You may have been told you have high blood pressure before you became pregnant and you may already be taking tablets to treat your blood pressure. Sometimes chronic hypertension is diagnosed in pregnancy as it is the first time you have had your blood pressure checked on such a regular basis and in this case, the diagnosis will be made as your blood pressure was high on two occasions before 20 weeks of pregnancy.
What does this mean?
For me:
Pregnancy can put a strain on your heart and blood vessels so your blood pressure may go up and need treatment
High blood pressure increases your chance of having pre-eclampsia (a pregnancy condition that can cause kidney, liver and other problems
You will be offered regular appointments to check your blood pressure and urine
You will be recommended to give birth in hospital on the labour ward
You will need long term follow up of high blood pressure with your GP to reduce risks of heart disease after your baby is born.
For my baby:
There is an increased chance of your baby not growing well in the womb
There is a higher risk of your baby being born early (before 37 weeks of pregnancy).
What will the medical team recommend?
Care under an obstetrician alongside your midwifery team
Regular blood pressure and urine tests 2-4 weekly and more often near the end of your pregnancy (this may be with your midwife, obstetrician or GP)
Blood pressure tablets if your blood pressure is high
Aspirin tablets (75 or 150mg) to reduce the risk of you developing pre-eclampsia
Home blood pressure monitoring
Induction of labour between 38 and 40 weeks of pregnancy. This decision will be agreed with you based on your blood pressure readings and the wellbeing of the baby, to reduce the risk of stillbirth. You will be supported to make the decision that is right for you.
What tests will/may be considered? How often may they be needed?
When you are first diagnosed in the pregnancy, your kidney function (blood test) will be checked and you may be asked to have an ECG (heart tracing) to check if your body has been affected by the high blood pressure
You will be offered extra scans of your baby to check your baby is growing well in your womb and how well your placenta is working
If we suspect you are developing pre-eclampsia, we will recommend tests of your liver, kidneys and blood and we may check your placental growth factor level (which is an indicator of how well your placenta is working).
What symptoms and signs should I be looking out for?
Headaches can occur if your blood pressure is too high or if you are developing pre-eclampsia
Other symptoms of pre-eclampsia include: swelling in your hands and face, blurred vision, pain in your tummy, vomiting, baby not moving so well
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If your baby isn’t moving as normal, then you should be seen at the hospital immediately
If you have any of the symptoms of pre-eclampsia listed above then you should contact your maternity unit immediately.
Likely recommendations
Treatment options
Tablet treatment for your blood pressure will be recommended if your blood pressure is more than or equal to 140/90 mmHgThe tablets most commonly used are:
Labetalol
Nifedipine
Methyldopa
Timing of birth
This will depend on how well you and your baby are in the pregnancy and on whether you develop pre-eclampsia
If the baby is well grown and the blood pressure is well controlled, then an induction of labour is likely to be recommended between 38 and 40 weeks of pregnancy.
How may this impact my birth choices?
Continuous monitoring of your baby’s heart beat in labour will be recommended whether your labour starts naturally or is induced. This is because the placenta may be working less well and we would not want to miss changes in the heart rate that would indicate the baby is not coping well with labour. This takes place in hospital on the labour ward.
How may this affect care after the birth?
You will need to have your blood pressure checked regularly and stay in the hospital for at least 24 hours after you give birth
Your blood pressure treatment will be switched to those suitable for breastfeeding
You will need to see your GP for ongoing monitoring of your blood pressure and treatment.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
High blood pressure can be reduced through diet and exercise if you are overweight or inactive
Ensuring your blood pressure is monitored and well controlled (less than 140/90 mmHg) will reduce the risk of harm for you and/or your baby in future pregnancies
What will this mean for future/my long-term health and how can I influence this?
Chronic hypertension increases your long term risk of heart disease including heart attacks and stroke.
Your risk of heart disease can be reduced by eating healthily, especially by reducing your salt intake and exercising regularly
Your risk of heart disease can also be reduced by taking your blood pressure treatment to control your blood pressure and your GP will tell you how low they would like your blood pressure to be while on treatment.
Where can I find out more information about this condition?
