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Hypertension / Pre-eclampsia

Hypertension during pregnancy is a serious condition that must not be ignored

High blood pressure in pregnancy can be quite serious and occurs in as many as 8% of pregnancies, according to the American College of Obstetricians and Gynecologists.

Hypertensive disorders in pregnancy propel expectant mothers into the high-risk category. Women with hypertensive disorder pregnancies require a healthcare provider such as Dr. Rad, a maternal-fetal medicine specialist, also known as a perinatologist. With special medical training in high-risk pregnancies, Dr. Rad helps minimize complications and make healthy pregnancy outcomes possible.

Pregnancy Hypertension

What is hypertension pregnancy?

Hypertensive disorders of pregnancy, an umbrella term that includes chronic hypertension, gestational hypertension, preeclampsia, and eclampsia, complicate pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality.

Plentiful evidence now links low birth weight due to intrauterine growth restriction and increased risk of vascular disease in later adult life to maternal hypertension

Chronic hypertension during pregnancy

Currently, chronic hypertension affects between 3 and 5% of pregnancies. That number is expected to rise as more women postpone pregnancy until they’re well into their 30s and 40s; the older you are when you get pregnant, the higher the chance of complications.

A chronic hypertension diagnosis is based on your blood pressure reading. Hypertension is diagnosed with systolic pressure reading above 140 MmHg and diastolic pressure reading above 90 MmHg before 20 weeks of gestation or before becoming pregnant.

Mild, pre-existing hypertension almost doubles the risk of pre-eclampsia, placental abruption, and fetal growth restriction. Without blood pressure control, the risk of pre-eclampsia soars to 46%.

However, pregnant women who control their blood pressure can experience a normal, healthy pregnancy and birth.

Gestational hypertension

Gestational hypertension, also known as pregnancy-induced hypertension, occurs when a patient’s body reacts to being pregnant by raising blood pressure. Unlike other pregnancy conditions that increase blood pressure, there is no trace of protein in the urine or kidney concerns. Gestational hypertension develops at about 20 weeks and typically returns to normal after delivery.

The true prevalence of gestational diabetes is unknown, with estimates ranging from 1 to 14% of pregnancies in the US being affected. Uncontrolled gestational hypertension can lead to pre-eclampsia, a very serious condition, as well as preterm delivery.

It should be noted that a woman who recovers from gestational hypertension is at an increased risk of having high blood pressure for the remainder of her life.

Pre-eclampsia in pregnancy

Pre-eclampsia, which occurs in 1 in 25 pregnancies, is a condition triggered by sudden high blood pressure in a woman who has previously had normal readings. The condition occurs after 20 weeks of pregnancy and includes proteinuria (having trace protein in the urine).

Symptoms of pre-eclampsia include:

  • severe headaches
  • vision changes
  • abdominal pain
  • nausea
  • swelling of the face and hands (edema)
  • rapid weight gain
  • trouble breathing

Important: some women do not demonstrate any symptoms when they develop pre-eclampsia, which is why it is extremely important to have a knowledgeable physician like Dr. Rad.

Without a doctor’s guidance, this condition can lead to maternal and neonatal morbidity. 

Risk factors for pre-eclampsia include:

  • first-time mothers
  • pre-eclampsia in a previous pregnancy
  • long-term high blood pressure and/or chronic kidney disease
  • a history of blood clots
  • in vitro fertilization (IVF)
  • Type 1 or Type 2 diabetes
  • obesity 
  • lupus
  • being over 40

Having pre-eclampsia may increase your risk of future cardiovascular disease.

Eclampsia in pregnancy

Eclampsia is a severe complication of pre-eclampsia characterized by seizures or coma. Most women with pre-eclampsia do not have seizures.

Though scientists do not understand the exact reason why some patients develop eclampsia, several factors can play a role. These include a poor diet, genetic predisposal, brain and nervous system anomalies, and blood vessel problems.

Warning signs for eclampsia include abnormal blood tests, severe headaches, extremely high blood pressure, changes in vision, and abdominal pain.

Schedule an Appointment with Dr. Rad

Call (844) 473-6100 or click here to schedule online

Hypertension after pregnancy

Although quite rare, blood pressure can soar after childbirth. This condition is called postpartum pre-eclampsia, which is defined by high blood pressure and protein in the urine.

Most times, postpartum pre-eclampsia develops within 48 hours after giving birth. However, it can occur up to six weeks after birth.

Postpartum pre-eclampsia is a medical emergency and can cause seizures. Symptoms are similar to those of pre-eclampsia during pregnancy. If you have any of the following symptoms, see your doctor immediately.

  • Severe headaches
  • Changes in vision (including temporary loss of vision or blurred vision)
  • Nausea and vomiting
  • Shortness of breath
  • Decreased urination
  • Pain in the upper belly, under the right ribs

What are the risks of hypertension during pregnancy?

Several risk factors indicate that you may have a greater chance of developing hypertension in pregnancy. People at higher risk are:

  • Over the age of 35
  • African American
  • Having their first baby
  • Giving multiple births (twins, etc.)
  • Teenagers
  • Obese
  • Have a family history of pre-eclampsia
  • Have an autoimmune disorder
  • Pregnant from in vitro fertilization (IVF)
  • Have renal dysfunction

Hypertension pregnancy treatment

Treatment for hypertension during pregnancy begins with a close relationship with your maternal-fetal medicine specialist, such as Dr. Rad. Treatment is then customized to your condition and circumstances. Sometimes medication is required, sometimes low-dose aspirin and antioxidant vitamins such as C and E will do the trick.

For women currently taking blood pressure medications, Dr. Rad may recommend you stop using certain medications. These medications include ACE inhibitors and ARBs. Though these medications are standard for patients with high blood pressure, they are not safe for use during pregnancy due to potential negative effects on the fetus.

Hypertensive pregnancy medication

Controlling blood pressure during pregnancy is a delicate balancing act of lowering maternal blood pressure while making sure the baby is achieving proper fetal growth and maturation.

Some expectant mothers suffering from mild to moderate hypertension before becoming pregnant can stop their medication during the first trimester of pregnancy; this is because blood pressure naturally falls during this period. Pregnant people can resume blood pressure medication when it becomes necessary.

The first line of defense for doctors treating pregnant patients is a drug called Methyldopa. The drug has withstood scrutiny and is deemed safe for both the patient and fetus. Side effects of Methyldopa include drowsiness, a rise in liver enzymes, and depression.

Several other hypertension drugs can be used if the patient cannot tolerate Methyldopa. These include:

  • Nifedipine is a popular drug that is widely used. It has been deemed safe to take during pregnancy.
  • Oral hydralazine is frequently administered as an infusion for acute severe hypertension. It is considered safe for the baby. Some of the potential side effects include flushing, headache, vomiting, loss of appetite, and rashes.
  • Beta-blockers such as Oxprenolol, Labetalol, and Doxazosin, are avoided during the first half of pregnancy because they may inhibit the baby’s growth by decreasing blood flow to the placenta

Why choose Dr. Steve Rad and the Los Angeles Fetal and Maternal Care Center?

Did you know that all pregnancies in the United States are at risk of becoming high-risk? Even a pregnancy that begins “low-risk” can become high-risk. That is no secret to double-board certified Dr. Steve Rad, an Obstetrician-Gynecologist with sub-specialty training in Maternal-Fetal Medicine / Perinatology.

Dr. Rad has been named a top Maternal-Fetal Medicine specialist in Los Angeles by Los Angeles Magazine for six years in a row.

Dr. Rad has undergone rigorous training with high honors at renowned institutions including the Department of Obstetrics and Gynecology at David Geffen School of Medicine at UCLA, USC, Cedars-Sinai Medical Center, and UCSF Medical Center, as well as centers internationally in London, Austria, Israel, and Africa.

Dr. Rad is passionate about obstetrics and gynecology while using his proficiency to guide high-risk mothers with prenatal testing, special monitoring, and diligent care during their pregnancy up to and including the birth of their baby.

Dr. Rad and his OB/GYN team understand your information needs before, during, and after birth. We help you understand your pregnancy, answer all your questions, and provide the emotional support and means to safely navigate your pregnancy.

Call us at (844) 473-6100 or schedule your consultation online. We are currently accepting new patients.

We are conveniently located for patients throughout Southern California and the Los Angeles area at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, Newport Beach, Irvine, and Downtown Los Angeles. We also offer in-home prenatal care and a fly-in program for out-of-town and international patients. Dr. Rad even travels to patients who need him throughout the U.S. and around the world.

If you can’t make it to Dr. Rad, he also offers virtual consultations worldwide.

Call (844) 473-6100 or click here to schedule online

What causes gestational hypertension?

Gestational hypertension, also known as pregnancy-induced hypertension, typically arises after the 20th week of pregnancy and is characterized by high blood pressure. The exact cause is not fully understood, but it is believed to stem from issues with the placenta, which supplies oxygen and nutrients to the growing fetus. Factors such as insufficient blood flow to the placenta, damage to blood vessels, and inflammation may contribute to the development of gestational hypertension. Additionally, pre-existing conditions like obesity, diabetes, and certain kidney diseases can increase the risk.

How can gestational hypertension be prevented?

Preventing gestational hypertension involves adopting a healthy lifestyle and attending regular prenatal care. Maintaining a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while limiting salt intake can help regulate blood pressure. Engaging in regular, moderate exercise, with guidance from a healthcare provider, can also support overall health. Additionally, managing pre-existing conditions like obesity, diabetes, and high blood pressure before conceiving can reduce the risk of developing gestational hypertension.

Is gestational hypertension the same as preeclampsia?

While gestational hypertension and preeclampsia share similarities, they are distinct conditions. Gestational hypertension refers to high blood pressure that develops after the 20th week of pregnancy in women who previously had normal blood pressure readings. In contrast, preeclampsia is characterized by high blood pressure that develops after the 20th week of pregnancy, along with signs of organ damage, such as protein in the urine (proteinuria), liver dysfunction, kidney impairment, fluid retention, and in severe cases, disturbances in the clotting system or neurological symptoms. Preeclampsia can progress rapidly and pose serious risks to both maternal and fetal health if not managed promptly.

What are the symptoms of gestational hypertension?

Gestational hypertension typically doesn’t present noticeable symptoms. In many cases, high blood pressure is the only indicator, which is why regular prenatal check-ups including blood pressure monitoring are crucial during pregnancy. However, in some cases, women may experience symptoms such

as severe headaches, visual disturbances (such as blurred vision or seeing spots), abdominal pain, particularly in the upper right portion, and swelling in the hands and face.

Can gestational hypertension continue after birth?

Gestational hypertension typically resolves after giving birth, with blood pressure returning to normal levels within a few days to weeks postpartum. However, in some cases, gestational hypertension can persist or evolve into chronic hypertension (high blood pressure that persists beyond pregnancy).

Can gestational hypertension lead to preeclampsia?

Yes, gestational hypertension can lead to preeclampsia in some cases, especially if left untreated or if additional risk factors are present. While gestational hypertension and preeclampsia are distinct conditions, they are related, and gestational hypertension is considered a risk factor for the development of preeclampsia.

Can stress cause gestational hypertension?

Stress can contribute to the development or exacerbation of gestational hypertension, although it’s not the sole cause. Pregnancy itself can be a stressful time, and high levels of stress may lead to increased blood pressure. When individuals experience stress, their bodies release hormones like adrenaline and cortisol, which can temporarily elevate blood pressure.

What is postpartum preeclampsia?

Postpartum preeclampsia is a rare but serious condition characterized by high blood pressure and signs of organ damage that develop in the mother after giving birth, typically within the first 48 hours postpartum, but it can occur up to six weeks after delivery. While the exact cause is not fully understood, it is believed to be related to the same underlying factors as preeclampsia during pregnancy, including issues with the placenta and blood vessels.

Symptoms of postpartum preeclampsia may include high blood pressure, severe headaches, visual disturbances (such as blurred vision or seeing spots), abdominal pain, shortness of breath, nausea, vomiting, and swelling in the hands and face. Prompt medical attention is crucial if postpartum preeclampsia is suspected, as it can lead to serious complications if left untreated.