Blood Pressure Study Advises More Induced Births
Expectant mothers with high blood pressure should be induced at 37 weeks, according to research published today that could change medical practice.
Researchers in the Netherlands found that women with high blood pressure or mild pre-eclampsia who were induced three weeks before their due date had nearly 30% less chance of developing further complications than those who were not. The Royal College of Obstetricians and Gynaecologists said the findings could bring back the days of advising more women to opt for induced births.
The study, to be published in the Lancet, was carried out by Dr Corine Koopmans, of University Medical Centre Groningen, in the Netherlands, where hypertensive disorders such as gestational hypertension and mild pre-eclampsia are the primary cause of maternal death.
Researchers looked at 758 pregnant women with high blood pressure or mild pre-eclampsia. They found that 31% of those who were induced developed birth complications, compared with 44% among women whose condition was monitored until delivery.
“Our findings that induction of labour was associated with a reduced risk of severe hypertension, and subsequent reduced need for caesarean section, emphasise the importance of frequent blood pressure monitoring during the concluding weeks of pregnancy,” said Koopmans.
“We believe that induction of labour should be advised for women with gestational hypertension or mild pre-eclampsia at a gestational age beyond 37 weeks.”
How High Is Too High
The American College of Obstetricians and Gynecologists estimates that 1.5 percent of patients enter pregnancy with chronic hypertension a number that increased 67 percent from 2000 to 2009 due in part to the obesity epidemic and increased maternal age.
Having high blood pressure in pregnancy or postpartum puts you at greater risk for stroke, preterm birth, seizures, and death. Chronic hypertension increases your risk of stroke, heart attack, and death. Keeping your blood pressure in check dramatically reduces your risks.
Follow these parameters when monitoring your blood pressure:
- Normal: A normal, healthy blood pressure reading is 120/80. Once we creep over that, the brain’s ability to regulate blood flow is impacted at varying levels, depending on the patient.
- High: During pregnancy and the few weeks after, your blood pressure may be 140/90. This is considered high, but not severe. You and your doctor should keep an eye on your blood pressure to make sure it goes no higher.
- Emergency: Having a blood pressure reading of 160/110 or higher is a medical emergency.
Women who had preeclampsia may still be at risk up to six weeks after delivery. Women who had high blood pressure before and during pregnancy continue to be at risk as long as their blood pressure remains high.
Managing High Blood Pressure During Pregnancy
As part of your regular prenatal care, your healthcare provider will measure your blood pressure at each visit. Learn more about how to prepare for a blood pressure test.
If you have high blood pressure, you and your baby will be closely monitored so you can receive special care to lower the chance of complications. You may need to:
- Check your blood pressure at home. Visit Measure Your Blood Pressure for more information.
- Keep track of how many times you feel the baby kicking each day.
- Limit your physical activity. Talk to your healthcare provider about what level of physical activity is right for you.
- Take medicine to control your blood pressure. If you do, talk to your provider about which medicines are safe for your baby. These medicines may include calcium-channel blockers taken by mouth, or beta blockers or vasodilators through an intravenous injection.
- Take aspirin in the second trimester,if you are at risk of preeclampsia and your provider recommends aspirin.
- Visit your provider more often to monitor your condition and your babys growth rate and heart rate. He or she may order blood and urine tests to check how well your organs are working, which can help detect preeclampsia.
Learn about the risks of high blood pressure before, during, and after pregnancy and get questions to ask your doctor.
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If You Are Already Taking Medicine For High Blood Pressure
If you’re already taking medicine to lower your blood pressure and want to try for a baby, talk to your GP or specialist first. They may want to switch you to a different medicine before you get pregnant.
If you find out you’re already pregnant, tell your doctor immediately. They may need to change your medicine as soon as possible.
This is because some medicines that treat high blood pressure may not be safe to take when you’re pregnant. They can reduce the blood flow to the placenta and your baby, or affect your baby in other ways.
What Causes High Blood Pressure
During pregnancy, existing high blood pressure can get worse and new blood pressure issues can develop. Total blood volume doubles during pregnancy, putting additional strain on the blood vessels.
Usually, the patient’s blood pressure levels off after delivery. But this can take time. Additionally, some women dont develop blood pressure issues until after delivery. When a patient’s blood pressure exceeds 140/90 for the first time in the postpartum period, the patient may have postpartum preeclampsia.
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Symptoms Of Early Labor
These signs appear days or hours before the labor begins. Count any of these signs as a warning signal and prepare for going into labor once these signs start to show up:
- The vaginal discharge increases and its appearance also change. It will become thicker. The mucus plug also will come out. It can come out either in a large single piece or many small pieces. Check for this after every time you urinate, before flushing. When the vaginal discharge turns out to be thick and pinkish, it is a vital sign of approaching labor
- You will start to experience stronger and more frequent contractions, which progress with time . The pain due to contractions starts in the lower back and moves to the abdomen and eventually progresses to the legs
- Rupture of the amniotic sac, in other words, the water breaking is one of the final signs of upcoming labor.
When To Treat Hypertension During Pregnancy
Significant hypertension must be treated in its own right, regardless of the assumed underlying pathology, largely to reduce the risk of maternal intracranial haemorrhage. The level at which antihypertensive treatment is initiated for non-severe hypertension remains controversial, depending on whether treatment is focused on maternal or fetal wellbeing.16,17 Most physicians commence antihypertensive medication when the systolic blood pressure > 140170 mm Hg or diastolic pressure > 90110 mm Hg. Treatment is mandatory for severe hypertension when the blood pressure is 170/110 mm Hg. Once treatment is started, target blood pressure is also controversial, but many practitioners would treat to keep the mean arterial pressure < 125 mmHgfor example, a blood pressure 150/100 mm Hg. Overzealous blood pressure control may lead to placental hypoperfusion, as placental blood flow is not autoregulated, and this will compromise the fetus. Unfortunately there is no evidence that pharmacological treatment of chronic or gestational hypertension protects against the development of pre-eclampsia. Changes in diet or bed rest have not been shown to provide maternal or fetal benefit.w1820
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What Should I Do If I Have High Blood Pressure Before During Or After Pregnancy
Before Pregnancy
- Make a plan for pregnancy and talk with your doctor or health care team about the following:
- Any health problems you have or had and any medicines you are taking. If you are planning to become pregnant, talk to your doctor.7 Your doctor or health care team can help you find medicines that are safe to take during pregnancy.
- Ways to keep a healthy weight through healthy eating and regular physical activity.1,7
During Pregnancy
- Get early and regular prenatal careexternal icon. Go to every appointment with your doctor or health care professional.
- Talk to your doctor about any medicines you take and which ones are safe. Do not stop or start taking any type of medicine, including over-the-counter medicines, without first talking with your doctor.7
- Keep track of your blood pressure at home with a home blood pressure monitorexternal icon. Contact your doctor if your blood pressure is higher than usual or if you have symptoms of preeclampsia. Talk to your doctor or insurance company about getting a home monitor.
- Continue to choose healthy foods and keep a healthy weight.8
After Pregnancy
- Pay attention to how you feel after you give birth. If you had high blood pressure during pregnancy, you have a higher risk for stroke and other problems after delivery. Tell your doctor or call 9-1-1 right away if you have symptoms of preeclampsia after delivery. You might need emergency medical care.9,10
How Do We Treat It
ACOG guidelines for preeclampsia recommend IV medication treatment that begins within 30 to 60 minutes of confirmed severe, acute hypertension. The goal is to lower the patient’s blood pressure to between 140/90 and 150/100 to prevent prolonged exposure to severely high blood pressure.
During this time, the care team will frequently check your blood pressure and monitor the baby for signs of distress, such as changes in fetal activity or heart rate. The only way to “cure” preeclampsia is to deliver the baby often, patients with preeclampsia must deliver early to prevent the mother from having a potentially deadly stroke or seizure.
Emergencypostpartum hypertension may also be treated with IV therapy or oral medication. In some cases, the doctor may recommend magnesium therapy to prevent preeclampsia-induced seizures. Patients who go to their local doctor’s office with very high postpartum blood pressure should be transferred to a hospital for treatment and monitoring.
Chronic hypertension, while not usually an emergency, is a long-term health risk that must be controlled. Most patients can achieve a healthy blood pressure through a combination of medication, exercise, and diet changes. Increasing exercise and reducing sodium are two key factors in getting blood pressure to a healthier level.
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What Are High Blood Pressure Complications During Pregnancy
Complications from high blood pressure for the mother and infant can include the following:
- For the mother:preeclampsiaexternal icon, eclampsiaexternal icon, stroke, the need for labor induction , and placental abruption .1,4,5
- For the baby:preterm delivery and low birth weight .1,6 The mothers high blood pressure makes it more difficult for the baby to get enough oxygen and nutrients to grow, so the mother may have to deliver the baby early.
Discuss blood pressure problems with your health care team before, during, and after pregnancy.
Learn what to do if you have high blood pressure before, during, or after pregnancy.
High Blood Pressure In Pregnancy
5-minute read
High blood pressure in pregnancy is a common medical problem that usually disappears once the baby is born. In some cases, it can signal a serious condition called pre-eclampsia.
Your blood pressure is a measure of how strongly your blood pushes against the walls of the blood vessels. Its normally recorded in 2 numbers: the top one is the pressure when the heart is pumping, and the bottom one is the pressure in between each beat.
When you are pregnant, you are considered to have high blood pressure when the top number is 140 or more or the bottom number is 90 or more . High blood pressure is sometimes called hypertension.
Seek medical attention urgently if you have high blood pressure in pregnancy along with:
- a severe headache
- sudden swelling of the face, hands and feet
- a pain in your upper abdomen
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Can High Blood Pressure During Pregnancy Be Prevented
Since the cause of high blood pressure during pregnancy is not known, it is not a condition that can usually be prevented. In some women at high risk for developing high blood pressure, healthcare providers often recommend daily baby aspirin for prevention. High blood pressure during pregnancy can sometimes be managed and controlled with the help of a healthcare provider. However, this may often require delivery of the baby. Your blood pressure will be checked regularly during prenatal appointments. If you have any concerns about your blood pressure, speak with your healthcare provider.
Home Blood Pressure Checks
We strongly encourage women to own and use a home blood pressure cuff. Devices can be purchased from local drug stores or online for $20 to $50.
If cost is a barrier, check out the Preeclampsia Foundation. This nonprofit organization offers low-to-no-cost blood pressure “Cuff Kits” for women who meet eligibility requirements. Learn more.
When checking your blood pressure at home:
- Check it at the same time every day when possible.
- Sit upright and slightly reclined. Lying down may lead to a false low reading.
- Record your blood pressure readings in a journal or on your phone. Show it to your doctor to assess trends related to your daily life. Get more tips now.
Morbidity and mortality related to postpartum hypertension should be 100 percent preventable. Our goal is to help educate and care for more women to prevent maternal blood pressure issues postpartum. It wont take much to make a big difference.
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What Is Normal Blood Pressure In Pregnancy
Normal blood pressure in pregnancy is less than 120/80 mm Hg. Thats expressed as 120 over 80.
Blood pressure is measured in millimeters of mercury , and the measurement has two numbers. The top number is the pressure of your blood against the walls of your arteries when your heart contracts and pumps blood. The bottom number is when the heart relaxes and fills with blood.
High blood pressure is diagnosed when either the systolic or diastolic number is at an unhealthy level or if both are.
The guidelines for blood pressure readings during pregnancy are:
- Normal: Less than 120/80 mm Hg
- Mild hypertension: Higher than 140/90 mm Hg
- Severe hypertension: Higher than 160/110 mm Hg
These numbers are different than guidelines for blood pressure for people who arent pregnant.
Your provider or a medical assistant will measure your blood pressure at each prenatal visit. Your healthcare provider may also ask you to monitor your blood pressure at home.
Before concluding that you have hypertension, your provider will probably take your blood pressure readings at least two different times. Thats because your blood pressure varies throughout the day, and it can go down when youre relaxed and up when youre active or stressed. Some people may have an above-normal blood pressure reading because they get nervous at the doctors office a phenomenon called white-coat hypertension.
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What Are The Different Forms Of High Blood Pressure During Pregnancy
High blood pressure complicates about 10 percent of all pregnancies. There are several different types of high blood pressure during pregnancy. These types vary in severity and impact on the body. The forms of high blood pressure during pregnancy include:
- Chronic hypertension: High blood pressure which is present prior to pregnancy.
- Chronic hypertension with superimposed preeclampsia: Preeclampsia, which develops in someone who has chronic hypertension .
- Gestational hypertension: High blood pressure is noted in the latter part of pregnancy, but no other signs or symptoms of preeclampsia are present. Some women will later develop preeclampsia, while others probably have high blood pressure before the pregnancy.
- Preeclampsia: A condition only found in the latter half of pregnancy and results in hypertension, protein in the urine, and generalized swelling in the mother. It can impact other organs in the body and also cause seizures .
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What Are The Signs And Symptoms Of A Normal Delivery
Understanding and recognizing signs and symptoms of delivery will not only help you to cope with the whole delivery process, but if you have a basic concept of what to assume in a normal delivery, itll also help to hold your anxieties down.
The signs and symptoms of normal delivery start weeks before the expected day of delivery. The due date for delivery is somewhat erratic even after your specialist gives you an estimated date for it.
In the case of normal delivery, the signs and signals indicate and alert you at the right time. The signs and symptoms vary with each expecting woman, as not all pregnancies are alike. Carefully watch out for the following signs and symptoms.
What Can High Blood Pressure After Delivery Mean
It can be common to see a hike in blood pressure after a woman delivers a baby. It can raise the risk for having chronic disease later in life. There are many different factors that can affect your postpartum blood pressure. To make sure you and your infant remain healthy, speak with your doctor if your blood pressure is elevated after delivery.
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Am I At Risk Of Developing Gestational Hypertension
- This is your first pregnancy.
- Youre expecting twins or more.
- Youre of black ethnic origin.
- You were obese at the start of your pregnancy. Your midwife will work out your body mass index at your booking appointment. If its 35 or more, it increases your chance of developing high blood pressure.
- You had type 1 diabetes before you were pregnant.
High Blood Pressure During Pregnancy
Some women have high blood pressure during pregnancy. This can put the mother and her baby at risk for problems during the pregnancy. High blood pressure can also cause problems during and after delivery.1,2 The good news is that high blood pressure is preventable and treatable.
High blood pressure, also called hypertension, is very common. In the United States, high blood pressure happens in 1 in every 12 to 17 pregnancies among women ages 20 to 44.3
High blood pressure in pregnancy has become more common. However, with good blood pressure control, you and your baby are more likely to stay healthy.
The most important thing to do is talk with your health care team about any blood pressure problems so you can get the right treatment and control your blood pressurebefore you get pregnant. Getting treatment for high blood pressure is important before, during, and after pregnancy.
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