Hypertension and Pregnancy: What to Know

The number of women with high blood pressure during pregnancy is rising — a dangerous situation because hypertension is the second leading cause of maternal mortality. The condition can also lead to pre-term birth and other delivery complications. 

Even after delivery, pregnancy hypertension increases the risk of a stroke and other cardiovascular problems. Yet, you can prevent many of these consequences with the proper care.

“This is such an important public health issue,” says Michael J. Paidas, M.D., an obstetrician-gynecologist who serves as chair of the obstetrics team at the University of Miami Health System. 

Women need to know that this disorder can be controlled through monitoring and medication.

Dr. Paidas

A recently released study from the Centers for Disease Control and Prevention reported that high blood pressure in pregnancy rose from 13% to 16% percent of hospital deliveries in just two years, from 2017 to 2019. This means 1 in 7 births faced preventable pregnancy complications. 

The prevalence is even higher among Black women, with 1 in 5 hospital deliveries and 1 in 6 for American Indian and Alaska Native women.

A more worrisome statistic: Almost 32% of deaths occurring during delivery hospitalization had a diagnosis of hypertension.

Dr. Paidas is not surprised by the climbing numbers. 

“It’s a reflection of what we see in the population in general. We’re not getting healthier.”

Various factors contribute to the issue, he adds. Obesity has become a public health crisis. In 2019, almost 3 in 10 women were considered obese prior to becoming pregnant, an 11% jump from 2016. The numbers were accurate across all races, ethnic groups, ages, and educational levels. In addition, women are getting pregnant at an older age, which can contribute to the hypertension risk. According to the new CDC report, the highest high blood pressure prevalence was among women aged 35–44 (18.0%) and 45–55 (31.0%).

Diabetes is also an ongoing issue. 

Studies have found that the percentage of expectant mothers with gestational diabetes (which develops during pregnancy) increased by 56%, and women with type 1 or type 2 diabetes before pregnancy increased 37% between 2000 and 2010.

There are four broad types of hypertension in pregnancy. 

Dr. Paidas explains. All four have seen their numbers spike since the 1990s. 

Chronic hypertension is present before pregnancy or is diagnosed early in pregnancy, before 20 weeks. 

Gestational hypertension usually develops later in the pregnancy, after 20 weeks. 

Preeclampsia, which occurs after 20 weeks of pregnancy, can damage the placenta as well as various organs. (If left untreated, it can lead to serious and sometimes fatal complications for the woman and her baby.) 

Lastly, a chronic hypertensive mother can also develop superimposed preeclampsia, which results in worsening high blood pressure and other health issues.

Monitoring and treating hypertension in pregnancy is vital because the disorder can lead to premature birth, decreased blood flow to the placenta (resulting in slow growth), placental abruption (when the placenta detaches from the uterus), and future cardiovascular disease.

 “We now know that a complicated pregnancy will have lifetime effects on the mom, just as we know that what happens in utero has a lifetime effect on the baby,” Dr. Paidas says.

However, consequences can be minimized. 

Prevention and monitoring of blood pressure health before and during pregnancy are vital. Research is also shedding light on the causes (and potential treatment) of this life-threatening disorder.

A recent study led by Shathiyah Kulandavelu, Ph.D., and Joshua Hare, M.D., University of Miami Miller School researchers, revealed that mutations in a gene called GSNOR could generate the complications of preeclampsia.

These findings, published in the Journal of the American Heart Association, could lead to potential diagnostics and treatments.

While more studies need to be conducted on the genetic factors that influence this life-threatening disorder, Dr. Paidas recommends lifestyle behaviors that can help cardiovascular health now:

• Know your numbers — blood pressure, cholesterol levels, BMI, for example — even before conception. “We want women going into pregnancy as healthy as they possibly can,” he adds.
• Lose excess pounds. Maintain a healthy weight and track your BMI, which measures body fat based on height and weight.
• Know your family risk factors for preeclampsia. While preeclampsia can occur in women with no known history of the disorder, some do display strong family ties.
• Take a folic acid supplement before and during pregnancy. This helps prevent birth defects.
• Ask your obstetrician if you need to take low-dose aspirin. Taking 60 to 100 milligrams (mg) daily is recommended for pregnant women with preeclampsia, recurrent pregnancy loss, or clotting disorders.
• Stay active and eat healthy at all times.
• Don’t miss your prenatal appointments. Monitoring your blood pressure and other vital signs is essential.

Ana Veciana-Suarez, Guest Columnist

Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author, who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.

Tags: Dr. Michael Paidas, heart atttack and stroke, maternal mortality, pregnancy and childbirth, symptoms of preclampsia