Author: Dr. Robert Moore, Maternal-Fetal Medicine, High-Risk Pregnancy
Most women of childbearing age do not have signiﬁcant cardiac disease; however, in south Louisiana there are many young women who have a long-standing history of high blood pressure, also known as hypertension. Because of hypertension’s effects on pregnant women and their unborn babies, we manage these patients in the Woman’s Maternal-Fetal Medicine Department.
Here are some of the common questions women ask about pregnancy and high blood pressure:
Is it safe for me to get pregnant with high blood pressure?
In most cases, hypertension can be easily managed in pregnancy. However, it is recommended that prior to attempting pregnancy, you meet with your primary care doctor to outline what medications are safe for pregnancy.
In those women with long-standing hypertension, it’s also advisable to check with your primary care doctor to ensure your hypertension hasn’t signiﬁcantly aﬀected other organs, such as your kidneys or your heart. Some primary care doctors recommend a study of your heart (called an EKG) and blood work to check on your kidney function prior to pregnancy.
What do I need to do differently once I become pregnant?
Once you become pregnant, your obstetrician may refer you to a Maternal-Fetal Medicine (MFM) high-risk pregnancy specialist throughout your pregnancy. We ensure that your medications can control your blood pressure and also that your baby is growing appropriately.
It’s important to note that during pregnancy the goals for your blood pressure levels are not the same as when you are not pregnant. Most times the high-risk pregnancy doctor will allow for mildly elevated blood pressure in pregnancy to allow for adequate blood ﬂow to your baby.
In pregnancy it’s also important that your high blood pressure treatment include the addition of a daily low dose aspirin. Low dose aspirin (81 mg each day) has been shown to decrease the risk of developing preeclampsia and thus leading to better outcomes for both mom and baby. This usually starts between 12 and 28 weeks gestation.
A high-risk pregnancy doctor will also work with your OB-GYN to determine the best time for delivery, which is typically between 37 and 39 weeks of gestation for a woman with well-managed hypertension. In the weeks leading up to your delivery, you will need to see your doctor fairly frequently, at least once if not twice per week, to ensure you and baby are both doing well. This extra care is usually termed “fetal testing.”
What is preeclampsia?
Preeclampsia is a complication of pregnancy where a mother’s blood pressure is much higher than her normal levels. This condition can cause damage to the mom’s organs such as her liver or kidneys. Preeclampsia sometimes can also lead to eclampsia, where a mom can begin to have seizures. Women get preeclampsia in pregnancy from the placenta, the organ that connects mom to baby.
The cure for preeclampsia is delivery of the baby, because most women will return to their normal blood pressure levels once the placenta is removed. Though delivery is always best for the mother with preeclampsia, delivery may not be best for the baby at a very early gestational age. If a patient develops preeclampsia early in pregnancy, she and her doctor will work with the MFM doctor to determine the safest timing for delivery that balances the safety for mom and baby.
Can I have a normal vaginal delivery with high blood pressure?
High blood pressure is not an indication for a Cesarean section. Most women can have a natural vaginal delivery without any major complications. Your blood pressure will still need control during delivery, which most times can be managed by your regular medications.