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I have chronic high blood pressure. What happens at my first prenatal visit?
At your first prenatal visit, be prepared to discuss your condition with your healthcare provider, including:
- When it started
- Which tests or procedures you've had
- Whether you've had complications, such as eye, heart, or kidney issues
- What medications you currently take or have previously taken
Arrange for your primary care provider or blood pressure specialist to send a copy of your medical records to your obstetrician, midwife, or nurse practitioner ahead of time. You could also bring them with you. This way your pregnancy provider can review your blood pressure readings over time as well as have the results of lab tests and other evaluations.
If you haven't had blood and urine tests (related to blood pressure) done recently, your provider will probably order new ones. This will give her a complete set of baseline measurements, which will be useful for noticing any changes as your pregnancy progresses.
Depending on the severity of your condition and your previous treatments, your provider may order an echocardiogram or an electrocardiogram (EKG) to check your heart.
You'll also have an eye exam. Chronic high blood pressure can damage the retina, the light sensitive tissue at the back of the eye.
If this is the first time you've been diagnosed with high blood pressure, you may have a complete workup, including tests to rule out other conditions that may cause high blood pressure, such as kidney disease, diabetes, or preeclampsia.
Your provider will explain the risks associated with chronic high blood pressure during pregnancy, and tell you to watch for the signs of preeclampsia.
Depending on your health and circumstances, your provider may take over your care during pregnancy, or she may work with the specialist who normally manages your blood pressure. She may also refer you to a maternal-fetal medicine specialist.
What's the treatment for high blood pressure during pregnancy?
That depends on the severity of your condition. Chronic high blood pressure can range from mild to severe. It also depends on whether you have any other health issues.
If you're taking medication, your provider may lower your dose, switch your medication, or take you off of it completely.
Mild high blood pressure
Mild high blood pressure is one or both of these numbers in the elevated range:
- A systolic (the first number) blood pressure reading between 140 and 159 millimeters of mercury (mmHg)
- A diastolic (the second number) blood pressure reading between 90 and 109 mmHg
Blood pressure tends to go down during the first trimester of pregnancy for all women and return to its normal level in the third trimester. Depending on how low your blood pressure gets, and whether you have any other complications (like diabetes or kidney disease), your provider may advise you to stop taking your blood pressure medication or reduce the dose. Stopping medication temporarily is unlikely to cause problems if your condition is mild.
If you're not currently taking blood pressure medication, your provider probably won't recommend starting now. But your provider will monitor you closely, and if your blood pressure starts to get too high, she'll prescribe medication.
In some cases, your provider may recommend starting or continuing to take medication, even if blood pressure is only in the mild range. This is usually the case if your high blood pressure is related to some other condition, like heart or kidney disease.
Severe high blood pressure
Severe high blood pressure is one or both of these numbers in the elevated range:
- A systolic blood pressure of 160 mmHg or higher
- A diastolic blood pressure of 110 mmHg or higher
If you had severe high blood pressure before pregnancy, you'll likely need to continue taking blood pressure medication during pregnancy. If your blood pressure is still severe, your medication will need to be adjusted to bring it down into the mild range.
Your provider may switch your usual medication to one that's safer for your baby. Some drugs for lowering blood pressure, such as ACE inhibitors, may raise the risk of birth defects if taken during pregnancy. However, it's critical to keep taking your medication because uncontrolled high blood pressure can cause life-threatening complications for you and your baby.
You may be given a blood pressure goal to guide your treatment. This will likely be in the range of 120/80 and 160/105 mmHg. If your blood pressure isn't under control, or if your provider suspects you may be developing complications, like preeclampsia, she may send you to the hospital for additional treatment or tests.
How will my healthcare provider monitor me and my baby?
You'll have more frequent prenatal visits and lab tests to monitor how you're both doing. Whether high blood pressure is mild or severe, it's important to keep all your appointments. This enables your provider to spot any developing problems, such as rising blood pressure, signs of preeclampsia, or indications that your baby isn't growing well.
In addition to a routine ultrasound in the second trimester, you'll also have regular ultrasounds in your third trimester to monitor your baby's growth and the level of your amniotic fluid.
Once your baby starts moving regularly, your provider may ask you to do fetal kick counts to keep track of your baby's movements. Let your provider know immediately if you notice that your baby is less active than usual.
Your provider may also have you check and record your blood pressure at home. She'll tell you how often to do this and ask to see the results at your visits. She'll tell you when to call the office or go to the hospital if your blood pressure numbers go above a certain level.
If your high blood pressure becomes severe, you show signs of developing preeclampsia, or your provider has concerns about the way your baby is growing, you'll have additional tests to check on your baby's well-being. These may include:
- Nonstress test: Your provider or a technician monitors your baby's heartbeat, first while the baby is resting and then while he's moving. It helps your providers see how your baby's doing.
- Biophysical profile: Using an ultrasound, your provider checks on your amniotic fluid level as well as your baby's body movements, muscle tone, breathing movements, and heart rate.
- Doppler ultrasound: This is a scan of the umbilical cord to check how well blood is flowing to your baby.
What happens if my blood pressure gets too high?
That depends on your particular situation. Your provider may adjust your medication and monitor you as an outpatient, or she may admit you to the hospital until your blood pressure is under control.
If your provider is concerned that you're developing preeclampsia in addition to your high blood pressure (superimposed preeclampsia), you'll be evaluated in the hospital. You may stay there until you give birth. Depending on your condition and your baby's health, you may have to deliver early, even if that means your baby is premature.
If you think you may be experiencing symptoms of preeclampsia at any point, call your provider right away. Warning signs and symptoms include:
- A severe headache that doesn't go away
- Sudden excessive swelling (Some swelling is normal during pregnancy.)
- Sudden weight gain
- Vision changes, including double vision, blurriness, seeing spots or flashing lights, light sensitivity, or temporary loss of vision
- Intense pain or tenderness in the upper abdomen
- Nausea and vomiting in the second half of pregnancy
- Difficulty breathing
What can I do to have a healthy pregnancy and baby?
There's a lot you can do to manage your blood pressure during pregnancy:
Gain a healthy amount of weight. Although conventional wisdom for controlling high blood pressure is to lose weight, this isn't recommended during pregnancy. But gaining a healthy amount of pregnancy weight can help keep blood pressure under control.
Eat well. Eat healthy, balanced meals with plenty of whole grains, low-fat dairy products, fish low in mercury, lean meats, and fresh produce.
Don't smokeor drink alcohol. Smoking and drinking raise blood pressure, and neither is recommended during pregnancy.
Say bye-bye to bedrest. In the past, pregnant women with high blood pressure were told to rest in bed, but there's no evidence that bedrest significantly improves outcomes for women or babies.
Exercise if possible. Talk to your provider about how much to exercise and what type you can do safely. If blood pressure is well controlled, you have no complications, and you're used to exercising, it's likely that you'll be able to continue your usual routine. If your provider suggests avoiding strenuous aerobic exercise because it could affect blood flow to the placenta, try a low-impact activity, such as walking or swimming.
Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.