A fast-growing cause for concern among women and their babies for adverse and sometimes fatal complications of pregnancy is chronic hypertension. Although it currently only occurs in about 1% of pregnant persons, the rate of maternal chronic hypertension has increased rapidly, especially among African American women in the past few decades. Fortunately, when under the care of Maternal Fetal Medicine specialists, the risk of negative side effects that can be expected from a diagnosis of hypertension can be minimized with treatment.

What is Hypertension?

Hypertension is the medical term for high blood pressure and chronic hypertension refers to patients who had high blood pressure before they became pregnant or developed it early in pregnancy. This is different from a special kind of high blood pressure that some women get during pregnancy called pre-eclampsia. Pre-eclampsia usually develops in the second half of pregnancy or in the post-partum period and goes away in the first few months after delivery.

Chronic Hypertension and Pregnancy

Women who have chronic hypertension and become pregnant need to be closely monitored. Chronic hypertension puts women at a higher risk of developing pre-eclampsia or other blood pressure conditions during pregnancy. Chronic hypertension is also associated with increased risks of pregnancy complications like stillbirth, placental abruption, and fetal growth restriction.

Treatment Before Pregnancy

Ideally, people who are thinking of becoming pregnant in the near future should schedule a pre-conception counseling appointment (or appointments) to check their health, medical history, medications, and lifestyle habits that can influence the outcome and experience of pregnancy.  People who have hypertension should also have a pre-conception consultation with their OB/GYN and/or Maternal Fetal Medicine specialist as well as their primary care physician or cardiologist to discuss solutions to reduce your risk of adverse outcomes.

Treatment During Pregnancy

An OB/GYN or Maternal Fetal Medicine specialist can help decide if you need treatment for your high blood pressure during pregnancy and/or to see if the medication you are taking is safe to take during pregnancy. Women’s blood pressure naturally varies during pregnancy, so we recommend that you check your blood pressure at home in addition to at your doctor’s office to see if you need to change the dose of your medication during the pregnancy. Many patients are started on a baby aspirin to help decrease the risk of developing pre-eclampsia.  We also recommend additional monitoring of your baby through ultrasounds to evaluate the growth and the well-being of the baby.

SYMPTOMS OF PRE-ECLAMPSIA

Whether you have chronic hypertension or not, it’s important to know and watch out for the symptoms of pre-eclampsia both during and before pregnancy to be aware of the signs of this potentially complicating condition. Symptoms include:

• Chronic headache
• Changes in vision
• Abnormal swelling in your hands or face

Pre-eclampsia can also manifest without any symptoms, which is why scheduling and keeping appointments with your pregnancy care team is vital to understanding and preventing complications that can arise during this time. If you experience any of these symptoms, it’s important to contact your doctor and visit your health care team to discover the cause and treatment options for your symptoms to ensure your health and the health of your child.

Treatment After Pregnancy

Some women develop pre-eclampsia after they deliver so if you have any feelings of pre-eclampsia or elevated blood pressures after childbirth, please call your doctor right away because you may need medical care. Some women also need to adjust their blood pressure medication after delivery so may need to continue to closely follow with their OB/GYN, MFM specialist, primary care physician, or cardiologist.