What are Hypertensive Disorders of Pregnancy
Hypertensive Disorders of Pregnancy (HDP) is a spectrum of conditions that can occur during pregnancy that affect a woman’s blood pressure and their heart health. These include chronic hypertension, gestational hypertension, preeclampsia and HELLP syndrome. HDP occurs in approximately 5 –10 % of all pregnancies and has a major impact on maternal and fetal health including fetal growth restriction, preterm delivery and newborn morbidity and mortality.
Blood pressure is a measure of the force of the blood against the walls of your blood vessels in the circulatory system. This force is necessary to make the blood flow through the body, delivering nutrients and oxygen. Too much force (pressure) can have a negative impact on the walls of blood vessels and can be a result of high blood pressure, also called hypertension. High blood pressure means there is too much pressure in your blood vessels. This causes your heart to work harder and can cause damage to your blood vessels and lead to heart damage over time.
Chronic hypertension or pre-existing hypertension is when a woman has high blood pressure (≥140mmHg / ≥ 90mmHg) before becoming pregnant or it develops within the first 20 weeks of pregnancy. Gestational hypertension is diagnosed when a woman develops high blood pressure (≥140mmHg / ≥ 90mmHg) for the first time after 20 weeks of pregnancy.
On the higher end of the spectrum, preeclampsia can develop from hypertension in pregnancy and can lead to serious complications. It generally occurs after 20 weeks of pregnancy and up to six weeks postpartum. Preeclampsia is diagnosed by persistent high blood pressure (≥140/90mmHg) and the presence of protein in the urine (proteinuria) or high blood pressure and new development of decreased blood platelets, trouble with the kidney or liver, fluid in the lungs or signs of brain trouble such as seizures. In cases where preeclampsia affects brain function causing seizures or a coma, this is known as eclampsia. Preeclampsia occurs in approximately 5 – 7% of pregnancies and it is one of the leading causes of maternal and perinatal death. It can prevent the baby from getting enough blood and oxygen and be harmful to the mother’s liver, kidney and brain function. The earlier that preeclampsia begins, the more severe it may be which increases the risk of preterm birth resulting in higher risk of complications for the baby.
HELLP Syndrome develops when a woman with preeclampsia suffers damage to the liver and blood cells. HELLP stands for Hemolysis Elevated Liver Low Platelet count. Hemolysis occurs when there is a breakdown of red blood cells that are responsible for carrying oxygen. Elevated liver enzymes indicate damage to the liver and platelets are the cells responsible for stopping bleeding. Having a low platelet count could lead to serious bleeding.
Signs and Symptoms
Hypertension often has no warning signs or symptoms, which is why it is important to attend all pre-natal appointments and have your blood pressure checked. The development of preeclampsia and HELLP syndrome can occur suddenly and without warning. However, some women can experience the following signs and symptoms associated with preeclampsia and HELLP which should be communicated with a healthcare provider.
- Swelling of the feet, hands and/or face (especially around the eyes)
- Sudden weight gain
- Severe headache that will not go away even after taking pain medication
- Blurred or altered vision (flashing lights, seeing spots, light sensitivity)
- Sudden nausea or vomiting after mid pregnancy (not morning sickness)
- Abdominal pain on the upper right side
- Shortness of breath or difficulty breathing
The risk of preeclampsia and HELLP syndrome does not end even after the baby has been delivered. Whether you have had high blood pressure during pregnancy or not, you are still at risk. It is important to pay attention to how you are feeling and to notify your healthcare provider if you experience any signs and symptoms.
Treatment
Early detection and quick treatment are important for the health of the mother and baby. The mother and baby are monitored throughout the pregnancy and blood pressure regularly checked. Medications to lower blood pressure and prevent seizures may be prescribed. The course of treatment depends on the health of the mother and the baby and delivery may need to be induced or an emergency c-section may be performed.
“I had a visiting nurse come because I had a high-risk pregnancy and c-section but the nurse didn’t even take my blood pressure. It was all about whether the baby was gaining weight and my c-section recovery. But I had a c-section because I was hypertensive! ”
- Women with Lived Experience
What You Can Do
There is no way to predict or prevent HDP syndrome, but early detection and monitoring are essential. Here is what you can do:
- Attend all your pre-natal appointments for continuous monitoring of your health and the health of your baby.
- Regularly check your blood pressure. This can be done at your pre-natal appointments, but your healthcare provider may ask you to use a home blood pressure monitor as well. Click here to learn more about monitoring your blood pressure.
- Monitor yourself and contact your healthcare team immediately if you have any signs and/or symptoms. Continue to be aware of the signs and symptoms and check your blood pressure in the post-partum period. Use the Pregnancy Passport Tool to help you track.
- Maintain physical activity. Pregnant women should aim for 30 minutes of moderate activity most days of the week. However, with some complications such as hypertension, preeclampsia and HELLP, exercise may not be recommended. Consult with your healthcare team before engaging in physical activity.
- Aim for a healthy diet of fruits and vegetables, whole grains, healthy fats, and protein (lean meats and/or plant based). Choose items that are low in salt, sugar and fat more often.
Hypertensive Disorders of Pregnancy and Heart Disease
Currently, cardiovascular disease (CVD) is on the rise and is leading cause of death for women worldwide. Women with a history of HDP are among the highest at risk for developing heart disease. HDP is associated with premature CVD, with most women experiencing their first heart event by an average of 38 years old. Although most women who have experienced HDP will recover, there are long lasting health implications.
The precise reason why HDP increases the risk of CVD is still unknown. One main theory as to why the increased risk occurs is that pregnancy is a “stress test” for the heart and that the development of hypertensive conditions during pregnancy identifies a woman who was destined to develop CVD. Another supported theory is that damage to the blood vessels during a hypertensive pregnancy may speed up the process of atherosclerosis (hardening of the arteries from plague build-up).
Know Your Risk
Speak to your healthcare provider. Inform your healthcare provider about your pregnancy history, including the number of pregnancies, history of chronic/gestational hypertension, preeclampsia, HELPP and/or diabetes, number of miscarriages and/or stillbirths, babies born early or small size. It is also important to note any family history of HDP, hypertension, high cholesterol, or heart disease. Don't have a healthcare provider or need help interacting with your healthcare provider? Click here to learn more.
Know your numbers. It is recommended that women who have had HDP be routinely screened for risk of CVD. This includes checking blood pressure, cholesterol, and glucose levels. Use the Pregnancy Passport Tool to help you track.
Reduce the Risk
There are several lifestyle factors that help reduce heart disease risk. You can improve your chances of being heart healthy by being aware of the risks and keeping the following factors in optimal range.
- Smoking cessation. Quitting smoking is the most important thing you can do to positively affect your heart health. It is never too late to quit.
- Get moving. Aim to engage in at least 150 minutes of moderate to vigorous exercise every week. That is an average of 30 minutes per day and can be broken down to as little as 10 minutes at a time.
- Follow a heart healthy diet. Look to incorporate lots of fruits and vegetables, whole grains, lean meat and/or plant-based proteins into all your meals. Reduce the number of foods that have high saturated fat and high salt content.
- Aim to achieve your best weight. Best weight is the weight you can maintain when living the healthiest life you are able.
- Reduce your alcohol intake. Less is best. We recommend you do not drink alcohol. But if you do, no more than 2 drinks/day or 6 drinks/week.
- Manage stress. Make time for yourself and discover what helps you relax. Stay connected to others and seek support if stress becomes a concern.