Preeclampsia and high blood pressure

Preeclampsia is a pregnancy-related condition characterized by new high blood pressure and protein in the urine. Symptoms usually go away after delivery. Rarely, high blood pressure can persist for up to 6 weeks after birth. Preeclampsia is dangerous for both the mother (damage to the kidneys, liver, and brain) and the baby (who does not receive enough nutrients and oxygen). Women in severe condition may have seizures (eclampsia).

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Causes pre-eclampsia

The causes of preeclampsia are not yet fully understood.

Preeclampsia develops as a result of placental pathology, through which blood circulates poorly, but the cause of the placental dysfunction is still a mystery. It is also not known why the mother's body increases blood pressure during pregnancy. Until now, the factors that provoke the development of preeclampsia are considered to be:

• family predisposition;
• a disorder of the immune system of a pregnant woman. Preeclampsia often occurs in first-time mothers, as well as in those who already have children, but are trying to give birth to a child from another man. Experts believe that a disorder of the mother's immune system provokes the disease, since the mother's body begins to repel the father's antigen. As a result, narrowing of blood vessels throughout the body can be observed, causing high blood pressure and other diseases;
• a biochemical factor that causes blood vessels to narrow and blood pressure to rise. Preeclampsia may occur as a result of the body's response to placental dysfunction, or the symptoms of placental abnormality and preeclampsia may be caused by the same factor;
• diabetes and other diseases that provoke vasoconstriction.

Experts suggest that preeclampsia:

• begins to develop when there is insufficient blood flow in the uterus;
• is inherited;
• is the result of the mother's immune system reacting to the father's sperm, placenta, or fetus;
• develops when the mother had high blood pressure before pregnancy;
• occurs as a result of obesity, polycystic ovary syndrome and diabetes.

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Risk factors

• Hypertension.
• Chronic kidney disease.
• Diabetes.
• Disease of the blood vessels.
• High blood pressure after 34 weeks of pregnancy.
• Family predisposition.
• Obesity (more than 20% excess weight) at conception. The higher the body mass index, the greater the risk of developing preeclampsia.
• Multiple births (two or three fetuses).
• First pregnancy, first pregnancy with a new partner, or first pregnancy within the last 10 years.
• Mother's age is under 21 or over 35.
• Chorionic adenoma.
• Polyhydramnios caused by Rh sensitization or an inflammatory process in the uterus.
• Artificial insemination.

Women with hypertension are at risk for premature separation of the placenta from the uterine wall. The risk increases when:

• mother smokes;
• hypertension is observed and preeclampsia develops;
• mother uses drugs (cocaine);
• Uterine trauma occurs as a result of a car accident.

Experts believe that after childbirth, blood pressure may increase in women who have experienced symptoms of preeclampsia.

Does preeclampsia and high blood pressure during pregnancy lead to hypertension later in life?

If you did not have hypertension before pregnancy, then after childbirth, it will most likely return to normal. But high blood pressure before pregnancy indicates that it will not decrease on its own after childbirth. Experts believe that preeclampsia does not provoke hypertension in the future after childbirth. But at the same time, women with symptoms of preeclampsia during pregnancy.

Pathogenesis

Women with chronic hypertension typically have low blood pressure during the first two trimesters. It begins to rise again in the late second and third trimesters, and it usually remains high after delivery. High blood pressure during pregnancy increases the risk of preeclampsia.

Preeclampsia affects blood pressure, the placenta, liver, blood, kidneys, and brain. It can be mild or severe and can worsen gradually or rapidly. Both mother and baby are at risk.

• Blood pressure. There is no increase in blood volume as it should be during pregnancy, which affects the growth and development of the fetus, while the blood vessels narrow (vasospasm), increasing blood pressure.
• Placenta: The blood vessels of the placenta do not grow into the walls of the uterus and do not expand as they should, so the fetus does not receive enough blood and nutrients.
• Liver. Impaired blood circulation leads to liver destruction, which causes HELLP syndrome, a dangerous condition that requires immediate treatment.
• Kidneys. During normal pregnancy, the kidneys function 50% more, but in preeclampsia their function is impaired.
• Brain. Visual disturbances, persistent headaches, and seizures (eclampsia) can result from decreased blood flow to the brain. Seizures occur in 1% of women with preeclampsia. Eclampsia can cause maternal coma and lead to fetal death, so women with preeclampsia are given preventive medications in almost all cases.
• Blood. In preeclampsia, there is a low number of platelets. Sometimes blood clotting occurs - generalized thrombohemorrhagic syndrome. After childbirth, it usually goes away. After childbirth and the birth of the placenta, the symptoms of preeclampsia go away. If the condition worsens and labor is not in progress, a cesarean section is performed. After childbirth, blood pressure returns to normal in a few days, and sometimes 6 weeks or more.

Newborn

The earlier the blood pressure increases during pregnancy, the greater the risk of premature birth, which is fraught with complications for the newborn. If the child is born before 37 weeks, respiratory distress syndrome may be observed. The small weight and height of the child also indicates the impact of the disease on the fetus due to insufficient blood circulation in the placenta, as a result of which the child received a small amount of nutrients and oxygen.

According to statistics, one in 100 pregnancies with symptoms of preeclampsia ends in fetal death.

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Hypertension

Blood pressure is how much blood pushes against the walls of the arteries. If the pressure is too strong, the pressure increases (hypertension). If the pressure increases after 20 weeks of pregnancy, it may be a sign of preeclampsia.

Blood pressure is measured in two numbers - the upper number (systolic) shows the strain with which the heart pumps blood. The lower (diastolic) is the pressure with which the heart relaxes and fills with blood. Pressure is considered high if the upper is more than 140 millimeters of mercury, and the lower is over 90. The upper, lower, or both at the same time can be elevated - 150/95.

Blood pressure may be high before pregnancy or increase as pregnancy begins, requiring more frequent visits to the doctor than usual. There is no predictor of preeclampsia, so careful monitoring by a doctor is needed throughout pregnancy. Hypertension and preeclampsia are related, but have distinctive features.

Usually, a pregnant woman's blood pressure drops in the second trimester, but by the end of the third trimester it returns to normal. Sometimes blood pressure increases in the second and third trimesters, which is called gestational hypertension, which leads to preeclampsia. It is necessary to measure blood pressure often and undergo treatment if necessary. As a rule, blood pressure normalizes after the birth of the child. But if the pressure was high before pregnancy, it does not decrease after childbirth. A slight increase in blood pressure is not a problem, you just need to be under the supervision of a doctor who checks for preeclampsia. With high blood pressure, the fetus does not receive enough nutrients and oxygen, which affects growth and development, and can also lead to premature detachment of the placenta and stillbirth of the fetus.

Symptoms pre-eclampsia

Typically, a pregnant woman's blood pressure is slightly lower than normal during the second trimester of pregnancy, but it gradually returns to normal. However, 10% of pregnant women experience significantly elevated blood pressure (hypertension) after 20 weeks of pregnancy. This condition is called late gestational hypertension. Sometimes blood pressure increases in the first days after delivery. When your blood pressure first increases, your doctor will not be able to predict whether it will remain slightly elevated, progress, or indicate preeclampsia. If preeclampsia begins to develop, a urine test will show elevated protein levels. This is a sign that kidney function is impaired. If you had hypertension before pregnancy, you have chronic hypertension, which may persist after the baby is born.

Increased blood pressure during pregnancy If the pressure increases before the 20th week of pregnancy, it is usually chronic. In rare cases, this indicates the development of preeclampsia. Increased pressure after the 20th week of pregnancy is a sign of preeclampsia.

High blood pressure usually causes no symptoms, but sometimes headache, difficulty breathing, or changes in vision may occur.

Mild preeclampsia causes no symptoms. However, a pregnant woman may gain weight rapidly and experience a sudden increase in the size of her arms or swelling of her face. Severe preeclampsia causes difficulty breathing, headache, blurred vision, abdominal pain, and increased urination.

High blood pressure does not always cause symptoms, and to accurately determine it, you need a blood pressure cuff and a stethoscope.

Blood pressure is measured in numbers, for example, 140/90 millimeters of mercury or higher indicates hypertension, and 160/110 or higher is a life-threatening condition.

Symptoms of preeclampsia may appear suddenly or gradually.

• Systolic blood pressure is above 140, or diastolic is above 90, measured after 6 hours.
• Increased protein in urine. A high amount is 300 mg in 24 hours.

You may also have other symptoms, but preeclampsia is only diagnosed if you have high blood pressure and protein in your urine. Other symptoms of preeclampsia include:

• Swelling of the hands and face does not go away during the day (but in the absence of other symptoms, swelling of the face is considered normal during pregnancy).
• Rapid weight gain (more than 900 grams per week or 2,700 per month).
• Poor blood clotting.

Severe preeclampsia

In severe preeclampsia, systolic pressure is above 160, and diastolic pressure is above 110. Since blood circulation in the body is reduced, more severe symptoms may be observed:

• severe headache that does not go away with acetaminophen;
• visual impairment;
• decreased urination (less than 400 grams in 24 hours);
• constant pain in the abdominal cavity, especially in the right side;
• difficulty breathing, especially when lying on your back;
• HELLP syndrome (decreased platelet count).

HELLP syndrome (low platelet count) is a dangerous liver disorder that is related to preeclampsia. Seek immediate medical attention if you experience any of the following symptoms:

• pain in the upper abdomen (liver);
• pain in the shoulders, neck and other upper parts of the body (the source of the pain is the liver);
• fatigue;
• nausea and vomiting;
• headache;
• visual impairment.

In severe preeclampsia, the risk of seizures increases.

Eclampsia

When seizures of unknown etiology occur during preeclampsia, they indicate eclampsia, a condition that is dangerous for both the mother and the fetus.

Diagnostics pre-eclampsia

Usually, hypertension and preeclampsia are diagnosed during a visit to the doctor. Therefore, pregnant women should not miss scheduled visits to the attending physician. A sharp increase in pressure is the first sign of a problem. The doctor prescribes a urine test for protein, the presence of which indicates the development of preeclampsia. If blood pressure is high, immediately inform the doctor about the appearance of abdominal pain or headache, which are observed before the appearance of protein in the urine.

Hypertension and preeclampsia are usually discovered during regular prenatal checkups. Because these conditions can quickly worsen and cause harm to both mother and unborn baby, it is important to see your doctor regularly.

Pre-pregnancy period

Before pregnancy, the goals of blood pressure control are:

• detection of hypertension, as it is important to know whether high blood pressure is chronic before pregnancy, as there is a risk of developing preeclampsia;
• control measurement of blood pressure before conception to compare pressure readings during pregnancy.

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Scheduled testing during pregnancy

During each visit to the doctor, the woman's blood pressure is measured to detect preeclampsia at an early stage. The doctor will also order a urine test for protein and weigh the pregnant woman, since rapid weight gain indicates fluid retention in the body and is a sign of preeclampsia.

Testing pregnant women at risk for developing preeclampsia

Other tests are also performed to detect preeclampsia:

• blood test to diagnose HELLP syndrome and signs of kidney dysfunction (an increase in the amount of uric acid in the blood indicates the development of preeclampsia;
• creatinine test, which requires collecting urine for 24 hours and donating blood (to determine kidney function);
• Analysis of urine collected over 24 hours for the presence of protein.

If your test results indicate that preeclampsia is developing, you will be monitored closely for the rest of your pregnancy. The type and frequency of testing depends on the severity of the condition and the stage of your pregnancy. A woman will need to be tested more often if signs of preeclampsia are detected before 36 weeks of pregnancy.

If a woman is diagnosed with preeclampsia, the following diagnostic tests are performed to determine the health of the fetus:

• physical examination for signs and symptoms of progressive disease;
• blood test for its components and kidney function;
• creatinine test (to determine kidney function).

If seizures (a sign of eclampsia) are present, additional tests are performed after birth to determine the condition and functioning of the brain:

• Computed tomography (CT scan) is performed for a detailed study of structural changes within the body.
• Magnetic resonance imaging (MRI) uses a tomographic method to examine internal organs and tissues using the physical phenomenon of nuclear magnetic resonance.
• An electroencephalogram (ECG) measures the electrical activity of the brain using sensors and a computer.

Fetal examination

In case of high blood pressure (preeclampsia), the mother and child are under close medical supervision. The frequency of fetal monitoring depends on the severity of the mother's condition - from once a week to once a day. The following tests are used to determine the condition of the fetus:

• Electronic fetal monitoring to determine fetal heart activity during movement;
• Ultrasound of the fetus (to determine the condition of the baby, placenta and uterus), namely, the height and weight of the fetus, the possibility of premature placental abruption, the amount of amniotic fluid;
• Doppler ultrasound examination.

Amniocentesis is sometimes performed in cases of premature labor to determine the health of the fetus. During the procedure, a sample of amniotic fluid is taken to test for chemicals that indicate lung maturity.

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Early detection of disease

During scheduled visits, your doctor will measure your blood pressure and order a urine test to look for signs of preeclampsia.

Preeclampsia and High Blood Pressure in Pregnancy: A Review of Treatment

If blood pressure begins to rise during pregnancy, the woman is closely monitored by a doctor until delivery. The pressure may increase slightly and does not harm the mother and child. But at the first signs of preeclampsia, the risk increases significantly when the pressure reaches a critical level (hypertension).

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Treatment pre-eclampsia

If your doctor thinks your blood pressure is too high and to prevent seizures, he will prescribe certain medications, but the only way to get rid of preeclampsia is to give birth to the baby. The doctor may also prescribe special drugs that accelerate the maturation of the fetus's lungs and, at the first signs of maturity, perform an early extraction of the fetus for the safety of the mother and child, while the child may remain in intensive care for some time.

Treatment during pregnancy includes:

Full monitoring of the mother and child's condition

Use of drugs to reduce blood pressure. Sometimes a woman with chronic hypertension takes medications on a regular basis, but if her condition improves during pregnancy, the dose may be reduced. A slight increase in blood pressure usually only requires monitoring by a doctor. In case of a rapid increase in pressure (140/105), the doctor prescribes certain drugs. With hypertension (160/110), there is a risk of fetal growth retardation, so antihypertensive drugs are recommended.

During pregnancy, certain medications should not be taken, so if you have hypertension, be sure to tell your doctor about your pregnancy and show him the entire list of medications you are taking.

Preeclampsia and eclampsia

If signs of preeclampsia are observed, the pregnant woman is hospitalized or kept at home under the supervision of a doctor. The goal of treatment is to prevent a life-threatening condition and prolong the pregnancy as long as possible so that the baby is born full-term and healthy.

Treatment is usually carried out until the end of pregnancy, during labor and during the recovery period, but everything depends on the severity of the disease. Therapy includes: anticonvulsants, drugs that lower blood pressure and labor itself, after which preeclampsia disappears.

• In mild preeclampsia that does not progress, a woman is advised to reduce her activity, pay close attention to her well-being, and visit a doctor regularly.
• In moderate or severe preeclampsia or in case of a sharp deterioration in health, immediate hospitalization is required, where the pregnant woman is under the supervision of doctors, takes certain medications and adheres to bed rest, and if the disease progresses, the woman will be given the necessary help. In case of convulsions, magnesium sulfate is administered, which relieves convulsions and prevents their occurrence in the future. If the woman is in the last stage of pregnancy or her condition deteriorates sharply, the doctor may plan a premature birth.
• In life-threatening conditions, the only treatment alternative is magnesium sulfate and delivery. If the pregnancy is less than 34 weeks and delivery can be delayed for 24-48 hours, antinatal corticosteroids are administered to accelerate maturation and lung expansion.

After childbirth

In moderate or severe preeclampsia, the risk of seizures (eclampsia) remains in the first two days after the baby is born.

In rare cases, they may be observed later. Therefore, it is recommended to continue the administration of magnesium sulfate for 24 hours after delivery.

Blood pressure usually returns to normal within a few days after delivery (unless the condition is chronic). Some women have high blood pressure for up to 6 weeks after delivery. If diastolic pressure is above 100 at the time of discharge from the maternity hospital, the doctor will prescribe certain medications to lower the pressure. In the future, you should regularly visit the doctor for preventive examinations.

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Taking Blood Pressure Medications While Breastfeeding

There are several blood pressure medications that are considered safe to take while breastfeeding. These include labetalol and propranolol, along with drugs such as hydralazine and methyldopa. Substances such as nadolol, metoprolol, and nifedipine pass into breast milk but do not cause side effects to the baby.

Anticonvulsants

Moderate to severe preeclampsia or the presence of seizures (eclampsia) requires the administration of magnesium sulfate.

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Blood pressure lowering drugs

Use of drugs to reduce blood pressure:

• does not exclude a deterioration in the condition, since increased pressure is only a symptom, not a cause;
• reduces blood flow to the placenta in the event of a sharp drop in blood pressure, which can harm the fetus. Therefore, such drugs are used only in emergency cases when there is a threat to life for both the mother and the child.

Childbirth

Vaginal birth is generally considered safe for mother and baby if the mother is in good health. If preeclampsia progresses and the fetus's condition worsens, and vaginal birth is not possible, a cesarean section is performed.

Preeclampsia usually does not cause problems later in life. It is important to maintain a healthy lifestyle, such as exercise and proper nutrition. Talk to your doctor about what you can do to stay healthy.

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Other treatments for preeclampsia

In severe preeclampsia, it is important to stabilize the mother (prevent seizures by administering magnesium sulfate and control blood pressure) before the baby is born. If the woman is in the last trimester of pregnancy, the doctor may decide to deliver the baby early. Vaginal delivery is preferred.

In case of high blood pressure and preeclampsia during pregnancy, surgical methods of treatment are not used. Caesarean section is performed in case of:

• the need for immediate extraction of the fetus in order to save the life of the mother and child;
• if stimulation of labor has not produced results;
• medical indications, namely, placenta previa.

Observation

The woman's condition can be improved by bed rest, whether at home or in hospital. It is important to give the fetus time to fully mature and prepare the mother's body for natural childbirth.

Social support

With preeclampsia, you need to reduce activity and avoid stressful situations. Sometimes talking to women who are in the same situation helps.

Preeclampsia: Home Treatment

If you have chronically high blood pressure and are taking medications to lower it, be sure to consult your doctor before becoming pregnant, as some medications can cause irreparable harm to the unborn child.

If you were unable to normalize your blood pressure before pregnancy, take all necessary measures to control it:

• Visit your doctor regularly for ongoing monitoring, as dangerously high blood pressure may not cause any symptoms. You can also record your blood pressure readings periodically at home.
• Quitting smoking can help lower your blood pressure and improve the health of your unborn baby.
• Try to keep your weight under control during pregnancy. Consult your doctor about acceptable norms.
• Do light exercise during pregnancy. Walking and swimming several times a week will undoubtedly be beneficial for both you and your baby.
• Avoid stressful situations. Make time for rest, especially if you work, care for small children, or have a busy schedule.
• By listening to these tips, you will be able to bear a healthy child, avoid complications during labor and successfully go through the postpartum rehabilitation period.

Monitoring women with preeclampsia

If you have signs of preeclampsia in early pregnancy, your doctor may give you the necessary recommendations to eliminate them, which you will need to follow for several weeks. For example, stop working, reduce your activity level, spend more time on rest, including partial bed rest. Complete bed rest increases the risk of blood clots. Regardless of whether you are advised to reduce activity or adhere to partial bed rest, one thing is clear - you will not be able to fully perform your duties, take care of children and remain active.

Your doctor may recommend monitoring your condition at home every day, so you will have to do it yourself or ask someone close to you:

• measure blood pressure at home
• do a urine test for protein
• control your weight (go to the toilet and take off your slippers before weighing yourself)
• observe fetal movements

Record all results in a diary, including the date and time, and show them to your doctor during your scheduled visit.

Medicines for the treatment of preeclampsia

Drugs to treat preeclampsia and high blood pressure may be used to:

• Control of high blood pressure. Lowering the pressure does not prevent the progression of the disease, since high blood pressure is only a symptom of the condition, not the cause. The doctor prescribes drugs only when the diastolic pressure exceeds 105 millimeters of mercury. With a slight increase in pressure, the woman is only under the supervision of a doctor.
• Prevention of seizures. Administration of magnesium sulfate begins before delivery and continues for 24 hours after delivery if the pregnant woman has seizures due to preeclampsia or if the condition is severe.
• Accelerating the maturation of the fetal lungs. If possible, the pregnant woman is given corticosteroids before the onset of premature labor (up to 34 weeks). This drug promotes the maturation and opening of the baby's lungs, which reduces the risk of breathing difficulties that often occur in premature babies.

After Childbirth: Taking Medications While Breastfeeding

Choice of drugs

• Medicines taken during pregnancy to lower blood pressure:
• Methyldopa (an oral medication to control high blood pressure during pregnancy)
• Hydralazine (an intravenous drug used to quickly lower high blood pressure during pregnancy)
• Labetalol (an intravenous drug to quickly lower high blood pressure in hospital, or an oral drug to control blood pressure at home)
• Nifedipine (an oral drug used to quickly lower high blood pressure during pregnancy)
• Magnesium sulfate is the most commonly prescribed drug to prevent eclampsia (seizures) during pregnancy.
• Steroid drugs (betamethasone and dexamethasone) are prescribed to quickly mature the fetal lungs when premature delivery of the fetus is necessary.

When to seek medical help?

If you have preeclampsia, you may experience seizures (eclampsia), which can lead to maternal coma and fetal death. You should call an ambulance immediately if a pregnant woman is having a seizure. Therefore, friends and family members need to know how to help a pregnant woman with preeclampsia when a seizure begins. Seek immediate medical attention if you experience symptoms of preeclampsia during pregnancy:

• Visual impairment
• Frequent headaches that progress and persistent headaches that cannot be relieved with medication.
• Pain in the abdominal cavity, especially in the upper sector.
• Weight gain of more than 900 grams per day.
• Pain in the shoulders, neck and other upper body parts.

Mild preeclampsia may not have any symptoms, so it's important to see your doctor regularly for a scheduled checkup. Your blood pressure will be measured, and a urine test will be done to check for protein and make a diagnosis.

Observation

Symptoms such as heartburn and swelling of the legs are considered normal during pregnancy and do not always indicate preeclampsia. Tell your doctor about them at your next visit. However, if swelling occurs along with other symptoms of preeclampsia, seek immediate medical attention.

What should you think about?

To date, it is impossible to say with certainty which of the above drugs is the most effective in combating high blood pressure during pregnancy. Some drugs should not be taken during pregnancy. Therefore, if you are taking drugs to lower blood pressure and are planning to have a child, be sure to consult a doctor, and if you suspect pregnancy, show the doctor the entire list of drugs you are taking. Too rapid a decrease in pressure reduces blood flow to the placenta, harming the fetus, so you need to take drugs when the pressure is greatly increased, when there is a threat to the life of the mother and child.

Prevention

If you have high blood pressure (hypertension), you can normalize it before pregnancy by exercising, eating a healthy diet with lots of fruits and vegetables, and maintaining a weight that corresponds to your body mass index. Lowering your blood pressure prevents your body from developing preeclampsia.

During pregnancy, you should visit your doctor regularly to detect the development of the disease early. This is when you need to start treatment in time to prevent the development of severe preeclampsia. Recent studies show that calcium supplements and aspirin in small doses help prevent the disease, especially among those women who are at risk. They also reduce the risk of developing severe preeclampsia and having a low birth weight baby. The recommended daily dose of calcium for a pregnant woman is 1200 mg.

Scientists agree that taking vitamins C and E does not reduce the risk of developing preeclampsia.

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