Topic Overview
What are high blood pressure and pre-eclampsia?
Blood pressure is a measure of how hard your blood pushes against the
walls of your arteries. If the force is too hard, you have
high blood pressure (also called hypertension). When
high blood pressure starts after 20 weeks of pregnancy, it may be a sign of a
very serious problem called
pre-eclampsia.
Blood pressure is shown as
two numbers. The top number (systolic) is the pressure when the
heart pumps blood. The bottom number (diastolic) is
the pressure when the heart relaxes and fills with blood. Blood pressure is
high if the top number is more than 140 millimetres of mercury (mm Hg), or if
the bottom number is more than 90 mm Hg. For example, blood pressure of 150/85
(say "150 over 85") or 140/95 is high. Or both numbers can be high, such as
150/95.
A woman may have high blood pressure before she gets
pregnant. Or her blood pressure may start to go up during pregnancy.
If you have high blood pressure during pregnancy, you need to have
checkups more often than women who do not have this problem. There is no way to
know if you will get pre-eclampsia. This is one of the reasons that you are
watched closely during your pregnancy.
High blood pressure and
pre-eclampsia are related, but they have some differences.
High blood pressure
Normally, a woman’s blood
pressure drops during her second
trimester. Then it returns to normal by the end of the
pregnancy. But in some women, blood pressure goes up very high in the second or
third trimester. This is sometimes called gestational hypertension and can lead
to pre-eclampsia. You will need to have your blood pressure checked often and
you may need treatment. Usually, the problem goes away after the baby is
born.
High blood pressure that started before pregnancy usually
doesn't go away after the baby is born.
A small rise in blood
pressure may not be a problem. But your doctor will watch your pressure to make
sure it does not get too high. The doctor also will check you for
pre-eclampsia.
Very high blood pressure keeps your baby from
getting enough blood and oxygen. This could limit your baby’s growth or cause
the
placenta to pull away too soon from the uterus. High
blood pressure also could lead to
stillbirth.
Pre-eclampsia
Pre-eclampsia is
a pregnancy-related problem. The symptoms of pre-eclampsia include new high
blood pressure after 20 weeks of pregnancy along with other problems, such as
protein in your urine. Pre-eclampsia usually goes away after you give birth. In
rare cases, blood pressure can stay high for up to 6 weeks after the
birth.
Pre-eclampsia can be deadly for the mother and baby. It can
keep the baby from getting enough blood and oxygen. It also can harm the
mother’s
liver,
kidneys, and brain. Women with very bad pre-eclampsia
can have dangerous seizures. This is called
eclampsia.
What causes pre-eclampsia and high blood pressure during pregnancy?
Experts don't know the exact cause of pre-eclampsia and
high blood pressure during pregnancy. But they have some ideas about
pre-eclampsia:
- Pre-eclampsia seems to start because the
placenta doesn't grow the usual network of blood vessels deep in the wall of
the uterus. This leads to poor blood flow in the
placenta.
- Pre-eclampsia may run in families. If your mother had
pre-eclampsia while she was pregnant with you, you have a higher chance of
getting it during pregnancy. You also have a higher chance of getting it if the
mother of your baby’s father had pre-eclampsia.
- The mother’s
immune system may react to the father's sperm, the
placenta, or the baby.
- Already having high blood pressure when you
get pregnant raises your chance of getting pre-eclampsia.
- Problems
that can lead to high blood pressure, such as
obesity,
polycystic ovary syndrome, and
diabetes, could raise your risk of
pre-eclampsia.
What are the symptoms?
High blood pressure
usually doesn't cause symptoms. But very high blood pressure sometimes causes
headaches and shortness of breath or changes in vision.
Mild
pre-eclampsia usually doesn't cause symptoms, either. But pre-eclampsia can cause
rapid weight gain and sudden swelling of the hands and face. Severe
pre-eclampsia causes symptoms of organ trouble, such as a very bad headache and
trouble seeing and breathing. It also can cause belly pain and decreased
urination.
How are high blood pressure and pre-eclampsia diagnosed?
High blood pressure and pre-eclampsia are usually found during a prenatal
visit. This is one reason why it’s so important to go to all of your prenatal
visits. You need to have your blood pressure checked often. During these
visits, your blood pressure is measured with a
blood pressure cuff. A sudden increase in blood pressure often is the first
sign of a problem.
You also will have a urine test to look for
protein, another sign of pre-eclampsia.
If you have high blood
pressure, tell your doctor right away if you have a headache or belly pain.
These signs of pre-eclampsia can occur before protein shows up in your
urine.
How are they treated?
Your doctor may have you
take medicine if he or she thinks your blood pressure is too high.
The only cure for pre-eclampsia is having the baby. You may get medicines
to lower your blood pressure and to prevent seizures. You also may get medicine
to help your baby’s lungs get ready for birth. Your doctor will try to deliver
your baby when the baby has grown enough to be ready for birth. But sometimes a
baby has to be delivered early to protect the health of the mother or the baby.
If this happens, your baby will get special care for premature babies.
Do pre-eclampsia and high blood pressure lead to long-term high blood pressure?
If you have high blood pressure during pregnancy
but had normal blood pressure before pregnancy, your pressure is likely to go
back to normal after you have the baby. But if you had high blood pressure
before pregnancy, you probably will still have it after you give birth.
Frequently Asked Questions
Learning about high blood pressure and pre-eclampsia during pregnancy: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Cause
The causes of
pre-eclampsia and
high blood pressure during pregnancy are poorly
understood. In fact, pre-eclampsia is sometimes called the "disease of
theories," and its cause is the subject of active research.1
Pre-eclampsia may start with a poorly developed
placenta that doesn't circulate blood normally. But
the cause of the placenta disorder isn't yet clear. Nor is it known why the
mother's body then develops high blood pressure. So far, a number of possible
factors are thought to play a part in pre-eclampsia, including:
- Family history (genetics). The tendency to develop
pre-eclampsia may run in families. Inherited factors (genes) seem to
make a woman more likely to develop pre-eclampsia.
- An abnormal immune system response. Pre-eclampsia
occurs most often in women who are pregnant for the first time and in women who
have been pregnant before but now have a first pregnancy with a different man. Exposure to an
antigen from the father (in the growing
placenta or fetus, for example) may trigger an immune
response in the woman's body. This immune response may result in narrowing of
the blood vessels throughout the body, causing higher blood pressure and other
problems.
- A biochemical factor that causes the blood vessels to narrow, raising blood pressure. Pre-eclampsia may be the body's reaction to
the poorly functioning placenta. Or both the poorly developed placenta and
pre-eclampsia symptoms may be caused by the same factor. This process is not yet
well understood.
- Diabetes or other diseases affecting blood vessels. Conditions that cause blood vessel problems (such as
lupus, preexisting high blood pressure, or
diabetes) may increase the risk of
pre-eclampsia.
Symptoms
High blood pressure
If you have developed
high blood pressure, you will probably not have any
symptoms. It usually requires a blood pressure check with a blood pressure cuff
and stethoscope to detect elevated blood pressure.
Blood pressure
measured at 140/90 millimetres of mercury (mm Hg) or higher is classified as
high (hypertensive) and 160/110 mm Hg or higher is classified as severe.
Pre-eclampsia
Symptoms of
pre-eclampsia can develop gradually or suddenly.
Symptoms include:
- Systolic blood pressure is over 140
mm Hg, or diastolic blood pressure is over 90 mm Hg, or both, for two
measurements.2
- Protein in the urine is
usually higher than normal. High urine protein is 300 milligrams (mg) measured
in 24 hours or protein consistently showing 1+ or greater on a dipstick.
Although you may have other symptoms, you will not be
diagnosed with pre-eclampsia unless you also have high blood pressure or high
protein in your urine. Other symptoms of mild pre-eclampsia may include:
- Swelling of the hands and face that does not
go away during the day. (If you have no other signs or symptoms of
pre-eclampsia, this swelling is probably a sign of normal
pregnancy.)
- Rapid weight gain [more than
0.9 kg (2 lb) per week or
2.7 kg (6 lb) per
month].
- Bleeding from a cut or injury that lasts longer than
usual.
Severe pre-eclampsia
In severe pre-eclampsia,
systolic blood pressure is over 160 mm Hg, or diastolic blood pressure is over
110 mm Hg, or both.
As blood circulation
to the organs decreases, more severe symptoms can develop, including:
- A severe headache that will not go away
with medicine such as acetaminophen.
- Blurred or dimming vision,
spots in the visual field, or periods of blindness.
- Decreased
urination [less than
500 mL (2 cups) in 24
hours].
- Persistent abdominal pain or tenderness, especially on the
upper right side.
- Problems breathing, especially when lying
flat.
- HELLP syndrome.
HELLP syndrome is a life-threatening liver disorder.
It is usually related to pre-eclampsia. Get emergency medical treatment if you
have several symptoms of HELLP syndrome. Symptoms include:
- Pain in the upper right abdomen
(liver).
- Shoulder, neck, and other upper body pain (this pain also
originates in the liver).
- Fatigue.
- Nausea and
vomiting.
- Headache.
- Vision problems.
HELLP is short for Hemolysis (destruction of red blood cells), Elevated Liver enzymes (which indicate
liver damage), and Low
Platelet count.
Severe pre-eclampsia increases the risk of seizures
(eclampsia).
Eclampsia
When pre-eclampsia leads to
seizures that are not from any other cause, it is
called
eclampsia. Eclampsia is life-threatening for both a
mother and her fetus. During a seizure, the oxygen supply to the fetus is
drastically reduced. Call 911 any time a pregnant woman has a
seizure.
What Happens
At the first sign of high
blood pressure during pregnancy, your health professional cannot predict
whether it will remain mild, become severe, or turn out to be an early sign of
pre-eclampsia. If you are developing pre-eclampsia, your
urine test (urine screen) will probably show increased protein levels before
long. This sign that your kidneys are being affected by the condition doesn't
develop right away.
If you aren't certain that you had normal
blood pressure before pregnancy, it is possible that you have preexisting
chronic high blood pressure. If so, your blood pressure may remain high after
your pregnancy.
High blood pressure that develops during pregnancy
High blood pressure that develops before the 20th week
of pregnancy is usually a sign of ongoing (chronic) high blood pressure or
short-term, mild high blood pressure. In rare cases, it is an early sign of
pre-eclampsia.
High blood pressure that
occurs after mid pregnancy could be a sign that you are developing pre-eclampsia.
This can be anytime after the 20th week.
Chronic high blood pressure and pregnancy
Women
with chronic high blood pressure (hypertension) who become
pregnant normally have a drop in blood pressure during the first two
trimesters. During the late second or in the third trimester, however, blood
pressure returns to higher-than-normal levels. Following delivery, their blood
pressure remains high. For more information, see the topic High Blood Pressure.
Chronic high blood pressure increases your risk
of pre-eclampsia during pregnancy.
Most women with chronic high
blood pressure who are otherwise healthy have a low risk for other
cardiovascular problems during pregnancy.
Women with chronic high blood pressure have an increased
risk of the premature separation of the placenta from the uterine wall (abruptio placenta). This risk may increase when:
- A mother smokes during
pregnancy.
- Pre-eclampsia develops in addition to chronic high blood
pressure.
- A mother uses certain drugs, such as cocaine.
- There
is an injury to the uterus, such as in a car accident or a fall.
Pre-eclampsia
Pre-eclampsia affects your blood
pressure,
placenta,
liver, blood,
kidneys, and brain. Pre-eclampsia can be mild or
severe, and it may get worse gradually or rapidly. Both you and your fetus can
potentially suffer life-threatening problems involving the following:
- Blood pressure. Blood
volume doesn't increase as much as it should during pregnancy. This can affect
fetal growth and well-being. The blood vessels also increase their resistance
against blood flow (vasospasm), increasing blood pressure.
- Placenta. The blood vessels of the placenta don't grow deep
into the uterus as they should, nor do they widen as they normally would. This
makes them unable to provide normal blood flow to the fetus.
- Liver. Impaired blood circulation to the liver can cause liver
damage. Liver impairment is related to the life-threatening
HELLP syndrome, which requires emergency medical treatment.
- Kidneys. During a normal pregnancy,
kidney
function increases by up to 50%.3 When affected by
pre-eclampsia, kidney function is usually higher than before pregnancy but not
as high as necessary for a healthy pregnancy. This is called mild renal
insufficiency.
- Brain. Vision impairment,
persistent headaches, and seizures (eclampsia) can develop, probably in
relation to reduced blood flow to or within the brain. Less than 1% of women
who have pre-eclampsia suffer one or more seizures.4
Eclampsia can lead to maternal coma and fetal and maternal death. This is why
women with pre-eclampsia are often given medicine to prevent
eclampsia.
- Blood. Low
platelet levels in the blood are common with
pre-eclampsia. In rare cases a potentially life-threatening blood-clotting and
bleeding problem develops along with severe pre-eclampsia.5 This condition is called disseminated intravascular
coagulation (DIC). After delivery, DIC goes away. In the meantime, you may be
given a medicine (clotting factor), blood transfusion, or platelet transfusion.
Delivery of the baby and placenta is the only "cure"
for pre-eclampsia. If your condition becomes dangerous enough that delivery is
necessary but you don't go into labour, your doctor will induce labour or
surgically deliver the baby (caesarean section). Unless you have
chronic high blood pressure, your blood pressure should return to normal in a
few days. In severe cases, this can take 6 or more weeks.
The infant
The earlier in the pregnancy that
pre-eclampsia begins and/or the more severe the condition becomes, the greater
the risk of preterm birth, which can cause newborn problems. For more
information, see the topic
Premature Infant.
An infant born before
37 weeks may have difficulty breathing because of immature lungs (respiratory distress syndrome). A newborn affected by
pre-eclampsia may also be smaller than normal (intrauterine growth restriction).
This is because of inadequate nutrition from poor blood flow through the
placenta.
What Increases Your Risk
Risk factors for developing
pre-eclampsia during pregnancy include:
- Chronic (ongoing) high blood pressure (hypertension), chronic kidney disease, or diabetes.
- High blood pressure in a past
pregnancy, especially before week 34.
- Personal history of
pre-eclampsia.
- Family history of pre-eclampsia.
- Obesity
(more than 20% over ideal weight) at the time of conception. If your weight is
within this range, the higher your pre-pregnancy
body mass index, the greater your pre-eclampsia
risk.6
- Multiple pregnancy (such as twins
or triplets).
- First pregnancy ever or first-time pregnancy with
current partner.
- Age younger than 21 or older than
35.
When To Call a Doctor
Seizures
If you have
pre-eclampsia, it is possible that you will have an
unexpected seizure (eclampsia). Eclampsia can lead to a
coma and is life-threatening to both you and your fetus.
Someone
must call 911 or other emergency services immediately if you are having an
eclamptic seizure.
If you are pregnant and have pre-eclampsia, your
family and friends should know
how to help during a seizure.
Seek medical care immediately
if you are pregnant and begin to have symptoms of pre-eclampsia, such as:
- Blurred vision or other vision
problems.
- Frequent headaches that are becoming worse or a
persistent headache that does not respond to non-prescription pain
medicine.
- Pain or tenderness in your abdomen, especially in the
upper right section.
- Weight gain of
0.9 kg (2 lb) or more over a
24-hour period.
- Shoulder, neck, and other upper body pain (this pain originates
in the liver).
If you have mild high blood pressure or mild pre-eclampsia,
you may not have any symptoms. It is important to see a health professional
regularly throughout your pregnancy. Your blood pressure will be checked and
your urine will be tested at every visit so that any abnormal rise in blood
pressure or urinary protein can be easily detected.
Watchful Waiting
Symptoms such as heartburn or swelling in the legs
and feet are normal during pregnancy and are not usually symptoms of
pre-eclampsia. You can discuss these symptoms with your doctor or midwife
at your next scheduled prenatal visit. But if swelling occurs along with other
symptoms of pre-eclampsia, contact your doctor immediately.
Who To See
Your family doctor, general practitioner, or midwife can treat high blood pressure and pre-eclampsia during pregnancy. You may be referred to an obstetrician, an internist, or a perinatologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Examinations and Tests
High blood pressure (hypertension) and
pre-eclampsia are typically found during regular
prenatal checkups. Because these conditions can get worse rapidly and can be
life-threatening to you and your fetus, it's important that you have regular
checkups during your pregnancy.
Routine prenatal tests
Certain tests are given at
each prenatal visit to monitor for high blood pressure and pre-eclampsia. These
include a:
- Blood pressure reading. Blood pressure is always monitored closely during pregnancy.
- Urine test for excess protein in the
urine (proteinuria), a sign of pre-eclamptic kidney damage.
- Weight
measurement. (Rapid weight gain can be a sign of pre-eclamptic fluid
retention.)
Tests for pregnant women considered high-risk for pre-eclampsia
Other tests may also be used to monitor for signs of
pre-eclampsia, including:
- Blood tests to check for blood
abnormalities (as in
HELLP syndrome) and for signs of kidney damage.
(Elevated uric acid in the blood is often the earliest sign of
pre-eclampsia.)
- Creatinine clearance test, which
requires both a blood sample and a 24-hour urine collection, to assess kidney
function.
- 24-hour urine collection test to assess protein in the
urine.
Tests for women who have pre-eclampsia
If results from
one or more of the above tests suggest that you have pre-eclampsia, you and your
fetus will be closely monitored throughout the remainder of your pregnancy. The
type and frequency of testing depend on the severity of the pre-eclampsia and
the time remaining until your pregnancy reaches full term (37 to 42 completed
weeks). Testing is more frequent and extensive when pre-eclampsia is severe and
the pregnancy is far from full-term (less than 36 weeks).
Tests that may be given to assess your health if you
have pre-eclampsia include:
- A
physical examination for signs and symptoms of pre-eclampsia
that is getting worse.
- Blood tests to check for blood abnormalities
and kidney damage.
- A creatinine clearance test, which requires both
blood and urine samples, to assess kidney function.
Tests for women who have eclampsia
If you have a
seizure (eclampsia), one or more of the following tests may be
done after delivery to assess your brain function and condition:
Tests for the fetus
If you develop high blood
pressure, pre-eclampsia, or both, your fetus's health also will be closely
monitored. The more severe your condition, the more frequent the fetal testing,
ranging from once a week to daily.
Tests commonly used to monitor
fetal health include:
Less commonly,
amniocentesis is used to check fetal well-being if
preterm delivery is being considered as a treatment option. For this procedure,
a needle is inserted into your abdomen to collect amniotic fluid from inside
the uterus. The fluid is then checked for chemical signs that the fetus's lungs
are mature.
Treatment Overview
If your blood pressure begins to
rise during pregnancy, you will need close monitoring until after your baby is
born. Your blood pressure may remain mildly elevated, which is not considered
dangerous for you or your fetus. But it can become dangerous if it turns out to
be a sign of
pre-eclampsia or if it progresses to more severe
high blood pressure (hypertension).
High blood pressure (hypertension) during pregnancy
If you have high blood pressure during your pregnancy, your treatment may
include:
- Close monitoring by a
doctor for signs of pre-eclampsia.
- Blood pressure medicine. Your doctor may have you take medicine if he or she thinks
your blood pressure is too high. Some women with ongoing (chronic) high blood
pressure stay on antihypertensive medicine but are prescribed a lower dose
during pregnancy if their blood pressure improves.
Mild
high blood pressure in pregnancy usually only requires close monitoring. If you
have high blood pressure that is rapidly increasing or has reached moderately
high levels, you may be
treated with blood pressure medicine.
Severe high blood pressure
(higher than 160 mm Hg
systolic or 110 mm Hg
diastolic) can result in poor fetal growth
(intrauterine growth restriction) and is likely to be treated with an
antihypertensive medicine.
Some high blood pressure medicines are dangerous during pregnancy.7, 8 If you take high blood pressure medicines, talk to your doctor about
the safety of your medicine before you become pregnant or as soon as you learn
you are pregnant. Make sure that your doctor has a complete list of all
medicines that you are taking.
Pre-eclampsia and eclampsia
If you show any signs
of pre-eclampsia, you will be closely monitored, either with frequent office
visits or in the hospital. The goal of treatment is to prevent pre-eclampsia
from becoming life-threatening to you and your fetus while prolonging the
pregnancy long enough for your fetus to be mature and healthy at birth.
Your treatment will last for the rest of your pregnancy, your delivery,
and your first postpartum weeks and will depend on how severe your condition
is. Treatment options include an anticonvulsant medicine; blood pressure
medicine if your blood pressure is dangerously high; and delivery, which is the
only known "cure" for pre-eclampsia.
- For mild pre-eclampsia that is not rapidly
getting worse, you may only have to reduce your level of activity, monitor how
you feel, and have frequent office visits and testing.
- For moderate or severe pre-eclampsia, or for pre-eclampsia
that is rapidly getting worse, you may require hospitalization, where
expectant management typically includes bedrest,
medicine, and close monitoring of you and your fetus. Severe pre-eclampsia or an
eclamptic seizure is treated with
magnesium sulfate. This medicine can stop a seizure
and can prevent seizures. If you are near delivery or have severe pre-eclampsia,
your doctor will plan to deliver your baby as soon as possible.
- If
your condition becomes life-threatening to you or your fetus, magnesium sulfate
to prevent seizure and delivery are the only treatment options. If you are less
than 34 weeks pregnant and a 24- to 48-hour delay is possible, you will likely
be given
antenatal corticosteroids to speed up fetal lung
development before delivery.
After childbirth
If you have moderate to severe
pre-eclampsia, your risk of seizures (eclampsia) continues for the first 24 to
48 hours after childbirth (in very rare cases, seizures are reported later in
the postpartum period). So you may continue
magnesium sulfate for 24 hours after delivery.5
Unless you have chronic high blood pressure,
your blood pressure is likely to return to normal a few days after delivery. In
rare cases, it can take 6 weeks or more. Some women still have high blood
pressure 6 weeks after childbirth yet return to normal levels over the long
term. If your blood pressure is still high after delivery, you may be given a blood pressure medicine. You will then have
regular checkups with your doctor to monitor your recovery.
What To Think About
To prepare
for a talk with your doctor or midwife about your condition, see
questions to ask your doctor about high blood pressure and pregnancy.
High blood pressure medicine
Lowering blood pressure with medicine:
- Does not prevent pre-eclampsia from getting
worse, because high blood pressure is only a symptom of the condition, not a
cause.
- Can reduce blood flow to the
placenta if blood pressure is lowered too rapidly,
causing problems for the fetus. So medicine is reserved for preventing severely
high blood pressure levels that are potentially life-threatening to you or your
fetus.
Delivery
A vaginal
delivery is usually safest for the mother and is attempted first if she and the
baby are both stable. If pre-eclampsia is rapidly getting worse or fetal
monitoring suggests that the baby cannot safely handle labour contractions, a
caesarean section (C-section) delivery is
needed.
Ongoing issues
Pre-eclampsia usually does not cause long-term problems. Healthy habits,
such as regular exercise and eating a healthy diet, may help prevent future
health problems. If you have had pre-eclampsia, talk to your doctor about what
you can do to stay healthy.
Prevention
If you have chronic
high blood pressure (hypertension), you can lower your
blood pressure before pregnancy by exercising, eating a diet low in sodium and
rich in fruits and vegetables, and staying at a healthy weight. Lowering your
blood pressure reduces your risk of
pre-eclampsia.
When you are pregnant,
regular checkups are key to early detection and treatment. Prompt treatment is
vital to preventing the development of severe and possibly life-threatening
pre-eclampsia.
Some pre-eclampsia research suggests that calcium
supplements and low-dose ASA may offer a preventive benefit, especially for
high-risk women.
Calcium supplements may reduce the risk of developing pre-eclampsia and the risk
of having a low-birth-weight baby, particularly among high-risk women who
normally don't get enough calcium.9 Taking a calcium
supplement may also lower the risk of moving from mild to severe
pre-eclampsia.10 Other experts have found that there is
no benefit from taking calcium.5
But all pregnant women can generally benefit from
taking the recommended dietary allowance of
1000 mg of calcium each day to keep their
bones healthy.11
Low-dose ASA
(antiplatelet) therapy may be a moderately effective preventive treatment for
women at risk of developing
pre-eclampsia. Although some experts question how
effective low-dose ASA is, others assert that high-risk women who take it
regularly as directed do significantly lower their pre-eclampsia risk.12 Talk to your doctor or midwife about whether this
treatment is right for you.
Research shows that taking vitamin C or vitamin E supplements does not
help prevent pre-eclampsia.13, 14
Home Treatment
High blood pressure
If you have ongoing (chronic)
high blood pressure and are taking blood pressure
medicine, talk to your doctor before becoming pregnant (or as soon as you learn
you are pregnant). Some high blood pressure medicines are dangerous to your
fetus.
If you have high blood pressure during pregnancy, take
steps that will help control your blood pressure:
- Go to all of your prenatal checkups. It is
important to monitor your blood pressure because a dangerous increase in blood
pressure can occur without symptoms. You may also want to keep track of your
blood pressure readings at home.
- If you smoke, quit smoking. This
helps decrease your blood pressure and improve your fetus's growth and
health.
- Do not gain an excessive amount of weight during your
pregnancy. Talk to your doctor about how much is healthy for you to
gain.
- Get regular mild exercise during pregnancy. Walking or
swimming several times weekly can be healthy for you and your developing fetus.
- Reduce stress. Find time to relax, especially if you continue to
work, are parenting small children at home, and/or have a hectic
schedule.
By following
general guidelines for a healthy pregnancy, you can
help optimize your own and your baby's overall health and make sure that you
are both in the best possible shape for handling the challenges of pregnancy,
delivery, and recovery.
For more tips on how to have a healthy pregnancy, see the topic Quick Tips: Healthy Pregnancy Habits.
Expectant management for pre-eclampsia
If you develop
signs of
pre-eclampsia early in pregnancy, your doctor or
midwife may prescribe something called
expectant management at home, possibly for many weeks.
This may mean you are advised to stop working, reduce your activity level, or
possibly spend a lot of time resting (partial bedrest). Although partial bedrest is considered reasonable treatment for pre-eclampsia, its effectiveness is
not proved for treating mild pre-eclampsia.15 It is
known that strict bedrest may increase your risk of developing a blood clot in
the legs or lungs.
Whether you are required to reduce your
activity or have partial bedrest, expectant management severely limits your
ability to work, remain active, take care of children, and fulfill other
responsibilities. It may be helpful to follow some
tips for dealing with bedrest.
You may be required to monitor your own condition on a
daily basis. If so, you or another person (such as a trained family member or a
visiting nurse) will:
Keep a
written record of your results, including the dates and times you checked. Take
this record with you when you visit your doctor or midwife.
Medications
Medicine for
pre-eclampsia and
high blood pressure during pregnancy may be used
to:
- Control high blood pressure.
Lowering high blood pressure does not prevent pre-eclampsia from getting worse,
because high blood pressure is only a symptom of the condition, not a cause.
Your doctor may recommend blood pressure medicine if your blood pressure reaches high levels. Expectant management is often used to treat
mild high blood pressure during pregnancy.
- Prevent seizures. Magnesium sulfate is usually started before delivery and
continued for 24 hours after delivery for women with pregnancy-related seizures
(eclampsia) and those who have moderate to severe
pre-eclampsia.
- Speed up fetal lung development. When possible, a corticosteroid (betamethasone or
dexamethasone) is given to the mother prior to a premature birth (up to 34
weeks of gestation). This medicine matures the fetus's lungs over a 24-hour
period, which lowers the risk of breathing problems after birth.
Medication Choices
Blood pressure medicines commonly used during
pregnancy include:
- Methyldopa (an oral medicine for
controlling high blood pressure during pregnancy).
- Hydralazine (an
intravenous medicine for quickly lowering severely
high blood pressure during pregnancy).
- Labetalol (an
intravenous medicine for quickly lowering severely high blood pressure in the
hospital, and also an oral medicine for controlling high blood pressure during
pregnancy).
- Nifedipine (an oral medicine for
controlling high blood pressure during pregnancy).
Magnesium sulfate is the most common medicine used for
preventing
eclampsia (seizures) during pregnancy.
Steroid medicines such as
betamethasone and dexamethasone may be used to help
the fetus's lungs mature faster. These medicines are often given if preterm
delivery is needed.
What To Think About
There is not enough
medical evidence to show which blood pressure medicine is most effective
for use during pregnancy.
Some high blood pressure medicines are dangerous during pregnancy. 7, 8 If you take high blood pressure medicines, talk to your
doctor about the safety of your medicine before you become pregnant or as soon
as you learn you are pregnant. Make sure that your doctor has a complete list
of all medicines that you are taking.
Lowering blood pressure too
much or too fast can reduce blood flow to the placenta, causing problems for
the fetus. So medicine is reserved for preventing severely high blood pressure
levels that may be life-threatening to you or your fetus.
Surgery
There is no surgical treatment for
high blood pressure during pregnancy or for
pre-eclampsia.
Surgical
caesarean section delivery is used when:
- A rapid delivery is medically needed for the
mother's or fetus's well-being or survival.
- Induction of labour has
not been successful, usually within a 24-hour period.
- There are
medical reasons, such as
placenta previa, that make vaginal delivery
dangerous.
For more information, see the topic
Caesarean Section.
Other Treatment
Delivery
The main treatment for severe
pre-eclampsia is stabilizing the condition (preventing
seizures with the anticonvulsant medicine magnesium sulfate and controlling
high blood pressure) and delivering the baby. If you have severe pre-eclampsia
or you have mild to moderate pre-eclampsia and are close to your due date, your
baby will be delivered. Vaginal delivery is preferred to caesarean
delivery.
Expectant management
Your condition may
be treated with
expectant management (bedrest) either at home or in
the hospital. The purpose of expectant management is to allow more time for
fetal development, for the cervix to become ready for a vaginal delivery, or
both.
Social support
Reduced
activity and worry are difficult parts of having pre-eclampsia. It often helps
to talk with women who are or have been in the same situation. See the Other
Places to Get Help section of this topic for more information.
Other Places To Get Help
Organizations
| Society of Obstetricians and Gynaecologists of Canada
(SOGC) |
| 780 Echo Drive |
| Ottawa, ON K1S 5R7 |
| Phone: | 1-800-561-2416
(613) 730-4192 |
| Fax: | (613) 730-4314 |
| Email: | helpdesk@sogc.com |
| Web Address: | www.sogc.org |
| |
The mission of SOGC is to promote optimal women's
health through leadership, collaboration, education, research, and advocacy in
the practice of obstetrics and gynaecology. |
|
| Canadian Hypertension Society |
| Email: | info@hypertension.ca |
| Web Address: | http://www.hypertension.ca/ |
| |
The Canadian Hypertension Society promotes the effective management of hypertension in Canada. The organization provides information about the condition and supports research. |
|
References
Citations
- Solomon CG, Seely EW (2004). Preeclampsia—Searching
for the cause. New England Journal of Medicine, 350(7):
641–642.
- Society of Obstetricians and Gynaecologists of Canada (2008). Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Journal of Obstetrics and Gynaecology Canada, 30(3, Suppl 1). Also available online: http://www.sogc.org/guidelines/documents/gui206CPG0803_001.pdf.
- Cunningham FG, et al. (2010). Maternal physiology. In Williams Obstetrics, 23rd ed., pp. 107–135. New York: McGraw-Hill.
- Habli M, Sibai BM (2008). Hypertensive disorders of
pregnancy. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 257–275. Philadelphia: Lippincott Williams and
Wilkins.
- Roberts JM, Funai EF (2009). Pregnancy-related hypertension. In
RK Creasy, R Resnik, eds., Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice, 6th
ed., pp. 651–688. Philadelphia: Saunders.
- O'Brien TE, et al. (2003). Maternal body mass index
and the risk of preeclampsia: A systematic overview. Epidemiology, 14(3): 368–374.
- Cooper WO, et al. (2006). Major congenital malformations after first-trimester exposure to ACE inhibitors. New England Journal of Medicine, 354(23): 2443–2451.
- Health Canada (2006). Health Canada reminds women not to use ACE inhibitors during pregnancy. Available online: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/2006/2006_52_e.html.
- Duley L (2008). Pre-eclampsia, eclampsia and hypertension, search date July 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Villar J, et al. (2006). World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women. American Journal of Obstetrics and Gynecology, 194(3): 639–649.
- Health Canada (2009). Prenatal Nutrition Guidelines for Health Professionals: Background on Canada's Food Guide. Available online: http://www.hc-sc.gc.ca/fn-an/pubs/nutrition/guide-prenatal-eng.php.
- Coomarasamy A, et al. (2003). Aspirin for prevention
of preeclampsia in women with historical risk factors: A systematic review.
Obstetrics and Gynecology, 101(6):
1319–1332.
- Poston L, et al. (2006). Vitamin C and vitamin E in pregnant women at risk for pre-eclampsia (VIP trial): Randomised placebo-controlled trial. Lancet, 367(9517): 1145–1154.
- Rumbold AR, et al. (2006). Vitamins C and E and the risks of preeclampsia and perinatal complications. New England Journal of Medicine, 354(17): 1796–1806.
- Sibai BM (2003). Diagnosis and management of
gestational hypertension and preeclampsia. Obstetrics and Gynecology, 102(1): 191–192.
Other Works Consulted
- American College of Obstetricians and Gynecologists
(2002, reaffirmed 2010). Diagnosis and management of preeclampsia and eclampsia. ACOG Practice
Bulletin No. 33. Obstetrics and Gynecology, 99(1):
159–167.
- Duley L, et al. (2001). Antiplatelet drugs for
prevention of pre-eclampsia and its consequences: Systemic review.
BMJ, 322(7282): 329–333.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
|---|
| Primary Medical Reviewer | Brian D. O'Brien, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | William Gilbert, MD - Maternal and Fetal Medicine |
|---|
| Last Revised | December 20, 2010 |
|---|
Solomon CG, Seely EW (2004). Preeclampsia—Searching
for the cause. New England Journal of Medicine, 350(7):
641–642.
Society of Obstetricians and Gynaecologists of Canada (2008). Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Journal of Obstetrics and Gynaecology Canada, 30(3, Suppl 1). Also available online: http://www.sogc.org/guidelines/documents/gui206CPG0803_001.pdf.
Cunningham FG, et al. (2010). Maternal physiology. In Williams Obstetrics, 23rd ed., pp. 107–135. New York: McGraw-Hill.
Habli M, Sibai BM (2008). Hypertensive disorders of
pregnancy. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 257–275. Philadelphia: Lippincott Williams and
Wilkins.
Roberts JM, Funai EF (2009). Pregnancy-related hypertension. In
RK Creasy, R Resnik, eds., Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice, 6th
ed., pp. 651–688. Philadelphia: Saunders.
O'Brien TE, et al. (2003). Maternal body mass index
and the risk of preeclampsia: A systematic overview. Epidemiology, 14(3): 368–374.
Cooper WO, et al. (2006). Major congenital malformations after first-trimester exposure to ACE inhibitors. New England Journal of Medicine, 354(23): 2443–2451.
Health Canada (2006). Health Canada reminds women not to use ACE inhibitors during pregnancy. Available online: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/2006/2006_52_e.html.
Duley L (2008). Pre-eclampsia, eclampsia and hypertension, search date July 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Villar J, et al. (2006). World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women. American Journal of Obstetrics and Gynecology, 194(3): 639–649.
Health Canada (2009). Prenatal Nutrition Guidelines for Health Professionals: Background on Canada's Food Guide. Available online: http://www.hc-sc.gc.ca/fn-an/pubs/nutrition/guide-prenatal-eng.php.
Coomarasamy A, et al. (2003). Aspirin for prevention
of preeclampsia in women with historical risk factors: A systematic review.
Obstetrics and Gynecology, 101(6):
1319–1332.
Poston L, et al. (2006). Vitamin C and vitamin E in pregnant women at risk for pre-eclampsia (VIP trial): Randomised placebo-controlled trial. Lancet, 367(9517): 1145–1154.
Rumbold AR, et al. (2006). Vitamins C and E and the risks of preeclampsia and perinatal complications. New England Journal of Medicine, 354(17): 1796–1806.
Sibai BM (2003). Diagnosis and management of
gestational hypertension and preeclampsia. Obstetrics and Gynecology, 102(1): 191–192.
