Pre-Eclampsia and High Blood Pressure During Pregnancy

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Pre-Eclampsia and High Blood Pressure During Pregnancy

Topic Overview

What are high blood pressure and pre-eclampsia?

Blood pressure is a measure of how hard your blood pushes against the walls of your arteries. If the force is too hard, you have high blood pressure (also called hypertension). When high blood pressure starts after 20 weeks of pregnancy, it may be a sign of a very serious problem called pre-eclampsia.

Blood pressure is shown as two numbers. The top number (systolic) is the pressure when the heart pumps blood. The bottom number (diastolic) is the pressure when the heart relaxes and fills with blood. Blood pressure is high if the top number is more than 140 millimetres of mercury (mm Hg), or if the bottom number is more than 90 mm Hg. For example, blood pressure of 150/85 (say "150 over 85") or 140/95 is high. Or both numbers can be high, such as 150/95.

A woman may have high blood pressure before she gets pregnant. Or her blood pressure may start to go up during pregnancy.

If you have high blood pressure during pregnancy, you need to have checkups more often than women who do not have this problem. There is no way to know if you will get pre-eclampsia. This is one of the reasons that you are watched closely during your pregnancy.

High blood pressure and pre-eclampsia are related, but they have some differences.

High blood pressure

Normally, a woman’s blood pressure drops during her second trimester. Then it returns to normal by the end of the pregnancy. But in some women, blood pressure goes up very high in the second or third trimester. This is sometimes called gestational hypertension and can lead to pre-eclampsia. You will need to have your blood pressure checked often and you may need treatment. Usually, the problem goes away after the baby is born.

High blood pressure that started before pregnancy usually doesn't go away after the baby is born.

A small rise in blood pressure may not be a problem. But your doctor will watch your pressure to make sure it does not get too high. The doctor also will check you for pre-eclampsia.

Very high blood pressure keeps your baby from getting enough blood and oxygen. This could limit your baby’s growth or cause the placenta to pull away too soon from the uterus. High blood pressure also could lead to stillbirth.

Pre-eclampsia

Pre-eclampsia is a pregnancy-related problem. The symptoms of pre-eclampsia include new high blood pressure after 20 weeks of pregnancy along with other problems, such as protein in your urine. Pre-eclampsia usually goes away after you give birth. In rare cases, blood pressure can stay high for up to 6 weeks after the birth.

Pre-eclampsia can be deadly for the mother and baby. It can keep the baby from getting enough blood and oxygen. It also can harm the mother’s liver, kidneys, and brain. Women with very bad pre-eclampsia can have dangerous seizures. This is called eclampsia.

What causes pre-eclampsia and high blood pressure during pregnancy?

Experts don't know the exact cause of pre-eclampsia and high blood pressure during pregnancy. But they have some ideas about pre-eclampsia:

  • Pre-eclampsia seems to start because the placenta doesn't grow the usual network of blood vessels deep in the wall of the uterus. This leads to poor blood flow in the placenta.
  • Pre-eclampsia may run in families. If your mother had pre-eclampsia while she was pregnant with you, you have a higher chance of getting it during pregnancy. You also have a higher chance of getting it if the mother of your baby’s father had pre-eclampsia.
  • The mother’s immune system may react to the father's sperm, the placenta, or the baby.
  • Already having high blood pressure when you get pregnant raises your chance of getting pre-eclampsia.
  • Problems that can lead to high blood pressure, such as obesity, polycystic ovary syndrome, and diabetes, could raise your risk of pre-eclampsia.

What are the symptoms?

High blood pressure usually doesn't cause symptoms. But very high blood pressure sometimes causes headaches and shortness of breath or changes in vision.

Mild pre-eclampsia usually doesn't cause symptoms, either. But pre-eclampsia can cause rapid weight gain and sudden swelling of the hands and face. Severe pre-eclampsia causes symptoms of organ trouble, such as a very bad headache and trouble seeing and breathing. It also can cause belly pain and decreased urination.

How are high blood pressure and pre-eclampsia diagnosed?

High blood pressure and pre-eclampsia are usually found during a prenatal visit. This is one reason why it’s so important to go to all of your prenatal visits. You need to have your blood pressure checked often. During these visits, your blood pressure is measured with a blood pressure cuff. A sudden increase in blood pressure often is the first sign of a problem.

You also will have a urine test to look for protein, another sign of pre-eclampsia.

If you have high blood pressure, tell your doctor right away if you have a headache or belly pain. These signs of pre-eclampsia can occur before protein shows up in your urine.

How are they treated?

Your doctor may have you take medicine if he or she thinks your blood pressure is too high.

The only cure for pre-eclampsia is having the baby. You may get medicines to lower your blood pressure and to prevent seizures. You also may get medicine to help your baby’s lungs get ready for birth. Your doctor will try to deliver your baby when the baby has grown enough to be ready for birth. But sometimes a baby has to be delivered early to protect the health of the mother or the baby. If this happens, your baby will get special care for premature babies.

Do pre-eclampsia and high blood pressure lead to long-term high blood pressure?

If you have high blood pressure during pregnancy but had normal blood pressure before pregnancy, your pressure is likely to go back to normal after you have the baby. But if you had high blood pressure before pregnancy, you probably will still have it after you give birth.

Frequently Asked Questions

Learning about high blood pressure and pre-eclampsia during pregnancy:

Being diagnosed:

Getting treatment:

Ongoing concerns:

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  High Blood Pressure: Checking Your Blood Pressure at Home

Cause

The causes of pre-eclampsia and high blood pressure during pregnancy are poorly understood. In fact, pre-eclampsia is sometimes called the "disease of theories," and its cause is the subject of active research.1

Pre-eclampsia may start with a poorly developed placenta that doesn't circulate blood normally. But the cause of the placenta disorder isn't yet clear. Nor is it known why the mother's body then develops high blood pressure. So far, a number of possible factors are thought to play a part in pre-eclampsia, including:

  • Family history (genetics). The tendency to develop pre-eclampsia may run in families. Inherited factors (genes) seem to make a woman more likely to develop pre-eclampsia.
  • An abnormal immune system response. Pre-eclampsia occurs most often in women who are pregnant for the first time and in women who have been pregnant before but now have a first pregnancy with a different man. Exposure to an antigen from the father (in the growing placenta or fetus, for example) may trigger an immune response in the woman's body. This immune response may result in narrowing of the blood vessels throughout the body, causing higher blood pressure and other problems.
  • A biochemical factor that causes the blood vessels to narrow, raising blood pressure. Pre-eclampsia may be the body's reaction to the poorly functioning placenta. Or both the poorly developed placenta and pre-eclampsia symptoms may be caused by the same factor. This process is not yet well understood.
  • Diabetes or other diseases affecting blood vessels. Conditions that cause blood vessel problems (such as lupus, preexisting high blood pressure, or diabetes) may increase the risk of pre-eclampsia.

Symptoms

High blood pressure

If you have developed high blood pressure, you will probably not have any symptoms. It usually requires a blood pressure check with a blood pressure cuff and stethoscope to detect elevated blood pressure.

Blood pressure measured at 140/90 millimetres of mercury (mm Hg) or higher is classified as high (hypertensive) and 160/110 mm Hg or higher is classified as severe.

Pre-eclampsia

Symptoms of pre-eclampsia can develop gradually or suddenly. Symptoms include:

  • Systolic blood pressure is over 140 mm Hg, or diastolic blood pressure is over 90 mm Hg, or both, for two measurements.2
  • Protein in the urine is usually higher than normal. High urine protein is 300 milligrams (mg) measured in 24 hours or protein consistently showing 1+ or greater on a dipstick.

Although you may have other symptoms, you will not be diagnosed with pre-eclampsia unless you also have high blood pressure or high protein in your urine. Other symptoms of mild pre-eclampsia may include:

  • Swelling of the hands and face that does not go away during the day. (If you have no other signs or symptoms of pre-eclampsia, this swelling is probably a sign of normal pregnancy.)
  • Rapid weight gain [more than 0.9 kg (2 lb) per week or 2.7 kg (6 lb) per month].
  • Bleeding from a cut or injury that lasts longer than usual.

Severe pre-eclampsia

In severe pre-eclampsia, systolic blood pressure is over 160 mm Hg, or diastolic blood pressure is over 110 mm Hg, or both.

As blood circulation to the organs decreases, more severe symptoms can develop, including:

  • A severe headache that will not go away with medicine such as acetaminophen.
  • Blurred or dimming vision, spots in the visual field, or periods of blindness.
  • Decreased urination [less than 500 mL (2 cups) in 24 hours].
  • Persistent abdominal pain or tenderness, especially on the upper right side.
  • Problems breathing, especially when lying flat.
  • HELLP syndrome.

HELLP syndrome is a life-threatening liver disorder. It is usually related to pre-eclampsia. Get emergency medical treatment if you have several symptoms of HELLP syndrome. Symptoms include:

  • Pain in the upper right abdomen (liver).
  • Shoulder, neck, and other upper body pain (this pain also originates in the liver).
  • Fatigue.
  • Nausea and vomiting.
  • Headache.
  • Vision problems.

HELLP is short for Hemolysis (destruction of red blood cells), Elevated Liver enzymes (which indicate liver damage), and Low Platelet count.

Severe pre-eclampsia increases the risk of seizures (eclampsia).

Eclampsia

When pre-eclampsia leads to seizures that are not from any other cause, it is called eclampsia. Eclampsia is life-threatening for both a mother and her fetus. During a seizure, the oxygen supply to the fetus is drastically reduced. Call 911 any time a pregnant woman has a seizure.

What Happens

At the first sign of high blood pressure during pregnancy, your health professional cannot predict whether it will remain mild, become severe, or turn out to be an early sign of pre-eclampsia. If you are developing pre-eclampsia, your urine test (urine screen) will probably show increased protein levels before long. This sign that your kidneys are being affected by the condition doesn't develop right away.

If you aren't certain that you had normal blood pressure before pregnancy, it is possible that you have preexisting chronic high blood pressure. If so, your blood pressure may remain high after your pregnancy.

High blood pressure that develops during pregnancy

High blood pressure that develops before the 20th week of pregnancy is usually a sign of ongoing (chronic) high blood pressure or short-term, mild high blood pressure. In rare cases, it is an early sign of pre-eclampsia.

High blood pressure that occurs after mid pregnancy could be a sign that you are developing pre-eclampsia. This can be anytime after the 20th week.

Chronic high blood pressure and pregnancy

Women with chronic high blood pressure (hypertension) who become pregnant normally have a drop in blood pressure during the first two trimesters. During the late second or in the third trimester, however, blood pressure returns to higher-than-normal levels. Following delivery, their blood pressure remains high. For more information, see the topic High Blood Pressure.

Chronic high blood pressure increases your risk of pre-eclampsia during pregnancy.

Most women with chronic high blood pressure who are otherwise healthy have a low risk for other cardiovascular problems during pregnancy.

Women with chronic high blood pressure have an increased risk of the premature separation of the placenta from the uterine wall (abruptio placenta). This risk may increase when:

  • A mother smokes during pregnancy.
  • Pre-eclampsia develops in addition to chronic high blood pressure.
  • A mother uses certain drugs, such as cocaine.
  • There is an injury to the uterus, such as in a car accident or a fall.

Pre-eclampsia

Pre-eclampsia affects your blood pressure, placenta, liver, blood, kidneys, and brain. Pre-eclampsia can be mild or severe, and it may get worse gradually or rapidly. Both you and your fetus can potentially suffer life-threatening problems involving the following:

  • Blood pressure. Blood volume doesn't increase as much as it should during pregnancy. This can affect fetal growth and well-being. The blood vessels also increase their resistance against blood flow (vasospasm), increasing blood pressure.
  • Placenta. The blood vessels of the placenta don't grow deep into the uterus as they should, nor do they widen as they normally would. This makes them unable to provide normal blood flow to the fetus.
  • Liver. Impaired blood circulation to the liver can cause liver damage. Liver impairment is related to the life-threatening HELLP syndrome, which requires emergency medical treatment.
  • Kidneys. During a normal pregnancy, kidney function increases by up to 50%.3 When affected by pre-eclampsia, kidney function is usually higher than before pregnancy but not as high as necessary for a healthy pregnancy. This is called mild renal insufficiency.
  • Brain. Vision impairment, persistent headaches, and seizures (eclampsia) can develop, probably in relation to reduced blood flow to or within the brain. Less than 1% of women who have pre-eclampsia suffer one or more seizures.4 Eclampsia can lead to maternal coma and fetal and maternal death. This is why women with pre-eclampsia are often given medicine to prevent eclampsia.
  • Blood. Low platelet levels in the blood are common with pre-eclampsia. In rare cases a potentially life-threatening blood-clotting and bleeding problem develops along with severe pre-eclampsia.5 This condition is called disseminated intravascular coagulation (DIC). After delivery, DIC goes away. In the meantime, you may be given a medicine (clotting factor), blood transfusion, or platelet transfusion.

Delivery of the baby and placenta is the only "cure" for pre-eclampsia. If your condition becomes dangerous enough that delivery is necessary but you don't go into labour, your doctor will induce labour or surgically deliver the baby (caesarean section). Unless you have chronic high blood pressure, your blood pressure should return to normal in a few days. In severe cases, this can take 6 or more weeks.

The infant

The earlier in the pregnancy that pre-eclampsia begins and/or the more severe the condition becomes, the greater the risk of preterm birth, which can cause newborn problems. For more information, see the topic Premature Infant.

An infant born before 37 weeks may have difficulty breathing because of immature lungs (respiratory distress syndrome). A newborn affected by pre-eclampsia may also be smaller than normal (intrauterine growth restriction). This is because of inadequate nutrition from poor blood flow through the placenta.

What Increases Your Risk

Risk factors for developing pre-eclampsia during pregnancy include:

  • Chronic (ongoing) high blood pressure (hypertension), chronic kidney disease, or diabetes.
  • High blood pressure in a past pregnancy, especially before week 34.
  • Personal history of pre-eclampsia.
  • Family history of pre-eclampsia.
  • Obesity (more than 20% over ideal weight) at the time of conception. If your weight is within this range, the higher your pre-pregnancy body mass index, the greater your pre-eclampsia risk.6
  • Multiple pregnancy (such as twins or triplets).
  • First pregnancy ever or first-time pregnancy with current partner.
  • Age younger than 21 or older than 35.

When To Call a Doctor

Seizures

If you have pre-eclampsia, it is possible that you will have an unexpected seizure (eclampsia). Eclampsia can lead to a coma and is life-threatening to both you and your fetus.

Someone must call 911 or other emergency services immediately if you are having an eclamptic seizure.

If you are pregnant and have pre-eclampsia, your family and friends should know how to help during a seizure.

Seek medical care immediately if you are pregnant and begin to have symptoms of pre-eclampsia, such as:

  • Blurred vision or other vision problems.
  • Frequent headaches that are becoming worse or a persistent headache that does not respond to non-prescription pain medicine.
  • Pain or tenderness in your abdomen, especially in the upper right section.
  • Weight gain of 0.9 kg (2 lb) or more over a 24-hour period.
  • Shoulder, neck, and other upper body pain (this pain originates in the liver).

If you have mild high blood pressure or mild pre-eclampsia, you may not have any symptoms. It is important to see a health professional regularly throughout your pregnancy. Your blood pressure will be checked and your urine will be tested at every visit so that any abnormal rise in blood pressure or urinary protein can be easily detected.

Watchful Waiting

Symptoms such as heartburn or swelling in the legs and feet are normal during pregnancy and are not usually symptoms of pre-eclampsia. You can discuss these symptoms with your doctor or midwife at your next scheduled prenatal visit. But if swelling occurs along with other symptoms of pre-eclampsia, contact your doctor immediately.

Who To See

Your family doctor, general practitioner, or midwife can treat high blood pressure and pre-eclampsia during pregnancy. You may be referred to an obstetrician, an internist, or a perinatologist.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

High blood pressure (hypertension) and pre-eclampsia are typically found during regular prenatal checkups. Because these conditions can get worse rapidly and can be life-threatening to you and your fetus, it's important that you have regular checkups during your pregnancy.

Routine prenatal tests

Certain tests are given at each prenatal visit to monitor for high blood pressure and pre-eclampsia. These include a:

  • Blood pressure reading. Blood pressure is always monitored closely during pregnancy.
  • Urine test for excess protein in the urine (proteinuria), a sign of pre-eclamptic kidney damage.
  • Weight measurement. (Rapid weight gain can be a sign of pre-eclamptic fluid retention.)

Tests for pregnant women considered high-risk for pre-eclampsia

Other tests may also be used to monitor for signs of pre-eclampsia, including:

  • Blood tests to check for blood abnormalities (as in HELLP syndrome) and for signs of kidney damage. (Elevated uric acid in the blood is often the earliest sign of pre-eclampsia.)
  • Creatinine clearance test, which requires both a blood sample and a 24-hour urine collection, to assess kidney function.
  • 24-hour urine collection test to assess protein in the urine.

Tests for women who have pre-eclampsia

If results from one or more of the above tests suggest that you have pre-eclampsia, you and your fetus will be closely monitored throughout the remainder of your pregnancy. The type and frequency of testing depend on the severity of the pre-eclampsia and the time remaining until your pregnancy reaches full term (37 to 42 completed weeks). Testing is more frequent and extensive when pre-eclampsia is severe and the pregnancy is far from full-term (less than 36 weeks).

Tests that may be given to assess your health if you have pre-eclampsia include:

  • A physical examination for signs and symptoms of pre-eclampsia that is getting worse.
  • Blood tests to check for blood abnormalities and kidney damage.
  • A creatinine clearance test, which requires both blood and urine samples, to assess kidney function.

Tests for women who have eclampsia

If you have a seizure (eclampsia), one or more of the following tests may be done after delivery to assess your brain function and condition:

Tests for the fetus

If you develop high blood pressure, pre-eclampsia, or both, your fetus's health also will be closely monitored. The more severe your condition, the more frequent the fetal testing, ranging from once a week to daily.

Tests commonly used to monitor fetal health include:

Less commonly, amniocentesis is used to check fetal well-being if preterm delivery is being considered as a treatment option. For this procedure, a needle is inserted into your abdomen to collect amniotic fluid from inside the uterus. The fluid is then checked for chemical signs that the fetus's lungs are mature.

Treatment Overview

If your blood pressure begins to rise during pregnancy, you will need close monitoring until after your baby is born. Your blood pressure may remain mildly elevated, which is not considered dangerous for you or your fetus. But it can become dangerous if it turns out to be a sign of pre-eclampsia or if it progresses to more severe high blood pressure (hypertension).

High blood pressure (hypertension) during pregnancy

If you have high blood pressure during your pregnancy, your treatment may include:

  • Close monitoring by a doctor for signs of pre-eclampsia.
  • Blood pressure medicine. Your doctor may have you take medicine if he or she thinks your blood pressure is too high. Some women with ongoing (chronic) high blood pressure stay on antihypertensive medicine but are prescribed a lower dose during pregnancy if their blood pressure improves.

Mild high blood pressure in pregnancy usually only requires close monitoring. If you have high blood pressure that is rapidly increasing or has reached moderately high levels, you may be treated with blood pressure medicine.

Severe high blood pressure (higher than 160 mm Hg systolic or 110 mm Hg diastolic) can result in poor fetal growth (intrauterine growth restriction) and is likely to be treated with an antihypertensive medicine.

Some high blood pressure medicines are dangerous during pregnancy.7, 8 If you take high blood pressure medicines, talk to your doctor about the safety of your medicine before you become pregnant or as soon as you learn you are pregnant. Make sure that your doctor has a complete list of all medicines that you are taking.

Pre-eclampsia and eclampsia

If you show any signs of pre-eclampsia, you will be closely monitored, either with frequent office visits or in the hospital. The goal of treatment is to prevent pre-eclampsia from becoming life-threatening to you and your fetus while prolonging the pregnancy long enough for your fetus to be mature and healthy at birth.

Your treatment will last for the rest of your pregnancy, your delivery, and your first postpartum weeks and will depend on how severe your condition is. Treatment options include an anticonvulsant medicine; blood pressure medicine if your blood pressure is dangerously high; and delivery, which is the only known "cure" for pre-eclampsia.

  • For mild pre-eclampsia that is not rapidly getting worse, you may only have to reduce your level of activity, monitor how you feel, and have frequent office visits and testing.
  • For moderate or severe pre-eclampsia, or for pre-eclampsia that is rapidly getting worse, you may require hospitalization, where expectant management typically includes bedrest, medicine, and close monitoring of you and your fetus. Severe pre-eclampsia or an eclamptic seizure is treated with magnesium sulfate. This medicine can stop a seizure and can prevent seizures. If you are near delivery or have severe pre-eclampsia, your doctor will plan to deliver your baby as soon as possible.
  • If your condition becomes life-threatening to you or your fetus, magnesium sulfate to prevent seizure and delivery are the only treatment options. If you are less than 34 weeks pregnant and a 24- to 48-hour delay is possible, you will likely be given antenatal corticosteroids to speed up fetal lung development before delivery.

After childbirth

If you have moderate to severe pre-eclampsia, your risk of seizures (eclampsia) continues for the first 24 to 48 hours after childbirth (in very rare cases, seizures are reported later in the postpartum period). So you may continue magnesium sulfate for 24 hours after delivery.5

Unless you have chronic high blood pressure, your blood pressure is likely to return to normal a few days after delivery. In rare cases, it can take 6 weeks or more. Some women still have high blood pressure 6 weeks after childbirth yet return to normal levels over the long term. If your blood pressure is still high after delivery, you may be given a blood pressure medicine. You will then have regular checkups with your doctor to monitor your recovery.

What To Think About

To prepare for a talk with your doctor or midwife about your condition, see questions to ask your doctor about high blood pressure and pregnancy.

High blood pressure medicine

Lowering blood pressure with medicine:

  • Does not prevent pre-eclampsia from getting worse, because high blood pressure is only a symptom of the condition, not a cause.
  • Can reduce blood flow to the placenta if blood pressure is lowered too rapidly, causing problems for the fetus. So medicine is reserved for preventing severely high blood pressure levels that are potentially life-threatening to you or your fetus.

Delivery

A vaginal delivery is usually safest for the mother and is attempted first if she and the baby are both stable. If pre-eclampsia is rapidly getting worse or fetal monitoring suggests that the baby cannot safely handle labour contractions, a caesarean section (C-section) delivery is needed.

Ongoing issues

Pre-eclampsia usually does not cause long-term problems. Healthy habits, such as regular exercise and eating a healthy diet, may help prevent future health problems. If you have had pre-eclampsia, talk to your doctor about what you can do to stay healthy.

Prevention

If you have chronic high blood pressure (hypertension), you can lower your blood pressure before pregnancy by exercising, eating a diet low in sodium and rich in fruits and vegetables, and staying at a healthy weight. Lowering your blood pressure reduces your risk of pre-eclampsia.

When you are pregnant, regular checkups are key to early detection and treatment. Prompt treatment is vital to preventing the development of severe and possibly life-threatening pre-eclampsia.

Some pre-eclampsia research suggests that calcium supplements and low-dose ASA may offer a preventive benefit, especially for high-risk women.

Calcium supplements may reduce the risk of developing pre-eclampsia and the risk of having a low-birth-weight baby, particularly among high-risk women who normally don't get enough calcium.9 Taking a calcium supplement may also lower the risk of moving from mild to severe pre-eclampsia.10 Other experts have found that there is no benefit from taking calcium.5

But all pregnant women can generally benefit from taking the recommended dietary allowance of 1000 mg of calcium each day to keep their bones healthy.11

Low-dose ASA (antiplatelet) therapy may be a moderately effective preventive treatment for women at risk of developing pre-eclampsia. Although some experts question how effective low-dose ASA is, others assert that high-risk women who take it regularly as directed do significantly lower their pre-eclampsia risk.12 Talk to your doctor or midwife about whether this treatment is right for you.

Research shows that taking vitamin C or vitamin E supplements does not help prevent pre-eclampsia.13, 14

Home Treatment

High blood pressure

If you have ongoing (chronic) high blood pressure and are taking blood pressure medicine, talk to your doctor before becoming pregnant (or as soon as you learn you are pregnant). Some high blood pressure medicines are dangerous to your fetus.

If you have high blood pressure during pregnancy, take steps that will help control your blood pressure:

  • Go to all of your prenatal checkups. It is important to monitor your blood pressure because a dangerous increase in blood pressure can occur without symptoms. You may also want to keep track of your blood pressure readings at home.
  • If you smoke, quit smoking. This helps decrease your blood pressure and improve your fetus's growth and health.
  • Do not gain an excessive amount of weight during your pregnancy. Talk to your doctor about how much is healthy for you to gain.
  • Get regular mild exercise during pregnancy. Walking or swimming several times weekly can be healthy for you and your developing fetus.
  • Reduce stress. Find time to relax, especially if you continue to work, are parenting small children at home, and/or have a hectic schedule.

By following general guidelines for a healthy pregnancy, you can help optimize your own and your baby's overall health and make sure that you are both in the best possible shape for handling the challenges of pregnancy, delivery, and recovery.

For more tips on how to have a healthy pregnancy, see the topic Quick Tips: Healthy Pregnancy Habits.

Expectant management for pre-eclampsia

If you develop signs of pre-eclampsia early in pregnancy, your doctor or midwife may prescribe something called expectant management at home, possibly for many weeks. This may mean you are advised to stop working, reduce your activity level, or possibly spend a lot of time resting (partial bedrest). Although partial bedrest is considered reasonable treatment for pre-eclampsia, its effectiveness is not proved for treating mild pre-eclampsia.15 It is known that strict bedrest may increase your risk of developing a blood clot in the legs or lungs.

Whether you are required to reduce your activity or have partial bedrest, expectant management severely limits your ability to work, remain active, take care of children, and fulfill other responsibilities. It may be helpful to follow some tips for dealing with bedrest.

You may be required to monitor your own condition on a daily basis. If so, you or another person (such as a trained family member or a visiting nurse) will:

Keep a written record of your results, including the dates and times you checked. Take this record with you when you visit your doctor or midwife.

Medications

Medicine for pre-eclampsia and high blood pressure during pregnancy may be used to:

  • Control high blood pressure. Lowering high blood pressure does not prevent pre-eclampsia from getting worse, because high blood pressure is only a symptom of the condition, not a cause. Your doctor may recommend blood pressure medicine if your blood pressure reaches high levels. Expectant management is often used to treat mild high blood pressure during pregnancy.
  • Prevent seizures. Magnesium sulfate is usually started before delivery and continued for 24 hours after delivery for women with pregnancy-related seizures (eclampsia) and those who have moderate to severe pre-eclampsia.
  • Speed up fetal lung development. When possible, a corticosteroid (betamethasone or dexamethasone) is given to the mother prior to a premature birth (up to 34 weeks of gestation). This medicine matures the fetus's lungs over a 24-hour period, which lowers the risk of breathing problems after birth.

Medication Choices

Blood pressure medicines commonly used during pregnancy include:

  • Methyldopa (an oral medicine for controlling high blood pressure during pregnancy).
  • Hydralazine (an intravenous medicine for quickly lowering severely high blood pressure during pregnancy).
  • Labetalol (an intravenous medicine for quickly lowering severely high blood pressure in the hospital, and also an oral medicine for controlling high blood pressure during pregnancy).
  • Nifedipine (an oral medicine for controlling high blood pressure during pregnancy).

Magnesium sulfate is the most common medicine used for preventing eclampsia (seizures) during pregnancy.

Steroid medicines such as betamethasone and dexamethasone may be used to help the fetus's lungs mature faster. These medicines are often given if preterm delivery is needed.

What To Think About

There is not enough medical evidence to show which blood pressure medicine is most effective for use during pregnancy.

Some high blood pressure medicines are dangerous during pregnancy. 7, 8 If you take high blood pressure medicines, talk to your doctor about the safety of your medicine before you become pregnant or as soon as you learn you are pregnant. Make sure that your doctor has a complete list of all medicines that you are taking.

Lowering blood pressure too much or too fast can reduce blood flow to the placenta, causing problems for the fetus. So medicine is reserved for preventing severely high blood pressure levels that may be life-threatening to you or your fetus.

Surgery

There is no surgical treatment for high blood pressure during pregnancy or for pre-eclampsia.

Surgical caesarean section delivery is used when:

  • A rapid delivery is medically needed for the mother's or fetus's well-being or survival.
  • Induction of labour has not been successful, usually within a 24-hour period.
  • There are medical reasons, such as placenta previa, that make vaginal delivery dangerous.

For more information, see the topic Caesarean Section.

Other Treatment

Delivery

The main treatment for severe pre-eclampsia is stabilizing the condition (preventing seizures with the anticonvulsant medicine magnesium sulfate and controlling high blood pressure) and delivering the baby. If you have severe pre-eclampsia or you have mild to moderate pre-eclampsia and are close to your due date, your baby will be delivered. Vaginal delivery is preferred to caesarean delivery.

Expectant management

Your condition may be treated with expectant management (bedrest) either at home or in the hospital. The purpose of expectant management is to allow more time for fetal development, for the cervix to become ready for a vaginal delivery, or both.

Social support

Reduced activity and worry are difficult parts of having pre-eclampsia. It often helps to talk with women who are or have been in the same situation. See the Other Places to Get Help section of this topic for more information.

Other Places To Get Help

Organizations

Society of Obstetricians and Gynaecologists of Canada (SOGC)
780 Echo Drive
Ottawa, ON  K1S 5R7
Phone: 1-800-561-2416
(613) 730-4192
Fax: (613) 730-4314
Email: helpdesk@sogc.com
Web Address: www.sogc.org
 

The mission of SOGC is to promote optimal women's health through leadership, collaboration, education, research, and advocacy in the practice of obstetrics and gynaecology.


Canadian Hypertension Society
Email: info@hypertension.ca
Web Address: http://www.hypertension.ca/
 

The Canadian Hypertension Society promotes the effective management of hypertension in Canada. The organization provides information about the condition and supports research.


References

Citations

  1. Solomon CG, Seely EW (2004). Preeclampsia—Searching for the cause. New England Journal of Medicine, 350(7): 641–642.
  2. Society of Obstetricians and Gynaecologists of Canada (2008). Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Journal of Obstetrics and Gynaecology Canada, 30(3, Suppl 1). Also available online: http://www.sogc.org/guidelines/documents/gui206CPG0803_001.pdf.
  3. Cunningham FG, et al. (2010). Maternal physiology. In Williams Obstetrics, 23rd ed., pp. 107–135. New York: McGraw-Hill.
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  6. O'Brien TE, et al. (2003). Maternal body mass index and the risk of preeclampsia: A systematic overview. Epidemiology, 14(3): 368–374.
  7. Cooper WO, et al. (2006). Major congenital malformations after first-trimester exposure to ACE inhibitors. New England Journal of Medicine, 354(23): 2443–2451.
  8. Health Canada (2006). Health Canada reminds women not to use ACE inhibitors during pregnancy. Available online: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/2006/2006_52_e.html.
  9. Duley L (2008). Pre-eclampsia, eclampsia and hypertension, search date July 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  10. Villar J, et al. (2006). World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women. American Journal of Obstetrics and Gynecology, 194(3): 639–649.
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  15. Sibai BM (2003). Diagnosis and management of gestational hypertension and preeclampsia. Obstetrics and Gynecology, 102(1): 191–192.

Other Works Consulted

  • American College of Obstetricians and Gynecologists (2002, reaffirmed 2010). Diagnosis and management of preeclampsia and eclampsia. ACOG Practice Bulletin No. 33. Obstetrics and Gynecology, 99(1): 159–167.
  • Duley L, et al. (2001). Antiplatelet drugs for prevention of pre-eclampsia and its consequences: Systemic review. BMJ, 322(7282): 329–333.

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer William Gilbert, MD - Maternal and Fetal Medicine
Last Revised December 20, 2010

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