Dr. Jacqueline Gerhart: Blood Pressure Worries Pregnant Woman
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: I'm pregnant, and I'm scared that I am going to get high blood pressure like my mom did. How likely is it that I'll get it?
Dear Reader: Congratulations on your pregnancy!
High blood pressure during pregnancy is a common problem. It affects 12 percent to 22 percent of pregnancies. If you have high blood pressure prior to pregnancy, or in the first 20 weeks of pregnancy, it is called "chronic hypertension." This occurs in about 5 percent of pregnancies. High blood pressure that develops after 20 weeks of pregnancy is called "gestational hypertension." And high blood pressure after 20 weeks of pregnancy along with elevated protein in the urine is called "preeclampsia." This affects about 7 percent of pregnancies.
Risk factors for chronic hypertension in pregnant women are similar to those of the general population. These are age, race, family history, obesity, smoking, a high salt diet and lack of exercise. If you have hypertension before pregnancy that continues during pregnancy, your family physician, obstetrician, or midwife may recommend lifestyle changes. These include a low salt diet and exercises that are safe during pregnancy - like walking, stationary biking, or yoga. If you were on high blood pressure meds prior to pregnancy, your provider may try slowly lowering your medication dose to see if you can maintain reasonable pressures without medication. Your provider should also make sure your medication is safe in pregnancy. ACE inhibitors - such as enalapril or lisinopril for example - can cause harm to a baby's kidneys if the mother takes them during second and third trimesters.
Your provider will continue to take your blood pressure every time you are seen for a pre-natal visit. If your blood pressure is elevated after 20 weeks of pregnancy, your provider will likely test your urine for elevated protein levels and will check your blood counts and liver function. If these labs are abnormal, you may be diagnosed with preeclampsia. In this case, you will be monitored more closely and you may need to be delivered earlier than your due date.
What is the likelihood of this? In the case of preeclampsia you are at increased risk if you have had hypertension or preeclampsia in the past, if this is your first pregnancy, if you are over age 35, if you are carrying multiple babies or if you have obesity, diabetes or kidney disease. You are more likely to be delivered early if your blood pressures or protein levels are very high, or if you are having other symptoms like headache, vision changes, severe pain, or your baby isn't growing well. Women with preeclampsia also have an increased risk for elevated blood pressure, stroke, vein clots and heart disease in the future.
There isn't a way to prevent preeclampsia - aside from not getting pregnant. Studies have focused on aspirin, calcium, vitamin C and vitamin E as possible preventive agents. Although these studies have mixed results, overall it seems aspirin and calcium are of little if any benefit. There is some evidence that 1000 mg of vitamin C and 400 mg of vitamin E daily may be helpful, but further studies are needed.
If you are concerned about blood pressure during pregnancy, discuss it with your provider. That's what we are here for - to support you and your baby!
Congratulations again, and good luck!
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 06/19/2012