Prepared by Dr. Hon Sook Kit,
Consultant Obstetrician and Gynaecologist,
Gleneagles Hospital Johor
What is High Blood Pressure During Pregnancy?
High blood pressure during pregnancy, also known as pregnancy-induced hypertension, occurs when a pregnant woman has a blood pressure reading of 140/90 mm Hg or higher in two separate readings that are 4 or more hours apart. Severe high blood pressure during pregnancy is diagnosed when a pregnant woman has a blood pressure reading of 160/110 mm Hg or higher on two or more occasions.
In Malaysia, hypertension during pregnancy is becoming increasingly prevalent. Non-communicable diseases, particularly hypertension, are on the rise. According to the National Health and Morbidity Survey 2015, high blood pressure affects 30.3% of all adults aged 18 years and above, meaning one in three Malaysians is affected.
Among those diagnosed with the condition, hypertension was prevalent in 14% of women compared to 12.2% of men. Although pregnancy is a known risk factor for developing high blood pressure, there is no direct link between the disease and gender.
Blood pressure is one of the vital signs your obstetrician looks for during an antenatal check-up. Blood pressure readings are given as two numbers: the first (systolic blood pressure) is the pressure when the heart contracts, and the second (diastolic blood pressure) is the pressure when the heart relaxes. High blood pressure in pregnancy can be confirmed when the systolic reading is 140 mm Hg or greater, or when the diastolic reading is 90 mm Hg or greater over a period of weeks.
The condition puts extra strain on the heart and kidneys, and left unchecked, can lead to more severe complications, including heart disease, kidney diseases, and stroke.
While hypertension during pregnancy is a concern, it is important to note that with proper blood pressure management, a safe pregnancy and healthy baby can be ensured. Regular monitoring and appropriate interventions can significantly reduce the risks associated with pregnancy hypertension.
Types of High Blood Pressure (Hypertension) in Pregnancy
There are several kinds of hypertension during pregnancy that can develop as a woman progresses through her pregnancy:
Gestational Hypertension
Gestational hypertension is a type of high blood pressure during pregnancy that only occurs while expecting and usually develops after the first 20 weeks of pregnancy. A warning sign of this condition is the presence of protein in urine or changes in liver function. Though this form of high blood pressure in pregnancy is typically temporary, some women may develop chronic hypertension later in life and could be at risk for more serious complications in pregnancy, such as preeclampsia. Women who are overweight or obese prior to pregnancy may lower their chances of having gestational hypertension by maintaining a healthy weight before conception.
Chronic Hypertension
Chronic hypertension affects women who either had high blood pressure prior to pregnancy or developed it within the first 20 weeks of pregnancy. It is important for women with chronic hypertension to disclose a blood pressure medication intake to your obstetrician so that they can determine its safety, advise a lower dosage, or recommend alternative treatments. Certain medicines, namely ACE inhibitors and angiotensin receptor blockers, can harm the foetus. It is possible for women to further develop chronic hypertension with superimposed preeclampsia. Those with this condition may experience worsening high blood pressure and abnormal amounts of protein in their urine, which can lead to changes in liver function and problems with the kidneys.
Preeclampsia
Preeclampsia is a severe hypertensive medical disorder that usually occurs in the third trimester, although it can also develop after delivery in rare cases. It is associated with signs of damage to other organs, including the brain, blood, kidneys, and liver. If left untreated, preeclampsia can lead to life-threatening complications for both the mother and baby. Among them are eclampsia, which causes seizures and possibly coma, as well as the fatal HELLP syndrome. In some cases, mild forms of preeclampsia usually do not exhibit symptoms. However, there are some red flags like proteinuria, excessive swelling of face and hands, weight gain, headaches and dizziness, irritability, shortness of breath, nausea, vomiting, blurred vision, and sensitivity to light.
Complications of Hypertension During Pregnancy
If hypertension during pregnancy has progressed to a severe state, it can lead to a range of health risks for the mother and baby:
Decreased Blood Flow to the Placenta
Severe high blood pressure can decrease blood flow to the placenta, leading to the baby receiving less oxygen and nutrients, which can cause slow growth and low birth weight. Preterm babies born due to pregnancy hypertension have a higher risk of breathing problems, infection, and other complications. The obstetrician may advise a premature birth to ensure the baby’s health is safeguarded.
Placental Abruption
Placental abruption is the separation of the placenta from the inner wall of the uterus (womb) before delivery. It is a serious complication of high blood pressure during pregnancy. Severe abruption may lead to heavy bleeding, which is a life-threatening risk for the mother and baby. Severe hypertension is one of the risk factors that can lead to placental abruption, necessitating immediate medical intervention.
Organ Damage
Severe hypertension can also cause injury to critical organs such as your brain, heart, lungs, kidneys, liver, and other major organs. This organ damage can lead to long-term health problems for the mother, especially if left untreated. For example, untreated preeclampsia can lead to stroke or kidney failure, both of which can have life-altering consequences.
Premature Birth
If hypertension in pregnancy compromises the health of the baby, an obstetrician may recommend premature delivery. This decision is typically made if your baby is not receiving adequate nutrients or if the mother’s life is in danger due to complications like preeclampsia or placental abruption.
Future Cardiovascular Risks
Women who experience hypertension during pregnancy, particularly those who have suffered from preeclampsia or have delivered a premature baby, are at a significantly higher risk of developing cardiovascular diseases in the future. Managing blood pressure during pregnancy can reduce the likelihood of these long-term health issues, but those with a history of pregnancy-related hypertension should monitor their heart health even after delivery.
New Test to Screen for Preeclampsia During Pregnancy
A new test has been developed to screen for preeclampsia during pregnancy, offering a more accurate way to identify women at risk for this serious condition. Biochemical substances such as angiogenic growth factors (namely sFIt-1 and PIGF) play a major role in the development of preeclampsia. These growth factors are thought to be mainly responsible for the imbalance that occurs during the development of hypertension in pregnancy.
By taking some blood samples, these growth factors can be measured to identify patients who need close monitoring. Patients with low risk can be reassured and continue pregnancy as per normal. For patients with higher levels, further testing and interventions may be required to manage pregnancy hypertension and prevent the onset of severe preeclampsia or other complications.
This test allows obstetricians to make more informed decisions regarding blood pressure management during pregnancy, ensuring that those at risk for preeclampsia are closely monitored and receive the appropriate care.
Managing High Blood Pressure Before and During Pregnancy
Managing high blood pressure during pregnancy involves taking proactive steps to reduce the risk of complications for both mother and baby:
Pre-Pregnancy Check-Up
It’s crucial to attend a pre-pregnancy check-up up to a year before you decide to have a child. The check-up will allow you to detect any pre-existing conditions, such as hypertension or other health issues, so you can begin managing them before pregnancy. Early intervention can help prevent the development of pregnancy hypertension and ensure that any health concerns are under control before conception.
Maintaining a Healthy Lifestyle
A healthy lifestyle plays a vital role in managing high blood pressure during pregnancy. This includes eating a balanced diet rich in essential nutrients, maintaining a healthy weight, and engaging in regular exercise. A healthy lifestyle can help regulate blood pressure and improve overall well-being, reducing the risk of gestational hypertension and other complications.
Avoiding Harmful Substances
Avoiding harmful substances such as smoking, drinking alcohol, and consuming any illicit substances is essential for keeping blood pressure in check before and during pregnancy. These substances can elevate systolic blood pressure, increase the risk of complications like preeclampsia, and harm both the mother and the baby.
By following these steps, you can better manage hypertension in pregnancy, promote a healthy pregnancy, and reduce the risk of complications such as low birth weight, preterm birth, and placental abruption.
Effects of Hypertension on Childbirth and Breastfeeding
Women with hypertension during pregnancy may be advised to induce labour before their due date to prevent severe complications for both the mother and baby. The timing of delivery depends on the degree of severity of your blood pressure, the presence of end-stage organ damage, as well as the presence of complications to the baby. Severe preeclampsia medication may be given during labour to stave off seizures.
Breastfeeding with Hypertension
Breastfeeding is generally not contraindicated for women with hypertension during pregnancy or preeclampsia. However, the obstetrician needs to make adjustments to the types of blood pressure medication to ensure that they are safe for both the mother and the baby during breastfeeding. Some medications may pass through breast milk, so it is essential for pregnant women to follow their healthcare provider’s guidance regarding medication adjustments while breastfeeding.
Manage Your High Blood Pressure During Pregnancy at Gleneagles Hospital Johor
Managing high blood pressure during pregnancy is essential for ensuring a safe and healthy pregnancy. At Gleneagles Hospital Johor, our expert obstetricians provide personalised care to monitor and manage hypertension during pregnancy, including conditions like preeclampsia and gestational hypertension. By attending regular check-ups, maintaining a balanced lifestyle, and following your doctor’s advice, you can minimize risks to both you and your baby. If you're concerned about your blood pressure or have already been diagnosed with hypertension, schedule an appointment with us today. Let Gleneagles Hospital Johor help you take proactive steps toward a healthy pregnancy and delivery.
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