High blood pressure is a concern for anyone who battles it, but when it happens during pregnancy it can be especially pernicious.
It can lead to a life-threatening condition called preeclampsia, which is when the mother’s blood pressure becomes elevated after the 20th week of pregnancy.
Blood pressure is one of the things nurses will check every time you visit your doctor during your pregnancy.
At the start of your journey, your blood pressure may be lower than normal. (The new normal for blood pressure has been changed to 120/80.)
High blood pressure can present itself long before pregnancy, as well as anytime during or after.
When it’s present before becoming pregnant, or even before the 20th week, it’s called chronic hypertension. This is simply hypertension that has already existed before the mom became pregnant, or she’s had previous blood pressure issues and she’s now taking medication.
Gestation hypertension, meanwhile, involves high blood pressure that presents itself after the 20-week mark. A woman’s blood pressure will typically drop to normal after birth, but issues could still arise. (According to the Preeclampsia Foundation, 42 percent of women who experience severe preeclampsia still had high blood pressure a year after delivery.)
A few years ago, doctors had considered proteinuria—protein in the urine—one of the hallmark signs of preeclampsia.
The American College of Obstetricians and Gynecologists changed those guidelines in recent years, however, after finding that some women had received delayed care for hypertension simply because they did not have protein in their urine.
The new guidelines say that treatment should be initiated even if proteinuria is not present.
The sooner hypertension is recognized and treated, the better the outcomes for mom and baby.
Hypertensive disorders such as preeclampsia affect about 10 percent of pregnant women worldwide.
While many studies have been done on preeclampsia, we still don’t know the exact cause as it relates to pregnancy. This is especially worrisome considering that the incidence rate has risen steadily in the last 30 years.
Preeclampsia can affect 1 in 12 pregnancies, either during pregnancy or afterward. Untreated, it can turn to eclampsia, which is when the mom suffers seizures.
When I began my career in nursing years ago, we were taught to look for three symptoms: elevated blood pressure, swelling and protein in the urine.
We now know that these three symptoms needn’t be present. There are other signs to watch for.
Lab values, for instance, can be especially useful in revealing the happenings inside a pregnant woman’s body.
To screen for issues, your obstetrician’s office will document critical details about your medical history and your family history. In the first trimester, your doctor will want to know:
- If you had preeclampsia with other pregnancies
- If a family member (mother or sister) had preeclampsia
- If you are pregnant with more than one baby
- Any history of high blood pressure before pregnancy
- Any medical history of diabetes, lupus, rheumatoid arthritis or kidney disease
A history of high blood pressure, diabetes, kidney disease or organ transplant increases a mother’s risk. Other risk factors include age (over 35 or under 20), polycystic ovarian syndrome, lupus or autoimmune disorders, in-vitro fertilization and sickle cell diease. The Preeclampsia Foundation provides more details on the condition.
Doctors will also check your weight and watch for any issues with obesity, which can play a role.
With my first baby, I gained 5 pounds in one weekend. At the 33-week mark I had still been working full time. I happened to catch my doctor in the hall, so he took my blood pressure.
It was a bit elevated, so he sent me to get checked out. I had the beginnings of preeclampsia.
Your don’t need to rely only on the watchfulness of doctors and nurses. There are signs of hypertension you can watch for, including:
- Quick weight gain
- Epigastric pain
- Dizziness or severe headaches
- Vision changes
- Less urine than normal
- Lower back pain
- Shoulder pain
- Sudden swelling of hands, feet or face
There’s also the matter of silent preeclampsia, which is when the mom doesn’t notice any of the symptoms. This is why it’s so important to have your blood pressure checked at your appointments.
Always alert your provider to any changes in how you’re feeling.
There is no cure for preeclampsia, other than the baby being born. And even then, the mother can still be at risk.
Depending on the severity of the condition, doctors can either monitor the mother and continue with the pregnancy, or they may have to induce labor. These are discussions moms should have with their provider in those circumstances.
But once the baby is born, the mother can typically begin to recover.
Keep in mind that preeclampsia can still develop after the birth of baby. Postpartum preeclampsia is more common in the first seven days, but it can still manifest up to six weeks after birth.
If you’re seeing spots, if your blood pressure is 160/110 or higher, or you’re having trouble breathing, head to the nearest emergency room.
With our sixth baby, I didn’t have any issues with my blood pressure during the pregnancy, although I had a lot of swelling.
Within three days of returning home, however, I got hit by a headache unlike anything I’d ever experienced. I checked my blood pressure—it was very high—and headed to the ER. I ended up in the ICU with medications for five days, returning home with nearly four weeks’ worth of blood pressure medications.
Here’s what to watch for when you return home.