Hypertension in Pregnancy – Is It A Cause For Concern?

Congratulations! You are going to have a baby!

Harkening back to the day you learnt you were pregnant, you would have been filled with joy, gratitude, and perhaps a little apprehension. That is perfectly natural. You are not alone, as all mothers feel that way, whether this is their first, or subsequent pregnancies.

Pregnancy is a journey of discovery for both Mum and Dad, as they wait in anticipation, their bundle of joy.

While most pregnancies progress along without a hitch, some Mums do face unexpected complications.

Experienced Mums can attest that every pregnancy is different. Having an easy pregnancy now does not necessarily mean the next one will be smooth sailing.

Amongst the possible complications, hypertension can be an unexpected and unwelcome one.

In this article, we are going to learn a little more about hypertension in pregnancy, together.

If you are expecting, and have hypertension, we hope this article will go in some way to answer your questions. Plus, we hope to alleviate any concerns and fears you may have.

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Hypertension In Pregnancy

According to the Ministry of Health Malaysia, hypertension in pregnancy is fairly common both locally, and globally.

That being said, hypertension, whether within or outside pregnancy, is a medical condition which needs regular monitoring, and in some cases, medication. Unchecked, hypertension can wreak havoc on your body, and cause serious complications, to both baby, and Mum.

If you suspect you have hypertension, it is a good idea to consult your gynaecologist or family doctor for medical advice. The sooner, the better.

What Is Hypertension?

Our heart works hard to pump blood to the vast network of arteries in our body. These arteries bring much-needed oxygen to our organs, muscles, and brain so we can function optimally.

The pumping of the heart courses blood flow at a certain pressure. If the pressure is low, we have low blood pressure and while not optimal, is not as dangerous as hypertension or high blood pressure.

To be in the pink of health, it is best to keep blood pressure within the normal range. 

While hypertension outside of pregnancy is a cause for concern, having it during pregnancy may give rise to complications. These complications can be dangerous to both Mum and baby.

Blood Pressure Range

According to the World Health Organisation (WHO), blood pressure is measured with two numbers, systolic and diastolic.

The systolic number is the measurement of the pressure in blood vessels when the heart beats, whereas the diastolic number measures the pressure in the blood vessels when the heart rests, in between beats.

If your pressure reads normally, your systolic number should be less than 120, and your diastolic number less than 80.

From the chart above, you can see that any measurements above those numbers show first an elevated reading, and as the numbers rise, the seriousness of the condition manifests.

Types Of Hypertension

Dr Ismail Tabash, M.D., a cardiologist at the Mayo Clinic Health System in Eau Claire, Wisconsin, USA, states that hypertension is often called a ‘silent killer’, and not without reason.

Hypertension can exist without symptoms.

Those who have hypertension may carry on with their lives not realising the precariousness of their medical condition and their deteriorating health. By the time symptoms finally present, the progression of the condition may be critical, and possibly, even dangerous.

Keeping this in mind, that explains why blood pressure is routinely taken at each medical visit, regardless of whether you are expecting. 

If you are concerned about your blood pressure or have hypertension, whether pregnant or not, it would be a good idea to invest in a blood pressure monitor at home. Nowadays, monitors are widely available, easy to use, and relatively inexpensive. 

According to the Ministry of Health Malaysia, there are 4 types of hypertension which can occur during pregnancy. They are listed and elaborated on below.

• Chronic Hypertension

Chronic hypertension occurs when a newly expectant Mum has a preexisting condition, or when the elevated blood pressure levels occur before the 20th week of pregnancy. Since hypertension symptoms are not obvious, Mums may not realise they have the condition, and therefore cannot determine its onset.

Doctors, after ruling out Cushing’s or Conn’s Syndromes, among others, will have to confirm the diagnosis so that the necessary monitoring and medication, can be administered.

According to the Ministry of Health Malaysia, chronic hypertension doubles the risk of pre-eclampsia in pregnancy. Pre-eclampsia and eclampsia are serious medical conditions which require urgent attention.

• Gestational Hypertension

Similar to gestational diabetes, some women develop hypertension after 20 weeks of pregnancy.

Mothers who develop gestational hypertension for one pregnancy face a higher possibility that the same complication will occur in their future pregnancies.

The Ministry of Health Malaysia has determined that the progression of hypertension to pre-eclampsia occurs in about 15% of all pregnancies.

According to Dr Reuben Sekhar, a senior medical practitioner at Bandar Sunway, gestational hypertension does need medical attention.

“Hypertension is a serious medical condition, whether pregnant or otherwise. To ensure a healthy baby, it is necessary to keep blood pressure at an optimal level. If necessary, pregnant mothers should consider medication, since the longer the condition persists, the more dangerous it is for the developing foetus,” he said.

But, all is not gloom and doom.

The silver lining to this is that the condition usually resolves itself within 6 weeks of delivery, although elevated pressure readings can remain for up to 3 months, postpartum.

• Pre-eclampsia

When hypertension is coupled with protein in urine specimen samples, there is a possibility that pre-eclampsia may have developed.

Mayo Clinic highlights its symptoms as follows, although some Mums remain asymptomatic.

• Severe headaches
• Visual disturbances, whether it is a temporary loss of vision, blurred vision, or light sensitivity
• Upper abdominal pain, usually under the right side of the ribs
• Nausea or vomiting
• Impaired liver function
• Decreased levels of platelets in the blood
• Shortness of breath, due to the build-up of fluid in the lungs
• Sudden weight gain, and the swelling of the face, hands and feet.

Pre-eclampsia is a medical emergency. Delayed medical treatment can cause multiple complications, which can include kidney damage, blood disorders leading to haemorrhage, and placenta abruption. These complications are serious and can be life-threatening.

Additionally, pre-eclampsia increases the risk of future cardiovascular disease, especially if it recurs in subsequent pregnancies.

The foetus can also suffer from brain damage, and growth anomalies, especially when there is a decrease in blood flow to the placenta. Blood carries with it nutrients and oxygen, so necessary for baby’s development and growth.

In severe cases, death can occur to both mother and child.

• Eclampsia

In addition to the above symptoms, eclampsia occurs when an epileptic seizure occurs.

“Eclampsia is a serious medical emergency. It can cause stroke and oedema (the swelling of the brain). There is also the possibility that permanent neurological damage can occur if treatment is not done on time,” says Dr Reuben.

According to the Ministry of Health Malaysia, while eclampsia occurs more commonly in teenage pregnancies (three times the average) compared to older women, we should keep a sharp eye out, nevertheless.

Moving Forward

• Before Conceiving

The National Institute of Health in USA has found that hypertension tends runs in families. As such, it would be a good idea for you to check if either hypertension or gestational hypertension runs in your family.

Additionally, it would be an excellent idea to start living a healthy lifestyle, if you are not already.

Exercise frequently. Watch your food intake, taking care to eat a healthy, balanced diet. Drink sufficient liquids, perhaps alternating between water and freshly squeezed fruit, and vegetable juices. Avoid excessive sugar, salt, oil, and processed foods.

Take the time to read up about the possible condition. Forewarned, after all, is forearmed.

• After Conception

Ensure that you continue your healthy and balanced diet. Where possible, keep to your exercise regimen, although you can opt for lighter exercises, like walking.

Keep to your periodic antenatal check-ups. If you have had hypertension before, or your close family members have it, inform your gynaecologist. That way he can keep an eye out on your blood pressure levels, and advise you accordingly.

If you already have hypertension, invest in a good blood pressure monitor, and periodically take your blood pressure to make sure you do not have elevated levels.

If your doctor requires you to take medication for the condition, it is important that you follow his instructions carefully. While we might baulk at having to take medication during pregnancy, the gravity of hypertension cannot be underestimated. 

Avoid smoking and alcohol.

Before you take any new medication or supplement, always check with your doctor to ensure that they do not contraindicate with your current medication.

• At Delivery

While your gynaecologist will endeavour to deliver your baby naturally, if that is what you prefer, there are times when it is not possible.

Due to your condition, your doctor may suggest delivery when the baby is viable, rather than when labour commences. If so, he may induce labour, or perform a C-Section, depending on the developing situation. As a doctor, he has both your interests at heart. Agreeing to a C-Section may be the safest way forward for you to deliver a healthy baby.

• After Delivery

Good news all around! 

Breastfeeding is encouraged for those who suffer from hypertension, even if they are on medication. Breast is best for baby, and your doctor will ensure that the medication you are on, is safe. If you have any doubts, feel free to discuss them at length with your gynaecologist and paediatrician, for good measure.

If you have gestational hypertension, hopefully, your pressure will return to normal after a while. Doctors may still require you to keep taking your medication, even as they gradually reduce your dose, before weaning you off it completely. If so, continuing your medicine regimen is a good idea, so as to avoid further complications.

Hypertension, gestational or otherwise, is a medical condition which needs close observation, monitoring and, at times, medication. However, rest assured that if you follow your doctor’s instructions, usually the condition can be kept under control.

Your success lies in your power to monitor, medicate, and live a healthy lifestyle. 

If you would like to start living healthily, now is as good a time to start as any. Good health, after all, is priceless.

The results of living a healthy lifestyle take time to show. Keep at it, and you will be delighted with the fruits of your labours. Maintaining good health is a lifelong journey. Your investment in your health today will reap rewards bountifully, tomorrow.