Chronic Hypertension In Pregnancy

Many pregnant women are often diagnosed with hypertension or high blood pressure. Since this condition was present in them even before pregnancy, it is called chronic hypertension. Chronic hypertension could lead to complications in a pregnancy in some cases. But it can be managed, and a woman with chronic hypertension in pregnancy can deliver a healthy baby. For this to happen, it is though imperative that the woman with chronic hypertension tell her doctors know when she is planning a pregnancy. The doctors can then give her pregnancy counseling and readjust antihypertensive medications if necessary.

Chronic hypertension can be of three types: essential hypertension, secondary hypertension and pregnancy-induced hypertension. It is believed that genes play a key role in essential hypertension, while secondary hypertension is often caused by another condition such as kidney disease, narrowing of the artery to the kidney, and adrenal tumors. For secondary hypertension, it is best to be treated for the underlying condition before becoming pregnant. Pregnancy-induced hypertension is one that develops during pregnancy, found usually in the third trimester.

Most women having chronic hypertension don't face problems in pregnancy. In normal pregnancy, blood pressure falls at the end of the first trimester and then rises to increases to pre-pregnancy levels in the third trimester. The same happens for most women with chronic hypertension. If the blood pressure of a woman rises considerably during pregnancy, there is a risk for stroke and she might need more aggressive antihypertensive treatment.

There is a cause for concern if a condition called superimposed preeclampsia develops because of chronic hypertension. Preeclampsia can affect several organ systems and lead to liver dysfunction, kidney failure, and an increase in bleeding tendency, and occasionally can cause eclampsia seizures also. As no treatment for preeclampsia exists as of now, the only remedy is premature delivery of the baby. Chronic hypertension can cause another complication called placental abruption that may cause premature birth. In the case of an early delivery, if it is not possible to have the baby delivered vaginally, a cesarean section may be needed.

There are some medications that are best avoided during pregnancy; so your doctor may change your medications before you become pregnant. This is because some medicines could cross the placenta and affect your fetus also. Those medication classes that are usually avoided in pregnancy include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and aldosterone receptor blockers.

During pregnancy, the goal for your blood pressure may be relaxed a bit because your fetus needs sufficient blood flow. In addition, since pregnancy is only nine months, the concern at that time is on short-term complications of hypertension. You need to have your blood pressure checked by your doctor frequently during the third trimester. The doctor will lookout for signs of problems, including placental abruption. Your urine will be examined at each visit to look for indications of protein loss, which can suggest impending complications. You should consult your doctor if you notice swelling of your hands and face or there is a decrease in the baby's movements.

Women with chronic hypertension have nothing to worry as they can and do have healthy babies. Before pregnancy, you should consult your doctor about whether you should change your blood pressure medications. Your doctor may ask you to undergo some baseline tests of your kidney function. Obese women may be asked to lose weight. Importantly, you should monitor your blood pressure at the frequency your doctor recommends during pregnancy.

• Matt Thompson
• 11/04/2009, 6:59 PM
• 0 Comments