What is Hypertension in Pregnancy?

Hypertension during pregnancy is considered to be a blood pressure above 140/90. Hypertension in pregnancy always requires treatment. In hypertension, kidney damage occurs, starting with protein (albumin) loss in the urine and resulting in edema. This can lead to the development of preeclampsia, also known as pregnancy poisoning.

Hypertension during pregnancy usually occurs after the 20th week of pregnancy and is one of the leading causes of maternal deaths related to pregnancy.

Rising blood pressure during pregnancy prematurely damages the placenta, known as the baby’s companion, and leads to delayed growth and preterm birth. Pregnant women with hypertension should undergo a complete urine test, complete blood count, liver and kidney function tests, and coagulation tests. Appropriate medications should be started immediately, and pregnancy should be closely monitored.

Early diagnosis and treatment are important. If your doctor suspects hypertension during the early stages of pregnancy and starts treatment early, it can be treated.

Who Is at Risk for Hypertension in Pregnancy?

• Those with high blood pressure before pregnancy,
• Pregnant women under 20 and over 40 years old,
• Women with multiple pregnancies,
• Overweight women,
• Women who gain excessive weight during pregnancy,
• Those with a family history of high blood pressure,
• Those with a history of high blood pressure in previous pregnancies,
• Women with systemic diseases (such as diabetes, kidney disease, etc.).

What Measures Should Be Taken for Hypertension and Preeclampsia in Pregnancy?

During pregnancy, visit your doctor regularly. Make sure you are at your ideal weight before getting pregnant and do not gain excessive weight during pregnancy. Moreover, nutrition plays a significant role in your pregnancy process. Eating too much salty food, excessive carbohydrate consumption, and drinking too many carbonated beverages can lead to bloating and high blood pressure.

If you have swollen limbs or a swollen face, make sure to consult your doctor. If you have sudden headache attacks, there might be an underlying blood pressure issue. If you have a headache, check your blood pressure.

How is Hypertension Treated in Pregnancy?

• The appropriate blood pressure level to start treatment for hypertension in pregnancy is debated. In the U.S., treatment is recommended for blood pressure of 160/105 mmHg and above, while in Canada, treatment is suggested for blood pressure exceeding 140-150/90 mmHg. In the presence of comorbidities (e.g., diabetes, CAD, CKD), target blood pressure levels are 130-139/80-89 mmHg. In Australia, treatment starts at 160/90 mmHg, and it is not recommended to reduce systolic pressure below 110 mmHg. According to NICE 2011, the target for women with uncomplicated chronic hypertension during pregnancy should be under 150/100 mmHg. In these patients, diastolic blood pressure should not drop below 80 mmHg. In cases with organ damage (e.g., kidney damage), blood pressure should be reduced to below 140/90 mmHg.
• If secondary hypertension is present, an appropriate treatment plan should be implemented.
• Mild to moderate hypertension and preeclampsia: In patients diagnosed with preeclampsia, if the gestational age is appropriate, delivery is performed. If preeclampsia occurs well before delivery time and blood pressure exceeds 150/100 mmHg, treatment should be initiated. In preeclampsia, both high (>160/110 mmHg) and low (<120/80 mmHg) blood pressure values should be avoided.
• For severe hypertension (>160/110 mmHg), there is consensus on treatment. The primary goal of treatment is to prevent intracerebral hemorrhage and maternal deaths. In severe hypertension, treatment aims to reduce the mean arterial blood pressure by 25% within minutes to prevent hypertensive encephalopathy, hemorrhage, or eclampsia. Within hours, blood pressure should be reduced below 160/100 mmHg. The selection of antihypertensive drugs: A meta-analysis of 24 studies (2949 women) found that parenteral labetalol, hydralazine, and oral nifedipine had low maternal and fetal side effects.
• For gestational hypertension or chronic hypertension in pregnancy, the first-line medication is methyldopa. It should be given in doses of 0.5-3 grams per day, divided into 2-4 doses. Second-line options include labetalol, nifedipine, hydralazine, hydrochlorothiazide (category C).
• In emergency situations, intravenous labetalol, oral methyldopa, or oral nifedipine may be indicated. Hydralazine is not used due to its potential to cause perinatal adverse events. In hypertensive crises, intravenous nitroprusside may be useful, provided long-term use is avoided.
• Calcium supplementation, fish oil, and low-dose aspirin are not recommended during pregnancy. However, aspirin may be used prophylactically in cases of early-onset preeclampsia.

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