Complications of high blood pressure in pregnancy

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Gestational hypertension is high blood pressure that occurs after 20 weeks of pregnancy. When it occurs before 20 weeks, it is likely that you had it before you even got pregnant. The midwife will describe this kind of high blood pressure as essential chronic hypertension which means that the high blood pressure was there before and will continue after delivery.

Determinants of high blood pressure
The midwife uses a small monitor to take readings of the blood pressure. The readings will consist of two figures that look like a fraction, for example, 120/80.The first, or top, number (120) indicates the blood pressure as the heart beats and pushes blood round the body. This is known as systolic blood pressure. The second, or bottom, number (80) is the blood pressure when the heart relaxes between beats. This is referred to as the diastolic blood pressure.

Following the measurement of the blood pressure, the midwife will tell you if they are high. The midwife will diagnose high blood pressure if: blood pressure shows a reading of 140/90 or higher for two readings, four hours apart blood pressure shows a one-off reading of the bottom number (diastolic) of 110 or more.

The diastolic reading is more important in giving information about your health. So if this figure alone is high, it is enough to mean you have high blood pressure. If the midwife discovers you have high blood pressure during an antenatal appointment, you will be requested to have further tests at hospital. You may be at the hospital for several hours while your blood pressure is monitored hourly over three or four hours. Prevalence of high blood pressure in pregnancy High blood pressure is fairly common in pregnancy. Being overweight is a risk factor for having high blood pressure is pregnancy. The midwife will calculate your body mass index (BMI) at your booking appointment. A high BMI, of 30 or more, increases your chances of developing high blood pressure by up to four times. It is important that you be closely monitor in the course of the pregnancy if you are overweight.

Complication of high blood pressure in pregnancy
In most cases of mild or moderate high blood pressure is not a problem for you or your baby. However, the earlier in pregnancy your blood pressure goes up, the greater your chance of developing pre-eclampsia later on.High blood pressure is a sign of pre-eclampsia, a condition that influences how well the placenta works. If the placenta is not working as well as it should, it can affect how your baby grows. This is because your baby may not be able to get all the nutrients and oxygen he or she needs. The midwife will test your urine to see if it has protein in it. Having protein in your urine and high blood pressure are both signs of pre-eclampsia. The chances of developing preeclampsia are also higher if you are very overweight. Having close care from your midwife, especially if you are overweight, means she will pick up any signs of the condition.

The key thing with pre-eclampsia is to catch it early, so that you and your baby can be monitored and treated. You may have very high blood pressure and feel absolutely fine. That is why it is important to go to all your antenatal appointments so your midwife can check your blood pressure at each visit.
If your blood pressure is too high, you may be advised to see a hospital specialist. This will be the case whether your blood pressure rose after 20 weeks and you have gestational hypertension, or you had high blood pressure before you became pregnant.

Treatment
Depending on how high your blood pressure is, you will be offered extra monitoring, blood tests, urine tests and, possibly, treatment. Blood pressure is only one factor in your health, so you may have scans too to check how your baby is growing.
If you had high blood pressure before you conceived (essential chronic hypertension), your doctor will prescribe medication to keep your blood pressure lower than 150/100.
If you were on medication before you became pregnant, this is likely to have been reviewed when planning your pregnancy or in early pregnancy. It’s also best to keep your salt intake low, as having a lot of salt can push up your blood pressure. Depending on your individual case, your midwife may organise extra antenatal checks for you.