High blood pressure (hypertension) can occur at anytime in life and may lead to serious and even life-threatening complications. It can be of greater concern in pregnant women as it can jeopardize the pregnancy. It therefore needs to be constantly monitored in pregnant women and treated if necessary to limit the complications. Sometimes the hypertension is present before pregnancy and persists through or even exacerbates with pregnancy. At other times, hypertension arises during pregnancy in women without a history of high blood pressure. Irrespective of the time of onset, hypertension carries the a definite risk in maintaining a health pregnancy. Hypertension is defined as a systolic blood pressure exceeding 140 mmHg and a diastolic blood pressure of 90 mmHg or more.
Types of Hypertension
Essential hypertension is the most common type of high blood pressure. It occurs for no known reason and may arise irrespective of pregnancy. It is a chronic type of hypertension that tends to get worse over time although lifestyle modification and medication can control it to some extent. In some instances it can arise during pregnancy although it is most likely not due to the pregnant state. It tends to continue after delivery and is defined by its persistence 6 weeks after delivery.
Gestational hypertension is high blood pressure that arises in pregnancy due to the pregnant state. The blood pressure tends to return to normal after childbirth but there is an increased risk of developing essential hypertension later in life. Gestational hypertension needs to be approached with caution as it may be a sign of pre-eclampsia – a potentially fatal condition in pregnancy. Therefore every case of gestational hypertension even in the absence of other signs is considered as pre-eclampsia until proven otherwise.
Pre-eclampsia, previously known as toxemia of pregnancy, is a dangerous condition that arises in pregnant women for no known reason. There are number of risk factors associated with pre-eclampsia including obesity, first pregnancy, family history of pre-eclampsia, multiple pregnancy and diabetes. However, even women without these risk factors may develop pre-eclampsia. Other typical signs and symptoms include swelling of the face and hands and protein in the urine. There may also be changes in vision, severe headaches, abdominal pain, nausea and vomiting and dizziness.
Treatment of Hypertension in Pregnancy
The treatment options depend on the type of hypertension and severity of the condition. While starting medication for hypertension during pregnancy is avoided as far as possible, if necessary it may be prescribed. Women who have pre-existing hypertension and are on anti-hypertensive medication should not stop drug therapy once they fall pregnant without consulting with a doctor. Bed rest, dietary modification like a low sodium diet and even weight control may all help with minimizing hypertension.
In pre-eclampsia, an early delivery is necessary even if this means giving birth to a pre-term baby. This is the only cure for pre-eclampsia which if left untreated can be life-threatening to both mother and the unborn child. However, if pre-eclampsia occurs very early in pregnancy where delivery is not a viable option as yet then close monitoring is essential. Drug therapy may also be commenced. In severe cases, however, labor may be induced or a Cesarean section conducted despite the baby’s gestational age.