Hypertension in Pregnancy

In honor of Preeclampsia Awareness Month, I want to dedicate this blog post to Hypertension in Pregnancy. Hypertension in Pregnancy is an umbrella phrase covering a few conditions, gestational hypertension, chronic hypertension, chronic hypertension with superimposed preeclampsia, preeclampsia, eclampsia, and HELLP syndrome. In summary, the onset of "gestational hypertension" happens on or after 20 weeks (5 months), instead of chronic hypertension, which occurs before pregnancy or before 20 weeks. The patient with chronic hypertension is usually already on blood pressure medication. Either diagnosis can lead to preeclampsia.

In 2017, the CDC reported cardiovascular disease was the number 1 killer of women of all races and ages in the United States. Currently, cardiovascular conditions and bleeding are the leading causes of death during pregnancy.

Hypertension (HTN), as known as high blood pressure, is usually defined as systolic blood pressure (SBP) of 140 or higher or diastolic blood pressure (DBP) of 90 or higher. Severe range blood pressures are SBP of 160 or higher and DBP of 110 or greater. Some common causes of HTN are diabetes, obesity, unhealthy diet, physical inactivity, stress, smoking, drinking, and genetics (family history).

The exact cause of preeclampsia is unknown, but it is thought to be caused by abnormal placenta implantation, causing issues with perfusion for the placenta. Preeclampsia can be considered mild, moderate, or severe, depending on the blood pressure readings and other symptoms that the client may exhibit. Everyone does not show or experience the same signs; however, there are a few classic symptoms. These symptoms include elevated blood pressure (SBP 140 or greater, DBP 90 or greater), proteinuria (protein in your urine, diagnosed by a urine dipstick), swelling in extremities, headaches, and visual disturbances (blurred vision, double vision, floaters or black spots before your eyes). Untreated hypertension can lead to a domino effect of complications because of the under-perfused placenta. More extreme complications are intrauterine growth restriction (IUGR) with the baby or even fetal death. Complications in mom can lead to severe conditions known as HELLP syndrome or Disseminated Intravascular Coagulation (DIC). HELLP syndrome stands for hemolysis, elevated liver enzymes, and low platelet. It's diagnosed with blood work. These conditions can be fatal as they deal with hemorrhaging and blood clots.

Preeclampsia can progress to eclampsia if not treated in time. Eclampsia occurs when the patient starts having seizures. The best way to prevent complications is by being aware of the risk factors and staying on top of your health.

Risk factors include first-time pregnancy, multiple gestations (twins, triplets), advanced maternal age (AMA), medical history of any of the following conditions: hypertension, diabetes, obesity, or a family history of preeclampsia. Interventions to decrease the likelihood of being diagnosed with preeclampsia are eating a healthy diet and staying active with moderate exercise activities. It is essential to take medications as prescribed, keep your health and wellness checkups, and follow medical advice from your healthcare provider. If we are proactive, we don't have to be reactive. Let's not wait until our bodies force us to make necessary lifestyle changes.

I hope you have gained some insight into hypertension in general and pregnancy so we can start to live a more healthy lifestyle and decrease the unfortunate outcomes in the maternal world.

Technology is AMAZING. These two blood pressure cuffs has the ability to track your BP readings on your electronic devices. Therefore, when you go to your regularly scheduled prenatal visits you can provide a log to your provider to review. These blood pressure cuffs are HSA/FSA eligible.

FYI: You will get a more accurate reading by using an upper arm cuff as opposed to a wrist cuff. Always make sure your feet are flat on the ground and try not to talk while taking your blood pressure.

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