High blood pressure — also called hypertension — in pregnancy may not be a common condition, but it can be a concerning one.
Women are considered to have chronic hypertension in pregnancy if they had a preexisting hypertensive condition before getting pregnant or developed high blood pressure within the first 20 weeks of pregnancy. This type of hypertension should not be confused with gestational hypertension, which is high blood pressure identified after 20 weeks of pregnancy paired with normal blood pressure before pregnancy.
For women with chronic hypertension who are pregnant or planning to become pregnant, there are a few things to know.
Know the risks
While many women with chronic hypertension do well in pregnancy, it is important to know the risks associated with the condition. New research shows mortality rates have increased for pregnant women with chronic hypertension, especially among Black women. Obesity and advanced age contribute to even greater risk of hypertension-related maternal deaths.
Women who are pregnant and have chronic hypertension are also at increased risk for possible pregnancy complications, including:
- Superimposed preeclampsia
- Fetal growth restriction
- Placental abruption
- Preterm birth
- Cesarean section
- Fetal demise
- Maternal death
“It's important for women to know the risks of chronic hypertension to help prepare for additional surveillance before and after pregnancy, as well as to modify lifestyle choices prior to conception,” says Dr. Sara Junya, a board-certified obstetrician-gynecologist with Sharp Rees-Stealy Medical Group.
Work closely with designated doctors
As with any pregnancy, it’s important to adhere to regular prenatal care checkups. For pregnant women with chronic hypertension, more frequent prenatal visits are recommended.
It’s also not uncommon for women with chronic hypertension to consult with various doctors. At some point during the pregnancy, for example, a referral to a cardiologist might be necessary.
“Do not be afraid to ask questions of your doctor,” adds Dr. Junya. “No question is silly or too small. I often recommend writing down any questions and bringing them to your visit to ensure that we do not miss a topic you would like to discuss.”
Dr. Gayatri Chhatre, a board-certified obstetrician-gynecologist with Sharp Rees-Stealy Medical Group, advises that women on antihypertensive drugs should work closely with their primary care doctor and obstetrician to switch to drugs with an established fetal safety profile.
“If possible, seek input from your primary care doctor or OBGYN prior to conceiving to find out what blood pressure medications you should take,” adds Dr. Chhatre. “Not all medications for treating high blood pressure are considered safe to take during pregnancy, so it’s important to make sure you are prescribed the right antihypertensive.”
Working closely with doctors includes maintaining care into the postpartum period. “We will work closely with you to make sure that the blood pressure fluctuations after delivery are not too low or too high, which can often require longer monitoring in the hospital postpartum or frequent postpartum visits to check blood pressure values,” Dr. Junya says.
Focus on factors within your control
Even though having chronic hypertension may seem overwhelming on top of managing pregnancy, there are strategies women can concentrate on to feel more in control. Dr. Junya emphasizes the critical importance of stress reduction, as well as quitting use of tobacco, drugs and alcohol.
Additionally, following doctors’ instructions to check blood pressure at home and report any elevated values or signs or symptoms of increasing blood pressure is one action patients can focus on, Dr. Junya says. Another is being diligent in taking prescribed or over-the-counter medications as recommended by your doctors.
Experts agree that while experiencing chronic hypertension during pregnancy is not without its risks, having an attentive care team and following good health habits will help ensure a successful pregnancy.
To learn more about how you can find a doctor at Sharp Rees-Stealy, visit sharp.com/srsdoctor.