High blood pressure in pregnancy

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Marie-Ange Demory
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Generally speaking of hypertension when the maximum (systolic) blood pressure value is equal to or greater than 140 mmHg, while that of the minimum (diastolic) blood pressure is equal to or greater than 90. "In pregnancy, however, also blood pressure values ​​greater than 120 and 80 respectively mmHg are considered to be at the limit and to be kept under strict control ", explains the professor, gynecologist and endocrinologist and head of the PMA center of the Policlinico San Matteo of the University of Pavia.



In fact, if low blood pressure in pregnancy can be considered physiological, high blood pressure certainly cannot be, due to the risks it can entail for mother and baby.



Read also: Pressure in pregnancy

Three main types of hypertension in pregnancy can be distinguished: chronic hypertension, gestational hypertension and preclampsia. 



In this article

  • Chronic hypertension
  • Gestational hypertension
  • Preeclampsia

Pregnancy and chronic hypertension

There is talk of chronic hypertension when the condition of hypertension was present already before pregnancy, so much so that perhaps the woman was taking specific drugs to combat it. In some situations, however, the woman may never have noticed this simply because she has not recently checked her blood pressure.



In these cases, chronic hypertension is diagnosed if it occurs before 20 weeks of pregnancy. According to the latest guidelines of the Del Paesena Society of gynecology on the subject (published in 2022), moreover, for this diagnosis it is necessary to find high pressure values ​​in more than one measurement after at least 4-6 hours.

Therapies

Chronic hypertension can be controlled during pregnancy with specific drugs: ace inhibitors and angiotensin II receptor antagonists are certainly contraindicated, while drugs such as labetalol, nifedipine and methyldopa can be used. 

Read also: Drugs in pregnancy: which are allowed and which are forbidden

Any complications

L'chronic hypertension it can be associated with various obstetric complications if it is not properly controlled (which can be achieved with medication). These include, for example, premature birth, growth retardation, intrauterine death, placental abruption and caesarean section. However, the possibility of these events seems to be related to various factors such as:

  • the duration of hypertension
  • its severity
  • the simultaneous presence of preeclampsia.

In case of chronic hypertension, pregnancy is considered pathological and checked more frequently than one physiological pregnancy (low risk). 

Gestational hypertension

There is talk of gestational hypertension if hypertension occurs in pregnancy after the twentieth week. Gestational hypertension must always be carefully monitored: the earlier it appears (always after 20 weeks), in fact, the greater the risk that it may evolve into preeclampsia over the weeks. If, on the other hand, it appears later, for example after the 34th week, it is unlikely that it will degenerate into preeclampsia.

Read also: Hellp syndrome in pregnancy: what it is, how it manifests itself, how to intervene

Preeclampsia

Preeclampsia is the most severe form of hypertension that can occur in pregnancy: it usually appears after 20 weeks of gestation associated with proteinuria, i.e. the presence of protein in the urine (levels above 290 mg / l). Preeclampsia can:

  • appear from scratch
  • represent the evolution of a gestational hypertension
  • complicate chronic hypertension on which it can overlap

Unfortunately, the symptoms are very vague. The main ones, which must make us suspect the condition, are precisely upper blood pressure a maximum of 140 and a minimum of 90 after 20 weeks and the presence of protein in the urine. Sometimes they can appear nonspecific symptoms, as

  • headache persistent
  • severe stomach pain
  • scotomas (visions of dark or bright spots in front of the eyes),
  • blurred vision
  • convulsions
  • oliguria, i.e. low amount of urine
  • swelling in the limbs

The possible complications

For the mother, the complications of preeclampsia can range from bleeding disorders to generalized organ damage, to evolution in eclampsia, which manifests itself with seizures, loss of consciousness and in some cases brain haemorrhages. For the child, the main risks are those of growth retardation or arrest, in addition to the risks of a premature birth: when preeclampsia occurs, in fact, the only possible solution to resolve it is childbirth.

How we intervene

Unfortunately, there are no drug solutions: the only way to stop preeclampsia is to stop pregnancy. In other words, the therapy is childbirth, which can however expose the baby to risks, if it is very premature.

Read also: Dizziness during pregnancy

To learn more

  • Pressure in pregnancy
  • Low blood pressure in pregnancy

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  • pregnancy pressure
  • high blood pressure in pregnancy
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