Hypertension and pregnancy: Essential guidelines for expectant mothers to manage high blood pressure

A very important health condition, which is the leading cause of maternal and perinatal morbidity and mortality in India, is hypertension or a high blood pressure during pregnancy that presents in a variety of scenarios and needs careful diagnosis and targeted treatment to achieve a good pregnancy outcome. Commonly, gestational hypertension or PIH (Pregnancy induced hypertension) is defined as high blood pressure only during pregnancy but that can be very risky for both the mother and her baby.

In an interview with HT Lifestyle, Dr Sushruta Mokadam, Consultant Obstetrician at Motherhood Hospital in Pune's Kharadi, shared, “Unmonitored high blood pressure can also invite various complications for the mother even after delivery. Mothers may encounter problems such as preeclampsia, eclampsia, ( convulsions) , stroke, and placental abruption (placenta getting separated from the wall of the uterus) during the course of the second and third trimesters. These are emergencies handled by immediate admission and delivery. Babies can have low birth weight and prematurity. Hence, a treating doctor must be alert and must devise a treatment plan for the pregnant woman to ensure successful delivery.”

She highlighted that hypertension before, during and after pregnancy falls in the following categories -

Chronic Hypertension: When a woman has pre-existing hypertension and gets pregnant, she is already on anti- hypertensive medicines, which need to be changed to pregnancy - friendly medicines as some antihypertensives are not safe for the baby. Hence measuring BP at the first visit is very important to establish this condition, especially in elderly patients. Some may be unaware of their condition until their first prenatal visit with their doctor, as high blood pressure doesn’t have any symptoms, making it hard to detect. Once diagnosed, counseling is important about the complications such as preeclampsia, premature birth, and low birth weight.

Gestational Hypertension: When an apparently healthy pregnant woman developed high blood pressure for the first time after the 20th week of pregnancy, it is called gestational hypertension, i.e. hypertension due to her pregnant state. This arises from changes in the placenta and is a worsening condition which is relieved only by delivery. If blood pressure is more than 130/90 mmHg, it is considered gestational hypertension.

Preeclampsia/Eclampsia: Preeclampsia is an exacerbated gestational hypertension with additional swelling of tissues , especially feet, and protein in the urine. These are ominous signs to suggest multi organ involvement, namely kidneys and liver and risk of mishaps, such as hemorrhage and seizures and even intrauterine death of the foetus.Those women known to have chronic hypertension can also develop preeclampsia. The signs of this condition include lingering headaches, blurred vision, nausea, vomiting, sudden weight gain, and breathing problems. Eclampsia is the catastrophic outcome of untreated preeclampsia when the patient has seizures, loss of consciousness, and fetal compromise.

Tips for managing high blood pressure before, during, and after pregnancy

Dr Sushruta Mokadam advised, “Before planning pregnancy, discuss with your doctor about any additional health problems, presence of family history of hypertension and start medication with an appropriate treatment plan. Particular attention to diet and treatment of underlying disorders such as deficiency of folates, Vit B12, Vit D3, thyroid hormone, sugar control and protein supplements should be considered. During pregnancy, women should opt for prenatal care without fail. They should follow guidelines given by the doctor to maintain a healthy weight by eating a well-balanced diet and exercising under the guidance of a certified expert.”

She recommended, “Pregnant women should monitor their blood pressure at home or in a clinical setting as suggested by the doctor. Eating packaged or processed food containing high amounts of sodium and preservatives which is harmful for the health of the mother and the baby should be curtailed. At least 8 hours of sound sleep at night is essential to relieve stress and allow for fetal growth. Regular blood tests to monitor crucial components of a mother's well being and some tests done early at 12 weeks even predict whether the patient can develop hypertension and low dose aspirin tablets are prescribed to such women at risk. Following the prescription to the T is very important.”

Thus, staying vigilant and improving quality of life by adhering to these foolproof tips will go a long way in avoiding problems and ensuring a healthy mother and baby.