High blood pressure before pregnancy

High blood pressure before pregnancy

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High blood pressure before pregnancy
Posted on 17th October 2016

High blood pressure (hypertension) is a problem for many women these days. Approximately five percent of pregnant women have chronic high blood pressure.
In the infertility population the percentage of women with chronic high blood pressure is even higher. That’s because the average woman with infertility is older and has a higher incidence of medical problems than the general population of pregnant women.
So what are the goals of the infertility doctor when a patient presents for fertility treatment with chronic hypertension? The first goal is to determine if there is end organ damage, which is harm to major organs fed by the circulatory system, and get the blood pressure under control, even if it requires medication. The second goal is to help the patient keep her blood pressure normalized and to try to achieve this without medications.
We need to control blood pressure at this point before fertility treatments succeed, because high blood pressure and pregnancy are a dangerous combination.
Early in pregnancy the blood pressure actually decreases, but in the second and third trimesters of pregnancy it rises naturally. For women with pre-existing high blood pressure, the second and third trimesters can present unique challenges and pose risks to the developing child.
Women with high blood pressure who are pregnant have a higher incidence of pre-eclampsia, fetal growth restriction, neonatal morbidity and cardiovascular disease. Severe hypertension occurs more often in women with pre-existing chronic high blood pressure and can lead to eclampsia, stroke, heart attack and placental abruption.
My advise
1....   Obesity, high cholesterol, stress, no time for exercise, all these can lead to high blood pressure. Some women also can inherit a tendency to get high blood pressure. Knowing what to do about your high blood pressure before you get pregnant is not as clear-cut as you may think.
2....   Surely, following a healthy diet and exercising are part of the pre-pregnancy goals, but doctors have debated about whether to start medication to lower your blood pressure. There are clear and current guidelines that recommend medication if the blood pressure is greater than 160/105 persistently when at rest. However, if your blood pressure is greater than 140/90, that is still considered hypertensive (having high blood pressure).
3...    But new data shows that treating this level of high blood pressure with medication is not always helpful, unless there is evidence of end organ disease, which includes kidney and heart disease. This is what I check for in infertile women with hypertension.
4....   The challenge for the infertile patient is that bringing her high blood pressure down may take time. Therefore, taking steps now to get your blood pressure to 120/80 and keeping it there is the best way to ensure a healthy pregnancy through fertility treatment.
5....   Chronic hypertension during pregnancy has been associated with a number of adverse pregnancy outcomes, including premature delivery, fetal growth restriction, fetal death, placental abruption and cesarean delivery. The incidence of these complications appears to be related to the duration and severity of the hypertension and the presence of superimposed preeclampsia.
6...     Elevated blood pressure before conception may increase the chances for pregnancy loss, according to an analysis by researchers at the National Institutes of Health. The authors conclude that lifestyle changes to keep blood pressure under control could potentially reduce the risk of loss. The study appears in Hypertension.

7..     The analysis found that for every 10 mmHg increase in diastolic blood pressure (pressure when the heart is resting between beats), there was an 18-percent-higher risk for pregnancy loss among the study population. Millimeter of mercury, or mmHg, is the unit of measure used for blood pressure. The researchers also found a 17 percent increase in pregnancy loss for every 10 mmHg increase in mean arterial pressure, a measure of the average pressure in the arteries during full heart beat cycles. The study was conducted by researchers at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

8....  The EAGeR trial enrolled more than 1,200 women ages 18 to 40 years and took blood pressure readings before the women were pregnant and again in the fourth week of pregnancy. Average diastolic blood pressure for the women in the study was 72.5 mmHg; normal blood pressure in adults is a diastolic reading of below 80 mmHg. The authors began to see an increase in pregnancy loss among women who had a diastolic reading above 80 mmHg (approximately 25 percent of the participants). None of the women in the study had stage II high blood pressure (above 90 mmHg in systolic high blood pressure or above 140 mmHg in systolic blood pressure).

9... I advise every woman who want healthy pregnancy should modify her life style and food habits to control hypertension naturally before pregnancy.   
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