CHRONIC HYPERTENSION IN PREGNANCY

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What is chronic hypertension? If you had high blood pressure before you got pregnant, or if you're diagnosed with it before you reach 20 weeks, you have chronic hypertension. Up to 5 percent of women start their pregnancies with this condition. High blood pressure is defined as a reading of 140/90 or higher, even if just one of the numbers is higher. Severe chronic hypertension is 180/110 or higher. How is chronic hypertension managed during pregnancy? Ideally, before getting pregnant, you discussed your plans to conceive with the healthcare provider who manages your hypertension and let your pregnancy provider...

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CHRONIC HYPERTENSION IN PREGNANCY What is chronic hypertension? If you had high blood pressure before you got pregnant, or if you're diagnosed with it before you reach 20 weeks, you have chronic hypertension. Up to 5 percent of women start their pregnancies with this condition. High blood pressure is defined as a reading of 140/90 or higher, even if just one of the numbers is higher. Severe chronic hypertension is 180/110 or higher. How is chronic hypertension managed during pregnancy? Ideally, before getting pregnant, you discussed your plans to conceive with the healthcare provider who manages your hypertension and let your pregnancy provider know about your hypertension at a preconception visit. Among other things, they might have changed your high blood pressure medication, because
some antihypertensive drugs, such as ACE inhibitors, may raise the risk of birth defects when taken during pregnancy. If that didn't happen before you got pregnant, call your provider right away and be sure to discuss any medications you're on. (If you don't have a pregnancy provider yet, call the provider who's been managing your hypertension.) Depending on your condition, you may be referred to a perinatologist (a high -risk specialist). At your first visit with your pregnancy caregiver, be prepared to tell her everything you know about your hypertension — for instance, when it started, what tests or work-up procedures have been performed, and what medications you've taken in the past and are currently taking (if any). It's a good idea to arrange for a copy of your medical records to be sent ahead of time (or bring them with you) so your caregiver can review your blood pressure readings over time, as well as the results of lab tests and other evaluations. If blood and urine tests relating to your hypertension haven't been done recently, she'll probably order a complete set now. And depending on your condition and what's been done in the past, she may order an EKG, an ultrasound of your kidneys, an eye exam, and possibly other tests If this is the first time you've been diagnosed with hypertension, then you'll have a complete work -up, including tests to rule out other conditions that may be causing your high blood pressure. If you have severe hypertension, you'll need to continue taking blood pressure medication during your pregnancy. Your doctor may need to switch your usual
medication to one that's safer for your baby, though, especially if you were on an ACE inhibitor-type medication. She may decide to hospitalize you for a few days so you can be monitored closely until your medication is adjusted and your blood pressure is under control. It's critically important to keep taking your medication, because severe uncontrolled hypertension can be life -threatening. If you have mild chronic hypertension (without other complications, such as advanced diabetes or kidney disease), your caregiver may advise you to stop taking your blood pressure medication or to reduce your dose. Being off medication temporarily is unlikely to cause problems for you. If you're not currently taking blood pressure medication, your caregiver probably won't recommend starting it now. That's because pregnancy itself tends to lower your blood pressure at the end of the first trimester and keep it down throughout much of the second trimester. And if your pressure gets too low, it may actually reduce blood flow to the placenta in some cases. Plus, studies suggest that blood pressure medication won't lower your risk of developing pregnancy complications. That said, if your pressure starts to get too high, you'll be started on medication (or have your dose increased) to protect you from the serious consequences of severe hypertension. Whether your hypertension is severe or mild, it's important to keep all of your prenatal appointments so your caregiver can monitor you and your baby and spot any developing problems, such as rising blood pressure, signs of preeclampsia, or
poor fetal growth. You'll have more frequent prenatal visits and lab tests to monitor how you're doin g. In addition to the usual second-trimester ultrasound, you'll have periodic ultrasounds in your third trimester to monitor your baby's growth and your amniotic fluid level, as well as regular fetal testing (nonstress tests or biophysical profiles) and possibly Doppler ultrasounds (to check blood flow to your baby). If at any time during pregnancy your blood pressure gets too high, you'll be hospitalized until it's under control, and if you develop superimposed preeclampsia, you'll be hospitalized until you give birth. Depending on your condition and your baby's health, you may have to deliver early, even if your baby is premature. You'll need to pay particular attention to your salt intake: Avoid the saltshaker, try to use fresh foods instead of prepared or processed ones, and check labels for sodium content. If you've never had nutritional counseling or are unclear about how to keep your salt intake within the limit recommended by your caregiver, ask her for a referral to a registered dietitian who can hel p devise a diet plan that works for you. She may also recommend cutting back on activity and avoiding aerobic exercise. If you smoke or drink alcohol, it's now even more important to stop, since they can both make your hypertension worse. Complications of Chronic Hypertension in Pregnancy Pregnancy-aggravated hypertension
Superimposed preeclampsia Placental abruption Fetal and Neonatal Complications of Hypertension in Pregnancy Prematurity Placental insufficiency Intrauterine growth restriction Placental abruption Blood Pressure Medications Commonly Used During Pregnancy Alpha-methyldopa Labetalol Calcium channel blockers