What are the types of high blood pressure during pregnancy?
During pregnancy, blood pressure usually decreases slightly in the first half of the term, and returns to its original level towards the end. The increase can be of different nature, and the risks and treatment depend on it. The doctor clarifies whether the pressure was elevated before pregnancy, when high numbers were first recorded, and whether there is protein in the urine. Sometimes blood pressure rises only in the doctor's office from excitement - this is determined using home measurements and ABPM.
- Chronic hypertension - before pregnancy or before 20 weeks
- Gestational hypertension - after 20 weeks, no protein in urine
- Preeclampsia—hypertension with protein in the urine or organ damage
- Preeclampsia due to chronic hypertension
- White coat hypertension
Causes and risk factors
The exact reasons are not fully understood. It is believed that gestational hypertension and preeclampsia are associated with impaired vascular adaptation to pregnancy and the functioning of the placenta. The likelihood is higher in women who are overweight, have a first or multiple pregnancy, have kidney disease, or have diabetes. If your blood pressure rises early, before 32–34 weeks, there is a greater risk of progression to preeclampsia.
- First pregnancy
- Excess body weight
- Multiple pregnancy
- Age over 35–40 years
- Kidney disease, diabetes
- Maternal hypertension during her pregnancies
Symptoms and how to measure blood pressure correctly
Most often, high blood pressure does not manifest itself in any way; sometimes headaches, tinnitus, and palpitations bother you. Therefore, the main method of detection is regular measurements. Pressure is measured while sitting, after 5 minutes of rest, with your back supported, your arm at heart level, and a cuff of a suitable size. It is better to take two measurements one minute apart and record the result in a diary in the morning and evening. An automatic tonometer for the shoulder is more accurate than a wrist one.
- Headache in the back of the head
- Noise in the ears, flashing of flies
- Heartbeat
- Swelling that increases rapidly
- Often - no complaints
Survey
If your blood pressure is 140/90 or higher, your doctor will check urine protein, a complete blood count with platelets, liver enzymes, and creatinine to rule out preeclampsia. These tests are repeated over time, usually once a week or more often. The child’s condition is assessed by ultrasound with Doppler and CTG. Daily blood pressure monitoring helps to estimate real numbers during the day and night. An ECG and consultation with a cardiologist are needed if blood pressure is difficult to control or if there are heart complaints.
- Home blood pressure diary
- ABPM
- Protein in urine, urinalysis
- Complete blood count, ALT, AST, creatinine
- Fetal ultrasound with Doppler and CTG
- ECG
Treatment and observation
With a moderate increase in blood pressure, the doctor prescribes medications approved during pregnancy. Many common medications for hypertension are contraindicated for pregnant women, so only a doctor can select the treatment, and those who took them before pregnancy should urgently discuss a replacement. Complete bed rest and strict salt restriction are not recommended. The goal is to keep your blood pressure within safe limits and spot signs of preeclampsia early. If the condition is stable, birth is usually planned closer to full term. After birth, blood pressure is monitored for several more weeks, and then annually.
- Antihypertensive drugs allowed during pregnancy
- Measuring blood pressure at home 2 times a day
- Weekly monitoring of protein in urine
- Moderate activity and adequate sleep
- Hospitalization for 160/110 or signs of preeclampsia
- Blood pressure control after childbirth and in the future
