Chronic hypertension in pregnancy refers to high blood pressure present before conception or diagnosed during the first 20 weeks of gestation. It is distinct from other forms of high blood pressure that can develop later in pregnancy, such as gestational hypertension or preeclampsia. Managing chronic hypertension throughout pregnancy is important for promoting healthy outcomes for both the pregnant individual and the developing fetus.
Associated Risks for Mother and Fetus
Chronic hypertension during pregnancy presents several potential complications for both the pregnant individual and the developing baby. One significant maternal risk is the development of superimposed preeclampsia, a severe condition characterized by new-onset protein in the urine or other organ dysfunction after 20 weeks of gestation. Additionally, pregnant individuals with chronic hypertension face a higher risk of placental abruption, where the placenta separates from the inner wall of the uterus before birth, potentially leading to bleeding and distress for the fetus.
Other maternal risks include an increased chance of stroke, particularly if blood pressure is poorly controlled, and a greater likelihood of requiring a Cesarean delivery. Elevated blood pressure can strain various organ systems, making careful management necessary to prevent serious health events.
For the developing fetus, chronic hypertension can lead to complications such as fetal growth restriction (FGR). This occurs when the baby does not grow as expected due to reduced blood flow and nutrient supply through the placenta.
The reduced blood flow to the placenta also increases the risk of preterm birth, meaning the baby is born before 37 weeks of gestation. Babies born prematurely may experience various health challenges due to their underdeveloped organs. Furthermore, chronic hypertension can contribute to low birth weight, even if the baby is not born prematurely, because of the compromised nutrient delivery.
Monitoring During Pregnancy
Regular monitoring is important for managing chronic hypertension during pregnancy to identify potential complications early. Pregnant individuals typically require more frequent prenatal visits, often every one to two weeks, especially as the pregnancy progresses. During these visits, blood pressure readings are consistently taken and assessed to ensure levels remain within a safe range. Some healthcare providers may also recommend at-home blood pressure monitoring to provide a more comprehensive picture of daily fluctuations.
Laboratory tests are also performed to check for signs of worsening hypertension or the development of superimposed preeclampsia. Regular urine tests are conducted to detect the presence of protein, which can indicate kidney involvement and is a marker for preeclampsia. Blood tests are also performed to monitor kidney function, liver enzyme levels, and platelet counts, as these can be affected by high blood pressure conditions.
Fetal surveillance is another important aspect of monitoring the baby’s well-being and growth. Ultrasounds are used frequently to monitor the baby’s growth, assessing parameters such as head circumference, abdominal circumference, and femur length to detect any signs of fetal growth restriction. Doppler ultrasound studies may also be performed to assess blood flow through the umbilical cord and to the baby’s brain. Later in pregnancy, nonstress tests (NSTs) or biophysical profiles (BPPs) may be conducted to evaluate the baby’s heart rate patterns, movements, breathing, and amniotic fluid levels.
Treatment Approaches and Lifestyle Adjustments
Managing chronic hypertension during pregnancy involves medical treatments and lifestyle adjustments to maintain blood pressure within a safe range. Healthcare providers often prescribe pregnancy-safe antihypertensive medications to control blood pressure levels. Common examples of medications considered safe for use during pregnancy include labetalol and nifedipine, which work by relaxing blood vessels or slowing the heart rate. These medications are carefully chosen to minimize any potential risks to the developing fetus while effectively managing maternal blood pressure.
Certain blood pressure medications, such as ACE inhibitors (e.g., lisinopril, enalapril) and angiotensin receptor blockers (ARBs) (e.g., valsartan, losartan), are not considered safe during pregnancy due to potential harm to the fetus. Individuals who were taking these medications before pregnancy will typically need to switch to pregnancy-compatible alternatives under strict medical supervision.
Lifestyle adjustments play a significant role in supporting medical treatment and promoting overall health. Dietary recommendations often include limiting sodium intake to help manage fluid retention and blood pressure. While a completely salt-free diet is not usually necessary, reducing processed foods and avoiding adding extra salt can be beneficial. Engaging in provider-approved physical activity, such as moderate walking, can also contribute to blood pressure control and overall well-being.
Managing stress through techniques like mindfulness, yoga, or deep breathing exercises can also positively impact blood pressure levels. Avoiding smoking and alcohol consumption is also strongly advised for all pregnant individuals, as these substances can further complicate hypertension and pose risks to fetal development.
Considerations for Labor and Postpartum Care
The management of chronic hypertension extends into the labor, delivery, and postpartum periods. For pregnant individuals with chronic hypertension, an induction of labor might be recommended, often scheduled before the estimated due date, typically between 37 and 39 weeks of gestation. This proactive approach aims to reduce the risk of complications that could arise if the pregnancy continues closer to full term, such as worsening hypertension or placental issues. During labor, blood pressure is continuously monitored, and medications may be adjusted to maintain stable levels.
The postpartum period also requires close attention to blood pressure management. Blood pressure can remain elevated or even spike in the days and weeks after delivery, sometimes leading to postpartum hypertension or preeclampsia. This fluctuation is due to various physiological changes occurring in the body as it recovers from pregnancy. Frequent blood pressure checks are scheduled during postpartum follow-up appointments.
Healthcare providers will assess the need for continued blood pressure medication or adjustments to the dosage based on the individual’s postpartum blood pressure readings. Some individuals may be able to reduce or discontinue medication over time, while others may need ongoing treatment.