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Hypertension, or high blood pressure, is incredibly prevalent in the United States affecting almost half of American adults. It is also one of the most common complications during pregnancy. Some people have high blood pressure before they get pregnant, while others may develop this condition for the first time during their pregnancy. Hypertensive disorders of pregnancy encompass a range of issues that affect about eight percent of pregnancies. These conditions can have serious implications for pregnant people and their babies. The good news is that those at an elevated risk for developing hypertension can take steps during their pregnancies to reduce their chances of developing one of these conditions.

What is hypertension?

Blood pressure is the force of blood that pushes against the walls of your arteries. When your heart beats, it pumps blood to your arteries, which carry the blood throughout your body. If the pressure inside your arteries is too high, it means you have high blood pressure, or hypertension. This can put extra stress on your organs and cause problems. Your blood pressure is measured at each prenatal visit with a cuff that compresses around your arm. The result is given as two numbers. The first is your systolic blood pressure, which is the pressure when your heart muscle contracts. The second is your diastolic blood pressure, which is the pressure when your heart relaxes. Your blood pressure varies throughout the day depending on a range of factors. If it is high at your prenatal visit, the midwife will check it again later or ask you to check it again at home. Hypertension during pregnancy is usually diagnosed after two or more readings that show a diastolic blood pressure of 90 or greater or a systolic blood pressure of 140 or greater.

Hypertensive disorders of pregnancy include the following conditions, which may or may not have any noticeable symptoms:

  • Chronic Hypertension – high blood pressure diagnosed before pregnancy or before 20 weeks of pregnancy. People who have chronic hypertension can also develop preeclampsia in the second or third trimester.

  • Gestational Hypertension – high blood pressure diagnosed after 20 weeks of pregnancy that is unaccompanied by other symptoms, like protein in urine or heart or kidney issues. Gestational hypertension usually goes away after birth. Some people who experience this may be at a higher risk of developing chronic hypertension in the future.

  • Preeclampsia – high blood pressure after 20 weeks of pregnancy (either chronic or gestational) that is accompanied by protein in urine and/or other symptoms. Preeclampsia affects about 1 in 25 pregnancies in the United States. Although some people with preeclampsia do not have any notable signs, symptoms can include:

    • Swelling of the face or hands

    • Headache that will not go away

    • Changes in vision, such as blurry vision, seeing spots, or having changes in eyesight

    • Pain in the upper stomach area or just under the ribs

    • Nausea or vomiting

    • Sudden weight gain

    • Difficulty breathing

In rare cases, preeclampsia can develop postpartum, even in people without any history of preeclampsia during their pregnancy. Postpartum preeclampsia is typically diagnosed within 48 hours of birth, but can occur up to 6 weeks postpartum.

  • Eclampsia – a rare and severe complication of preeclampsia where high blood pressure results in seizures during pregnancy or childbirth.

  • HELLP Syndrome – a rare and severe pregnancy complication which usually develops in the third trimester and affects the blood and liver. It is characterized by Hemolysis (breakdown of red blood cells), Elevated Liver enzymes (sign of liver problems), and a Low Platelet count (can lead to serious bleeding), which is where the condition gets its name. HELLP Syndrome can occur either with or without other typical symptoms of preeclampsia.

Identifying risk factors as early as possible, promoting a prevention protocol, and recognizing subtle signs and symptoms is essential to ensuring the best outcomes for pregnant people and their babies. Because hypertensive disorders of pregnancy can cause serious and often unpredictable complications during childbirth, clients diagnosed with a hypertensive disorder during their prenatal care are unable to give birth in the community setting with Fika Midwifery and must transfer their care.

If you do develop high blood pressure during your pregnancy, we can help you find a hospital-based provider that fits your individual needs for the remainder of your pregnancy and birth, and you are welcome to return to us for your postpartum care. It is important to maintain your routine prenatal visits, eat a nutritious diet low in sodium, and stay physically active throughout your pregnancy in a way that feels right for you. You may also be prescribed medication to help keep your blood pressure at a healthy level.

What are the risk factors?

If you fit one or more of the following criteria, you may be at a higher risk for developing hypertensive issues in pregnancy. Consider beginning a prevention protocol as soon as possible.

  • Having your first baby

  • Being 40 years or older

  • Having certain autoimmune disorders, such as lupus

  • Having a gap of more than 10 years since your last pregnancy

  • Having a history of preeclampsia or gestational hypertension in a previous pregnancy

  • Having a family history of preeclampsia

  • Having blood pressure higher than 130/80 at your initial prenatal visit, if this was in your first trimester

  • Having a pre-pregnancy BMI of greater than 35

How can I prevent gestational hypertension?

If you are planning to conceive, do your best to live a healthy lifestyle. This means eating nutritious foods whenever possible, moving your body several times a week in a way that feels good to you, and refraining from smoking.

If you are already pregnant, you should begin the following protocol as soon as your risk factors have been identified by the midwife. This protocol has the highest chance of success if you start before 16 weeks of pregnancy, but you can safely begin at any time.

  • Low dose (81mg) aspirin before bed every night

  • 1500mg calcium every day

You should be able to find both low dose aspirin and calcium supplements over-the-counter at any drug store or supermarket.

For more information on the screening, diagnosis, management, and prevention of hypertensive disorders of pregnancy, check out this thorough literature review from the Association of Ontario Midwives. As always, if you have any questions about your health, don’t hesitate to ask the midwife!

Author Mary Badame is the Quality Assurance Manager at Fika Midwifery and is a passionate advocate for midwife-led care, increased birth options, and better reproductive healthcare for everyone.