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    High Blood Pressure During Pregnancy

    What is considered high blood pressure during pregnancy?

    In a healthy individual, the systolic blood pressure should ideally range below 120 mmHg while the diastolic blood pressure should be lower than 80 mmHg [1] . Ideally, the BP range should remain within these limits throughout the pregnancy. Having a BP reading over 140/90 mmHg is considered high blood pressure in a pregnant woman [2] while a BP reading above 120/80 and below 140/90 calls for a visit to your doctor.

    High blood pressure and pregnancy: Is it an early sign?

    Although a little high BP is quite common while pregnant, it is not considered an early sign as it can occur anytime in pregnancy. Women with blood pressure too high are more at risk of various complications.

    Your Normal Blood Pressure while Pregnant

    Your body produces around 1 liter of extra blood by the 24th week (sixth month) of pregnancy to transport oxygen and nutrients to the developing fetus and to carry the fetal waste products away [3] . As a result, your blood pressure may rise a little with your heart working extra hard to pump the additional blood. Progesterone (pregnancy hormone) relaxes the blood vessel walls to allow the extra blood to pass, which may lower your BP around the mid weeks of pregnancy. However, there is nothing to worry about as your BP becomes normal again in later third trimester [4] . Your doctor may get concerned only if your BP reading remains higher than normal over several weeks.

    High Blood Pressure during Pregnancy Stage Chart

    Severity Level [5]

    Systolic Pressure [6]

    Diastolic Pressure [6]

    What are the different types of high blood pressure in pregnancy?

    The following classification depends on the underlying causes, possible outcomes and the stage of onset of the condition:

    • Pre-existing or chronic high blood pressure [6]
    • Gestational hypertension
    • Preeclampsia (earlier referred to as toxemia of pregnancy)
    • Preeclampsia superimposed on chronic hypertension [7]

    What causes high blood pressure in pregnancy

    As the name suggests, the pre-existing form refers to high blood pressure that continues from before pregnancy. High BP diagnosed before the 20th week is considered to be pre-existing and not caused by pregnancy [8] . On the other hand, gestational high blood pressure develops during pregnancy after the 20th week, with the exact triggering factors still remaining unknown. The pregnancy induced form may later advance to complications like preeclampsia, HELLP syndrome and eclampsia.

    Risk Factors for High Blood Pressure While Pregnant

    • Chronic high BP or kidney disease before conceiving
    • First pregnancy
    • A family history of pregnancy induced hypertension [9]
    • Being younger than 20 years or older than 40 years
    • Twin pregnancy (2-3 times more at risk) [39]
    • Too much smoking and/or alcohol consumption
    • Overweight or obesity [5]
    • Thyroid and adrenal disorders
    • Diabetes
    • African-American race [8]
    • Drinking lots of water to stay hydrated
    • Consuming salt only as necessary [9]
    • Following a diet containing fresh fruits and vegetables [12]
    • Avoiding gaining too much weight in pregnancy [13]
    • Following a regular exercise routine
    • Avoiding alcohol, caffeine and smoking
    • Getting plenty of rest
    • Keeping your feet elevated when resting
    • Doing pre-natal yoga [40] and practicing relaxation techniques to reduce stress [14]

    How to prevent high blood pressure during pregnancy?

    Women suffering from chronic hypertension should consult a health care practitioner to lower the BP before planning to have a baby [7] . The above healthy lifestyle changes are also recommended for ensuring a healthy pregnancy. Taking calcium supplements (FDA recommended RDA of 1200 mg) is also believed to help to avoid extremely high BP (preeclampsia) in high risk pregnancies [12] ; although, no supplements should be used without consulting the doctor.

    What are the signs and symptoms of high blood pressure during pregnancy?

    In many cases, it does not lead to any signs and the high BP is only detected during a regular pre-natal check-up [7] . But, you should look out for symptoms like:

    • Severe persistent headache [6]
    • Changes in vision (sensitivity to light, flashing lights, blurred vision or vision loss)
    • Dizziness
    • Severe upper abdominal pain (especially on your right side) [15]
    • Severe nausea and vomiting in later pregnancy
    • Sudden swelling (edema) of the face, hands and feet
    • Sudden weight gain (over 5 pounds a week) [15]
    • Reduced urination [8]
    • Lower back pain [16]
    • Chest pain
    • Breathing difficulty
    • Nosebleeds [41]

    Make sure to call your doctor immediately in case you have one or more of the above signs as they may indicate serious complications like preeclampsia.

    How is high blood pressure diagnosed during pregnancy?

    Your blood pressure is checked as a routine procedure during the pre-natal visits to your doctor. High BP is diagnosed if:

    • Two BP readings taken 4 hours apart are 140/90 or higher [3]
    • The BP shows a reading of only the diastolic pressure of 110 or higher (a higher than normal diastolic reading is enough to diagnose high BP) [4]

    You may be asked to stay at the healthcare facility for several hours so the doctor can monitor your BP on an hourly basis. Other tests like ultrasound scans, blood tests [17] , urine tests, non-stress tests [8] and biophysical profile may be necessary for assessing the maternal and fetal health as well as for checking the heart and kidney functioning.

    Urine tests are vital for detecting protein in the urine, which (along with high BP) confirms the diagnosis for preeclampsia [18] . Women who have high BP with no protein in the urine are also at risk of developing the complication.

    High Blood Pressure during Pregnancy Differential Diagnosis

    What are the risks of high blood pressure during pregnancy?

    Effects on the baby

    • Lower than normal birth weight due to decreased blood flow to placenta that lowers the oxygen and nutrient supply to the developing fetus [15]
    • Various birth defects (especially neural tube defects and heart malformations) [22]

    Dangers to the Mother

    • Developing preeclampsia, a serious complication that may endanger the lives of both mother and child [21]
    • Placental abruption [23]
    • Premature labor and delivery (before the 37th week of pregnancy) [37]
    • Miscarriage, especially in later pregnancy [38]
    • Elevated risk of stroke as well as various heart diseases, kidney disorders and diabetes in the mother in future [24]

    How to reduce high blood pressure during pregnancy?

    Close monitoring with tests and medications is necessary depending on how high the BP is and when it is diagnosed [18] . Mild cases of high BP are often managed by bed rest and going for frequent prenatal check-ups. [25] . The treatment for severe chronic or gestational high blood pressure involves both prenatal and postnatal care with its main object being preventing the condition from getting any worse [26] .

    Medication for Lowering High Blood Pressure during Pregnancy

    Women with chronic hypertension are often prescribed medicines to keep their BP below the 149/90 mark. Those already on BP medication before conceiving should consult a doctor to determine whether it is safe to take the same medicine in pregnancy. Regular BP medications like ACE inhibitors, angiotensin II receptor blockers [27] And renin inhibitors are not recommended to pregnant women as they can cause serious side effects both in the mother and the baby (especially in the second and third trimesters) [28] . Possible risks include kidney damage and potassium accumulation in the mother as well as fetal death [23] .

    Medications considered safe during pregnancy include:

    Magnesium sulfate is often used to prevent seizures (eclampsia) associated with extremely high blood pressure [29] .

    Natural Remedies

    Regular home remedies used for managing high BP are often Not recommended during pregnancy. Those considered relatively safe include herbal teas like dandelion, nettle and lime flower as well as fresh beetroot juice [30] . But, never consider any of these remedies without consulting your doctor.

    Treatment of Severe Cases

    Hospitalization may be necessary to prevent the condition from advancing to serious complications in women with unusually high BP readings. Early delivery by a c-section (cesarean section) or induction of labor is an option in women past the 38th week of pregnancy with preeclampsia. Those between the 34th and 37th week are monitored closely at the hospital for development and functioning of the fetal organs. Steroid medicines (e. g. betamethasone, dexamethasone) can be used for accelerating the fetal lung maturation so that the baby can be delivered as soon as possible.

    Diet for High Blood Pressure during Pregnancy

    The National Heart, Lung and Blood Institute (NHLBI) recommend the DASH Diet (Dietary Approaches to Stop Hypertension) [31] for lowering the sodium intake and fight high BP. Additionally, it increases the intake of calcium, potassium and magnesium, the three minerals known to help control BP. The principal food items included in this diet plan are whole grains, fresh fruits and vegetables, low-fat dairy, poultry, fish and meat products nuts, beans as well as small helpings of sweets.

    Foods to avoid: Mainly fatty and salty foods [10] as sodium causes more fluid to remain in your body, requiring the heart to work harder [11]

    Treatment of High Blood Pressure after Pregnancy

    Although the blood pressure gradually comes down to normal after delivery in most women with severe high blood pressure (or preeclampsia) late in pregnancy, some women may need medical treatment even after the baby is born. In some cases, a woman may develop extreme high blood pressure along with abnormally high amounts of protein in the urine following pregnancy (postpartum preeclampsia) [35] . Like during pregnancy, magnesium sulfate is used to manage seizures after childbirth. Other antihypertensive medicines may also be prescribed while the patient may even have to stay at the hospital for a few days longer so the doctors can monitor their BP. It is recommended to consult your doctor regarding whether it is safe to breastfeed your baby while taking the medications [36] .

    How common is high blood pressure in pregnancy?

    It affects 1 out of every 10 pregnant women [18] . Around 1 in every 20 woman has pre-existing high BP while 1 in every 20 women develops high BP without preeclampsia while pregnant. The high BP advances to preeclampsia in 2-8 pregnant women out of 100 while eclampsia develops in about 1 in 200 women [6] .

    High Blood Pressure ICD-9 and ICD-10 Codes

    The ICD-9 code used for identifying high BP is 401 [33] while its ICD-10 codes are I10, I11, I12, I13, I15 [34]

    Causes & Symptoms of Low Blood Pressure During Pregnancy

    Low blood pressure also referred to as hypotension is caused by reduced flow of blood from your heart to other part of your body. Occurrence of high and low blood pressure during pregnancy is very common, although low blood pressure during pregnancy is more common during the early months.

    Causes of Low Blood Pressure in Pregnancy

    Low blood pressure during pregnancy usually occurs in order to cater to the supply of blood to the growing baby. Other causes of low blood pressure during pregnancy are as under:

    • Secretion of certain hormones related specifically to the changes in the body during pregnancy.
    • Pressure on the blood vessels resulting from the growth of the uterus.
    • Dehydration is another common cause of low blood pressure during pregnancy. This can occur due to inadequate intake of water and other fluids as well as prolonged exposure to sun and heat.
    • Emotional stress and strain.
    • Anemia and low sugar levels also referred to as hypoglycemia are other major causes of low blood pressure during pregnancy.
    • Deficiency of certain minerals and nutrients in the diet.

    Low Blood Pressure Symptoms in Pregnancy

    Low blood pressure during pregnancy symptoms are as listed below:

    • Heaviness in the head, dizziness, and even fainting
    • Nausea and vomiting
    • Depression
    • Fatigue and weakness
    • Blurred vision
    • Loss of appetite

    If you are pregnant and happen to experience these symptoms, you should consult your health care provider immediately for treatment.

    Preventing Hypotension in Pregnancy

    • Drink plenty of water and your favorite juices at regular intervals in order to prevent dehydration.
    • In order to prevent hypoglycemia and anemia, you need to follow a healthy dietary plan. Ask your dietician to make the requisite dietary plan for you.
    • Instead of lying on your back, you should try to lie on your side.
    • Do a mild workout regularly and go for walks in the morning as well as evening. It will greatly help in improving your blood circulation.

    These steps not only prevent the occurrence of low blood pressure during pregnancy but also serve as the natural cures for low blood pressure during pregnancy.

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    Use the blood pressure chart below to see what your blood pressure means. The blood pressure chart is suitable for adults of any age. (The level for high blood.

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    Blood pressure readings have two numbers, for example 140/90mmHg. The top number is your systolic blood pressure. (The highest pressure when your heart beats and pushes the blood round your body.) The bottom one is your diastolic blood pressure.

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