St. Luke’s Maternal Fetal Medicine
Hypertensive Disease (High Blood Pressure) During Pregnancy
High blood pressure that occurs during pregnancy can be divided into the following: chronic (ongoing) hypertension, gestational hypertension (high blood pressure that occurs as a complication of pregnancy), and pre-eclampsia.
Chronic hypertension is when blood pressure is persistently greater than 140/90, occurs in pregnancy before the 20th week, and continues beyond the sixth week after delivery. This is high blood pressure that exists outside of pregnancy and may or may not require medical therapy. Evaluation and treatment of chronic high blood pressure during pregnancy is important, because of its affect on the pregnancy. These affects include increased incidence of growth delays in the fetus and other pregnancy complications. There is also a need for follow-up and close monitoring of the fetus’s progress. The majority of women with chronic hypertension have good outcomes during pregnancy, however, more frequent doctor visits are required, particularly for women undergoing therapy for the condition. A baseline evaluation of kidney function, as well as laboratory testing, is a relatively routine aspect of early pregnancy care in women with chronic hypertension. Most medical therapies are reasonable to continue during pregnancy, however, a group of medications called ACE inhibitors are usually not recommended during pregnancy and the doctor will make changes to the medical therapy as needed during the pregnancy.
Gestational hypertension is blood pressure elevation that exists exclusively during the pregnancy. A diagnosis of gestational hypertension occurs when at least two blood pressure readings (generally in the latter part of pregnancy) are 140/90 or above. Gestational hypertension can be considered a mild variant of toxemia of pregnancy. It usually does not require delivery of the baby, but it does require enhanced prenatal care and close monitoring of the fetus. This is because gestational hypertension can develop into true, full-fledged pre-eclampsia.
Pre-eclampsia is gestational hypertension with protein in the urine or other indications of pre-eclampsia. Pre-eclampsia usually involves blood pressure elevation and can involve other organs, including the kidney and liver, in addition to affecting the baby’s growth and the amount of amniotic fluid (fluid that surrounds the baby in the uterus) that is produced. When a diagnosis of pre-eclampsia is made, as with gestational hypertension, conservative measures are usually taken, unless the mother is at term; then, considerations for delivery are made. When pre-eclampsia is thought to be severe, based on certain conditions, the mother often is hospitalized and given steroids to enhance the fetal lungs, if necessary, and considered for delivery. The cause of pre-eclampsia is unknown; however, certain risk factors are known. For example, a previous history of pre-eclampsia does increase the chances that pre-eclampsia will occur in another pregnancy. Additionally, a previous history of pre-eclampsia or current pre-eclampsia increases the risk of chronic hypertension or blood pressure elevation later in life. Treatments for pre-eclampsia are primarily conservative. When the condition exists at term, delivery is usually the cure, and problems with kidney and liver function resolve. There is no prevention for this pre-eclampsia – good prenatal care and close monitoring of the fetus help to achieve the best outcome possible.
St. Luke’s Maternal Fetal Medicine
333 N. 1st Street, Suite 150
Boise, ID 83702
(208) 381-3088
