follow up.”
Anu wondered why strict monitoring and several tests were important and posed her question at a follow-up consultation.
“Medication cannot correct the cause of high BP during pregnancy,” explains Dr. Priti.
“Monitoring helps rule out possible damage occurring to the mother and baby that cannot be otherwise detected.”
How will I Know if I Develop High BP During Pregnancy?
Anu was informed of warning signs she needed to keep an eye out for to immediately report to the hospital.
Symptoms such as giddiness, headaches, blurred visions, decreased urine production, or a pain in their upper abdomen may be a mark of sudden rise in BP.
“In such situations women should immediately get in touch with their doctor to implement definitive measures to control BP and other complications.”
Anu’s labour had to be induced at 38 weeks because her BP stayed around 150/100 despite medication.
“Time and mode of delivery is usually decided if BP stays uncontrolled despite definitive measures, or monitoring of the mother or baby shows unfavourable signs,” says Dr Priti.
Even after her delivery, Anu’s BP remained high for a week and gradually her medicines were tapered.
“We kept monitoring her blood pressure until it returned to normal” says Dr. Priti.
How to Control BP during Pregnancy with Pre-eclampsia?
Pre-eclampsia may lead to fetal complications such as growth retardation and diminished blood flow to baby.
“Management of pre-eclampsia involves more frequent antenatal check ups, special ultrasounds and nonstress tests” explains Dr Priti.
“If your blood pressure is not controlled or the blood flows to your baby are not adequate, or your baby is not growing well, you may need induction of labour before your due date,” cautions Dr Priti.
Induced labour offers the baby a safer environment when the mother’s uterus becomes too dangerous for its welfare.
“The decision to deliver is taken when the baby’s survival outside the mother’s body is associated with lesser risk than if the pregnancy is continued.”
3. Chronic Hypertension and Pregnancy
Deepti Dawar, 37, had hypertension for years before she became pregnant. She was concerned whether having a baby would be safe given her condition.
Are Medications Safe in Pregnancy?
Deepti was unsure if she could continue taking her BP medication during pregnancy.
“Certain medications like your antihypertensive medication taken even before pregnancy started may have to be changed or stopped to something which is more pregnancy-friendly,” said Dr. Priti.”
Because Deepti had chronic hypertension, she needed more frequent check-ups during pregnancy as well.
Deepti was encouraged to reveal her medical history at the time of check-up and consult a doctor before starting any new medication during pregnancy.
How to Control BP During Pregnancy in Chronic Hypertension?
In general, if you have high BP especially after 36 weeks, you will have to monitor it frequently and watch out for fluctuations. If your BP crosses 140/90, you must consult your doctor right away.
“Deepti’s blood pressure did not worsen during pregnancy. She had regular blood and urine tests to see that her high blood pressure was not affecting her kidney and liver function.”
Does hypertension in pregnancy increase chances of cesarean?
“Early detection and proper management is the first step towards ensuring a healthy maternal and fetal outcome.”
Since the cause of high BP cannot always be identified, certain precautions and lifestyle changes benefit both mother and child.
“Those with chronic BP during pregnancy should avoid excessive weight gain and eating processed or junk foods. Restrict your salt intake and increase your protein intake.”
Deepti was induced at 40 weeks and had a normal delivery, like she had hoped. To prevent her BP from rising drastically due to stress of labour, she was offered epidural during delivery.
“In most situations, if blood pressure is controlled and the baby is growing well, pregnancy can be continued till 40 weeks. Induction of labour may be required in selected situations if there is any associated complication,” Dr. Priti concludes.
Consult our doctor immediately to closely monitor your blood pressure for the remainder of your pregnancy.