The Pressure’s On…

To all of the women who have reached out to me through emails or direct messages to ask me questions: Thank you! I love hearing your thoughts and questions. One of the most common questions I get is about high blood pressure and what the differences are between high blood pressure, hypertension, and preeclampsia. So, here is a post on the differences between each of the maternal conditions related to blood pressure that happen during pregnancy.

What is blood pressure?

Blood pressure, essentially, is a measurement of how forcefully the blood is circulating through the arteries. It is impacted by several factors, but most importantly by the heart rate and the elasticity of the arterial walls. When the blood meets resistance, the heart has to work harder to force the blood to circulate. That increased workload of the heart translates into high blood pressure. Blood is supposed to flow freely throughout the body, not be under force or pressure to get to all parts of the body.

Why it matters for pregnancy

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Photo by Kewei Hu

In pregnancy we keep a close eye on women’s blood pressures. Most people have no symptoms when their blood pressure is elevated. Dangerously high or sudden spikes in blood pressure may be associated with dizziness or headaches, but elevations in blood pressure are typically unnoticed.  

The reason why we get so concerned about blood pressure during pregnancy is because we are always worried about the placenta. Since the placenta is how the baby gets nourished and sustained, we in obstetrics want to keep the placenta working properly. The placenta is vascular and susceptible to blood pressure changes. High blood pressure in the mother means the placenta is under pressure too and that could lead it to not function properly as a filter and source of nutrition and oxygenation for the baby.

Types of blood pressure issues

There are different kinds of high blood pressure issues for pregnant women. Among these include:

Gestational hypertension.  

Women with gestational hypertension have high blood pressure that develops after 20 weeks of pregnancy. Treatment for gestational hypertension differs and can range from close monitoring to medication. Typically there is no organ damage and the condition usually goes away once the baby is delivered. However, some women with gestational hypertension may progress to have persistent high blood pressure or hypertension after delivery or worsen to develop preeclampsia.

Chronic hypertension.

Chronic hypertension is high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy.  Some women are aware they have hypertension because it was diagnosed by their health care practitioner, but sometimes it is not diagnosed until pregnancy. Since there are generally no symptoms with high blood pressure, it is often hard to determine when it actually began (i.e. with pregnancy or before).

Chronic hypertension with superimposed preeclampsia.

This condition occurs in women with chronic hypertension before pregnancy who develop worsening high blood pressure during pregnancy. What makes this significant is that women begin to have protein in the urine or other blood pressure related complications during pregnancy. Protein in the urine is an indicator that the high blood pressure is causing the kidneys to not work properly.

Preeclampsia.

Preeclampsia occurs when hypertension develops after 20 weeks of pregnancy, and is associated with signs of damage to other organ systems, including the kidneys, liver, blood or brain. Untreated preeclampsia can lead to serious — even fatal — complications for mother and baby, including development of seizures. Fortunately there are various medications available to treat preeclampsia. However, since this condition is serious, most women are monitored closely and are often admitted to the hospital for the duration of the treatment.

Just a summary

This is just a snapshot of the various blood pressure-related conditions during pregnancy. It is not exhaustive or all-inclusive. The message I want to emphasize is that blood pressure is an important parameter to monitor during pregnancy.  Most women never realize they have elevations in blood pressure, so we act swiftly to create a monitoring plan and schedule additional testing as needed.

 

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