Managing Blood Pressure During Pregnancy

Blood pressure naturally fluctuates during pregnancy due to hormonal and circulatory changes. In the first and second trimesters, blood pressure typically decreases as blood vessels relax under the influence of progesterone. It gradually rises back to pre-pregnancy levels in the third trimester. Understanding these normal patterns helps distinguish between expected changes and concerning elevations.

Normal blood pressure during pregnancy is generally below 120/80 mmHg. Readings consistently at or above 140/90 mmHg are classified as hypertension and require medical evaluation and management. The space between these values represents a range that doctors monitor closely, especially in women with risk factors for hypertensive disorders.

Regular blood pressure monitoring at every antenatal visit is a cornerstone of prenatal care. Some women may also be advised to monitor their blood pressure at home using a validated device. Accurate and consistent monitoring is the first step in identifying and managing hypertensive disorders during pregnancy.

Chronic hypertension refers to high blood pressure that exists before pregnancy or is diagnosed before 20 weeks of gestation. Women with chronic hypertension require close monitoring throughout pregnancy, as they are at increased risk for superimposed preeclampsia, fetal growth restriction, and placental abruption.

Gestational hypertension develops after 20 weeks of pregnancy in women who previously had normal blood pressure. While it may resolve after delivery, it increases the risk of developing preeclampsia. Regular urine tests for protein and blood tests for organ function help monitor for progression.

Preeclampsia is the most serious form of pregnancy-related hypertension. It involves high blood pressure combined with protein in the urine or evidence of organ damage. It can affect the liver, kidneys, brain, and blood clotting system. Severe preeclampsia and eclampsia are obstetric emergencies that require immediate treatment and often delivery of the baby.

Risk factors for hypertensive disorders during pregnancy include first pregnancy, maternal age over 35, obesity, multiple pregnancy, family history of preeclampsia, pre-existing kidney disease, diabetes, and autoimmune conditions. Women with these risk factors are monitored more closely for signs of developing hypertension.

Low-dose aspirin, started before 16 weeks of pregnancy, has been shown to reduce the risk of preeclampsia in high-risk women. This preventive measure should only be started under medical guidance after individual risk assessment. Calcium supplementation may also offer protective benefits, particularly in populations with low dietary calcium intake.

Maintaining a healthy weight, staying physically active within the limits advised by the doctor, and eating a balanced diet with controlled salt intake are lifestyle measures that support healthy blood pressure. While these measures do not guarantee prevention, they contribute to overall cardiovascular health during pregnancy.

When blood pressure remains elevated despite lifestyle measures, anti-hypertensive medication may be prescribed. Medications commonly used during pregnancy include labetalol, nifedipine, and methyldopa, which have established safety profiles for use in gestation. The choice of medication depends on the severity of hypertension and the individual's medical history.

Blood pressure targets during treatment are determined by the doctor and typically aim to keep readings below 140/90 mmHg while avoiding excessive lowering that could reduce blood flow to the placenta. Regular follow-up visits, often weekly or biweekly in the third trimester, ensure that medication dosages are adjusted as needed.

Women on anti-hypertensive medication require additional monitoring of fetal growth and well-being through regular ultrasound scans and non-stress tests. The goal is to continue the pregnancy as long as it is safe for both mother and baby while managing blood pressure effectively.

The timing of delivery for women with hypertensive disorders depends on the severity of the condition and the gestational age. Mild gestational hypertension or well-controlled chronic hypertension may allow pregnancy to continue to 37 to 39 weeks with close monitoring. Severe preeclampsia, however, may necessitate delivery as early as 34 weeks or even earlier if the mother or baby's health is at immediate risk.

Antenatal corticosteroids are administered before premature delivery to mature the baby's lungs. Magnesium sulphate may be given during labour and delivery to prevent seizures in women with preeclampsia. The delivery is planned at a facility equipped for emergency obstetric and neonatal care.

Blood pressure monitoring continues after delivery, as preeclampsia can develop or worsen in the postpartum period. Women who had hypertensive disorders during pregnancy typically have their blood pressure checked daily in the hospital and at regular intervals after discharge. Anti-hypertensive medications may be continued, adjusted, or discontinued based on postpartum blood pressure trends.

Women who experienced gestational hypertension or preeclampsia should be aware that they have an increased lifetime risk of cardiovascular disease. Long-term follow-up with a primary care physician, maintaining a healthy lifestyle, and regular blood pressure monitoring beyond the postpartum period are important for long-term health. Hospitals and clinics in Visakhapatnam offer comprehensive postpartum follow-up services for these women.