Understanding Preeclampsia and High Blood Pressure during Pregnancy

High blood pressure during pregnancy can have severe implications, posing risks to both the mother and the baby. Among these risks, preeclampsia is one of the most serious complications that can arise. In this article, we will delve into the causes, symptoms, treatment, and prevention methods associated with high blood pressure and preeclampsia during pregnancy.

1. High Blood Pressure during Pregnancy

1.1 What is High Blood Pressure?

Blood pressure refers to the force exerted by the blood on the artery walls when the heart contracts to pump blood throughout the body. High blood pressure, also known as hypertension, can lead to various health issues. During pregnancy, uncontrolled or severe high blood pressure can cause complications for both the mother and the fetus.

Gestational hypertension occurs when high blood pressure develops after the 20th week of pregnancy in women who had normal blood pressure readings prior to pregnancy. Although most pregnant women recover after giving birth, having high blood pressure during pregnancy can increase the risk of developing hypertension later in life.

Blood pressure is categorized as follows:

• Normal blood pressure: Less than 120/80 mmHg
• High normal blood pressure: Systolic blood pressure between 120-129 and diastolic blood pressure below 80 mmHg
• Grade 1 hypertension: Systolic blood pressure between 130-139 or diastolic blood pressure between 80-89 mmHg
• Grade 2 hypertension: Systolic blood pressure of 140 or higher or diastolic blood pressure of 90 mmHg or higher

1.2 What Complications Can High Blood Pressure during Pregnancy Cause?

High blood pressure during pregnancy can strain the heart and kidneys, increasing the risk of cardiovascular and kidney diseases, as well as stroke.

Other potential complications include:

• Fetal growth restriction: High blood pressure can hinder the flow of nutrients through the placenta, leading to fetal development issues.
• Preeclampsia: Women with chronically high blood pressure are more susceptible to developing preeclampsia than those with normal blood pressure.
• Premature birth: Insufficient nutrient and oxygen supply from the placenta can result in premature birth.
• Placental abruption: This condition occurs when the placenta separates from the uterine wall prematurely, requiring immediate emergency care for pregnant women.
• Cesarean section: Pregnant women with high blood pressure are more likely to undergo a cesarean section compared to those with normal blood pressure. Risks associated with this procedure include infection, organ damage, and bleeding during surgery.

1.3 How to Treat and Monitor High Blood Pressure during Pregnancy?

Throughout pregnancy, blood pressure will be closely monitored, which may involve self-monitoring at home. Periodic ultrasounds will be conducted to monitor fetal development. If issues with fetal growth are suspected, additional tests will be conducted in the final three months of pregnancy to ensure the baby's health.

In cases of mild hypertension, blood pressure may remain stable or even return to normal during pregnancy, allowing for the discontinuation or reduction of medication. However, if severe hypertension poses health problems, blood pressure medication may be necessary during pregnancy.

2. Preeclampsia

2.1 What is Preeclampsia?

Preeclampsia is a dangerous blood pressure disorder that can impact multiple organs in a woman's body. It occurs as a result of high blood pressure during pregnancy, accompanied by signs of organ dysfunction, such as proteinuria (an abnormal amount of protein in the urine). Severe preeclampsia is associated with low blood platelet count, abnormal liver and kidney function, upper abdominal pain, vision changes, pulmonary edema, severe headaches, and very high blood pressure.

2.2 When Does Preeclampsia Occur?

Preeclampsia typically manifests after the 20th week of pregnancy, usually during the final three months. Early-onset preeclampsia refers to cases occurring before the 32nd week of pregnancy. Preeclampsia can also develop in the postpartum period.

2.3 What Causes Preeclampsia?

The exact cause of preeclampsia remains unknown. However, several factors contribute to an increased risk, including:

• First-time pregnancy
• Previous history of preeclampsia or a family member with a history of preeclampsia
• Chronic hypertension or kidney disease
• Maternal age of 40 or older
• Multiple pregnancies
• Pre-existing health conditions such as diabetes, hypercoagulability syndrome, or lupus
• Obesity
• In vitro fertilization (IVF)

2.4 Risks of Preeclampsia to Mother and Baby

Risks to the Baby: If preeclampsia develops during pregnancy, terminating the pregnancy may be necessary at any gestational age. Premature birth increases the risk of serious complications for the baby, including long-term disabilities and ongoing medical treatment. Premature babies are also at risk of mortality.

Risks to the Mother: Women with preeclampsia, particularly those who deliver prematurely, face an increased risk of cardiovascular and kidney diseases, as well as heart attacks, strokes, and high blood pressure. A history of preeclampsia raises the likelihood of developing it in subsequent pregnancies. Preeclampsia can also lead to eclampsia and HELLP syndrome.

2.5 Signs and Symptoms of Preeclampsia

Recognizing the signs and symptoms of preeclampsia is crucial for timely intervention and treatment. These symptoms may include:

• Facial and hand swelling
• Persistent headaches
• Visual disturbances or seeing spots
• Upper abdominal or shoulder pain
• Nausea and vomiting (occurring in the second half of pregnancy)
• Sudden weight gain
• Shortness of breath

3. Treatment of Gestational Hypertension and Mild Preeclampsia

For cases of gestational hypertension or mild preeclampsia that are not severe, pregnant women can be monitored either in the hospital or through outpatient care, where medical professionals closely track their condition.

At home, mothers can monitor fetal movements and measure their blood pressure, while regularly visiting their healthcare provider at least once, or sometimes twice, a week. Delivery may be recommended at 37 weeks or earlier if test results indicate fetal distress.

Pregnant women with severe preeclampsia are usually treated in the hospital. If stable, those beyond 34 weeks of pregnancy are often advised to give birth promptly. Women with stable health before the 34th week may wait until the optimal time for delivery.

Corticosteroids may be administered to promote lung maturation in the baby. Medication to lower blood pressure and prevent seizures will also be prescribed. If the condition of the mother or fetus worsens, prompt delivery becomes necessary.

4. Preventing Preeclampsia and High Blood Pressure during Pregnancy

Preventive measures involve assessing the pregnant woman's risk of developing preeclampsia. Those with high blood pressure who are planning to conceive should undergo a pre-pregnancy health check to evaluate blood pressure control and overall health.

Overweight individuals are advised to lose weight before becoming pregnant. Women with specific medical conditions, such as diabetes, are often recommended to manage their condition prior to pregnancy.