Can a hypertensive woman get pregnant
Poorly-controlled hypertension in the first trimester significantly increases maternal and fetal morbidity and mortality. The majority of guidelines and clinical trials focus on the management and treatments for hypertension during pregnancy and breast-feeding, while limited evidence could be applied to the management for hypertension before pregnancy. In this review, we summarized the existing guidelines and treatments of pre-pregnancy treatment of hypertension. Methyldopa and labetalol are considered the first choice, but angiotensin-converting enzyme ACE inhibitors and angiotensin receptor blockers ARBs need to be withdrawn if a hypertensive woman wishes to become pregnant. In women with chronic hypertension, it is very important to make an assessment before conception to exclude secondary causes of hypertension, evaluate their hypertensive control to ensure that it is optimal, discuss the increased risks of pre-eclampsia, and provide education regarding any drug alterations before they become pregnant.
- High Blood Pressure and Getting Pregnant?
- High blood pressure during pregnancy
- I have hypertension. What do I need to know before I get pregnant?
- Hypertension in pregnancy
- Pregnancy-induced Hypertension
- High Blood Pressure in Pregnancy
- High Blood Pressure and Women
- Number of pregnant women with high blood pressure spiked over last four decades
- High Blood Pressure During Pregnancy
- Preeclampsia and High Blood Pressure During Pregnancy
High Blood Pressure and Getting Pregnant?
Poorly-controlled hypertension in the first trimester significantly increases maternal and fetal morbidity and mortality. The majority of guidelines and clinical trials focus on the management and treatments for hypertension during pregnancy and breast-feeding, while limited evidence could be applied to the management for hypertension before pregnancy. In this review, we summarized the existing guidelines and treatments of pre-pregnancy treatment of hypertension.
Methyldopa and labetalol are considered the first choice, but angiotensin-converting enzyme ACE inhibitors and angiotensin receptor blockers ARBs need to be withdrawn if a hypertensive woman wishes to become pregnant. In women with chronic hypertension, it is very important to make an assessment before conception to exclude secondary causes of hypertension, evaluate their hypertensive control to ensure that it is optimal, discuss the increased risks of pre-eclampsia, and provide education regarding any drug alterations before they become pregnant.
There is increasing debate regarding discouraging the use of diuretics. There is also controversy regarding the use of supplementations such as calcium, antioxidants and low-dose aspirin. A less restricted blood-pressure goal could be set for hypertensive women planning for pregnancy. A healthy body weight before pregnancy could lower the risk of pregnancy-related hypertensive disorders.
Recent guidelines also encourage women with chronic hypertension to keep their dietary sodium intake low, either by reducing or substituting sodium salt before pregnancy. Pregnancy-associated hypertension remains an important cause of maternal and fetal morbidity and mortality, 2 and more evidence has confirmed that pregnancy-associated hypertension could cause early childhood cardio-metabolic disorder. Most current guidelines and clinical trials focus on the management and treatments for hypertension during pregnancy and breast-feeding, while limited evidence could be applied to the management of hypertension before pregnancy.
There are three types of hypertensive disorders of pregnancy: chronic hypertension, gestational hypertension and pre-eclampsia. Pre-eclampsia is a leading cause of pre-term birth and cesarean delivery. The presence of mild-to-moderate pre-existing hypertension systolic blood pressure SBP — mmHg or diastolic blood pressure DBP of 90—99 mmHg increases the risk of pre-eclampsia, placental abruption and growth restriction in the fetus.
In a prospective study including women with mild-to-moderate hypertension, the non-treatment group experienced higher complication rates than did the treatment group for severe hypertension Table 1 Summary of antihypertensive treatment for pre-pregnancy hypertension.
In women with a history ofhypertension for severalyears, evaluate for target-organdamage, includingleft ventricular hypertrophy, retinopathy. Most guidelines gave the pre-pregnancy antihypertensive advice based on the evidence from pregnancy chronic hypertension guidelines. Internationally, the guidelines vary for the management of chronic hypertension during pregnancy.
It must be stressed that none of the many antihypertensive agents used in routine practice have been shown to be teratogenic to be taken safely Table 1. The majority of the guidelines recommend that women on angiotensin-converting enzyme ACE inhibitors or angiotensin II receptor blockers ARBs and planning to become pregnant have to discuss with their doctor prescription of an alternative.
Methyldopa is often considered the first-line therapy for pre-pregnancy antihypertensive treatment 24 , 25 with the largest quantity of data regarding fetal safety since it has been used for pregnancy hypertension since s 26 even in the first trimester.
Labetalol, a combined alpha-blocker and beta-blocker, is an alternative to methyldopa, as it is well-tolerated with an easier twice-a-day dosing schedule than methyldopa, 29 particularly for severe hypertension. Beta-blockers is generally safe, but intrauterine growth retardation and pre-term birth have been reported. A randomized controlled trial conducted by Webster L demonstrated that nifedipine controlled BP of chronic hypertension in pregnancy and reduced the incidence of severe hypertension without an increase in adverse perinatal outcome.
Amlodipine has been used in pregnancy but safety data are lacking. There could also be an increased risk of congenital abnormalities and neonatal complications if chlorothiazide is taken. There is also controversy regarding antihypertensive benefits for mild-to-moderate hypertension based on the unpredicted adverse outcomes of these antihypertensive drugs, particularly for those that aggressively lower blood pressure. A systemic review from the Lancet claims that the evidence base regarding pharmacologic management of chronic hypertension during pregnancy is too small to either prove or disprove moderate-to-large benefits of antihypertensive therapy; every mmHg drop in blood pressure in women taking antihypertensives was associated with a g decrease in birth weight.
Regarding these opinions, we should pay more attention to the blood-pressure goal before pregnancy. One reason is that blood pressure, including SBP, DBP, mean arterial pressure and central SBP, has been confirmed to decrease in the early stage in the first trimester 36 ; and the majority of the decrease occurs early in pregnancy 6—8 week gestational age. Accordingly, for women with hypertension who wish to become pregnant, a less restricted blood-pressure goal could be set. Women with mild-to-moderate hypertension and a normal BMI may choose to discontinue the use or reduce the doses of antihypertensive agents.
The most difficult problem for the management of pre-pregnancy hypertension was that the majority of women with chronic hypertension who became pregnant did not know their blood pressure and did not start hypertension management before pregnancy or when they are planning to become pregnant. Undiagnosed hypertensive women may appear normotensive in early pregnancy because of the normal fall in blood pressure, commencing in the first trimester.
This may mask pre-existing hypertension, and when blood pressure is recorded later in the pregnancy it may be interpreted as gestational hypertension. Those with high blood pressure should be screened for underlying secondary causes and endocrine causes such as hyperaldosteronism.
In addition, age is the strongest risk factor for the occurrence of hypertension. Childbirth at earlier ages could bring much more benefits for decreasing the risk of delivery complications and improving childhood developmental outcomes. Long-term hypertension induces damage to the vasculature, 44 myocardium, kidney 45 and other organs.
Additionally, if the urinalysis is positive for protein, then a h urine collection for protein analysis or measurement of spot urine protein-to-creatinine ratio should be assessed. Calcium supplementation 1. Only one randomized controlled trial looked at the effect of calcium mg plus additional supplements in the early stages of pregnancy, 54 but no studies of calcium alone were found.
Based on the fact that whether calcium supplementation could reduce blood pressure in hypertensive female patients remains unclear, 55 we currently cannot conclude whether the use of calcium in pre-pregnancy women is effective. Antihypertensive effects of antioxidants such as vitamin C and resveratrol were hypothesized and tested in many laboratory 57 and human studies 58 — 60 because of their antioxidative effects in reducing oxidative stress and enhancing endothelial function.
However, the evidence for blood-pressure-lowering effects of these antioxidants in clinical trials is inconsistent. However, studies have shown a lack of efficacy of vitamin C or E administered from the second trimester to reduce the rates of either pre-eclampsia or other adverse outcomes. Another supplement that may have the same effect to prevent pre-eclampsia is low-dose aspirin 60 mg daily. Low-dose aspirin therapy inhibits thromboxane production more than prostacyclin production and therefore should protect against vasoconstriction and pathologic blood coagulation in the placenta.
Numerous studies have demonstrated the importance of body weight or weight loss to control of blood pressure during pregnancy. They found that pre-pregnancy BMI determines the level but not the change of blood pressure during pregnancy. Another study from Australia excluded women with a history of hypertension before pregnancy, and the result was inconsistent with the above conclusion. A Chinese study showed both pre-pregnancy BMI as well as gestational weight change were positively associated with the risk of hypertensive disorders in pregnancy Dietary intake during pregnancy was proposed to play a role in the etiology of pregnancy hypertensive disorders, but the evidence for the relation between diet and the prevention of hypertensive disorders remains inconclusive.
Dietary sodium and potassium intake are also believed to significantly contribute to the change in blood pressure in both general and hypertensive population.
In another meta-analysis, potassium supplementation was found to decrease SBP of 4. There are no trials of sodium or potassium intake for reducing the relative risks for hypertensive women before pregnancy.
As overall dietary patterns remain relatively stable from pre-pregnancy and throughout pregnancy, a large nationwide randomized trial is underway. For women with hypertension who wish to become pregnant, antihypertensive treatment should be discontinued in those taking ACE inhibitors or ARBs even chlorothiazide , and methyldopa should be used as an alternative.
Women with chronic hypertension should be encouraged to maintain low dietary sodium intake. Moreover, large, multicentre, randomized trials should be conducted to determine the efficacy of supplements such as antioxidants and calcium used from the pre-pregnancy stage.
Trefor Owen Morgan for his advise on this review. Ambulatory management of chronic hypertension in pregnancy. Clin Obstet Gynecol ; 55 : — Google Scholar. Management of hypertension before, during, and after pregnancy.
Heart ; 90 : — Preeclampsia and gestational hypertension are associated with childhood blood pressure independently of family adiposity measures: the Avon Longitudinal Study of Parents and Children. Circulation ; : — 9. Clinical cardiovascular risk during young adulthood in offspring of hypertensive pregnancies: insights from a year prospective follow-up birth cohort. BMJ open ; 5 : e Mechanisms and management of hypertension in pregnant women.
Curr Hypertens Rep ; 13 : — Sibai BM. Diagnosis and management of chronic hypertension in pregnancy. Obstet Gynecol ; 78 : — Treatment of hypertension in pregnant women. N Engl J Med ; : — Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. Hypertension and pregnancy. Tex Heart Inst J ; 44 : — 1. Maternal hypertension during pregnancy and the risk of congenital heart defects in offspring: a systematic review and meta-analysis.
Pediatr Cardiol ; 36 : — Seely EW , Ecker J. Clinical practice. Chronic hypertension in pregnancy. Management of hypertension in pregnancy. Clin Exp Hypertens ; 21 : — Circulation ; : — Delayed childbearing: more women are having their first child later in life. Extreme obesity in pregnancy in the United Kingdom. Obstet Gynecol ; : — Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis.
BMJ ; : g Maternal and fetal morbidity following discontinuation of antihypertensive drugs in mild to moderate chronic hypertension: a 4-year observational study. Pregnancy Hypertension ; 6 : — 4. Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: a prospective study.
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High blood pressure during pregnancy
What is gestational hypertension? What kinds of problems can hypertension cause during pregnancy? How is chronic hypertension during pregnancy managed?
The biggest hiccup, though, is if your partner is the one taking an antihypertensive medication, since it can affect how well and for how long he can maintain an erection and achieve ejaculation. But all your plumbing should continue to work fine. However, managing your pregnancy will take a little extra work on your part. Certain high blood pressure meds like beta-blockers are usually okay, but others, including ACE angiotensin-converting enzyme inhibitors, are a no-go because they can be dangerous to you and your developing baby. Talk to a cardiologist before you start to get too busy — she can help give you the all-clear and make sure your condition is well controlled.
I have hypertension. What do I need to know before I get pregnant?
Back to Your pregnancy and baby guide. If you're pregnant and have a history of high blood pressure hypertension , or have developed high blood pressure for the first time in pregnancy, here's what you need to know about managing it. If you're taking medicine to lower your blood pressure and want to try for a baby, talk to your GP or specialist first. They may want to switch you to a different medicine before you get pregnant. If you find out you're already pregnant, tell your doctor immediately. They may need to change your medication as soon as possible. This is because some medicines that treat high blood pressure may not be safe to take when you're pregnant. They can reduce the blood flow to the placenta and your baby, or affect your baby in other ways.
Hypertension in pregnancy
High blood pressure and pregnancy isn't necessarily a dangerous combination. Here's what you need to know to take care of yourself — and your baby. Sometimes high blood pressure is present before pregnancy. In other cases, high blood pressure develops during pregnancy. Preeclampsia occurs when hypertension develops after 20 weeks of pregnancy, and is associated with signs of damage to other organ systems, including the kidneys, liver, blood or brain.
Please sign in or sign up for a March of Dimes account to proceed. High blood pressure can cause problems for you and your baby during pregnancy, including preeclampsia and premature birth. Go to all of your prenatal care visits so your provider can check your blood pressure.
Some women have high blood pressure during pregnancy. This can put the mother and her baby at risk for problems during the pregnancy. High blood pressure can also cause problems during and after delivery.
However, nearly half of all adults with high blood pressure are women. And at 65 and older, women are more likely than men to get high blood pressure. Medical researchers have found that birth control pills increase blood pressure in some women. The combination of birth control pills and cigarette use may be especially dangerous for some women. Learn more about quitting smoking.
High Blood Pressure in Pregnancy
Blood pressure is the force of your blood pushing against the walls of your arteries as your heart pumps blood. High blood pressure , or hypertension, is when this force against your artery walls is too high. There are different types of high blood pressure in pregnancy:. If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure. Your health care provider will check your blood pressure and urine at each prenatal visit. They may include blood tests other lab tests to look for extra protein in the urine as well as other symptoms. Delivering the baby can often cure preeclampsia.
The number of women with high blood pressure HBP when they become pregnant or who have it diagnosed during the first 20 weeks of pregnancy has spiked in the United States over the last four decades, especially among black women, according to new research in the American Heart Association's journal Hypertension. Having high blood pressure before becoming pregnant and during pregnancy poses potential complications for both women and their unborn children, including increased risks of stillbirth or infant death and preeclampsia life-threatening high blood pressure during pregnancy , stroke, heart failure, cardiomyopathy heart muscle disease or kidney failure and death among other risks for the mother. The researchers defined high blood pressure as mm Hg systolic blood pressure and 90 mm Hg diastolic blood pressure over the course of the study, however, the American Heart Association defines high blood pressure as mm Hg systolic blood pressure the top number in a blood pressure reading and 80 mm Hg diastolic blood pressure the bottom number in a blood pressure reading. Ananth, Ph. In this study, the largest of its kind according to the researchers, the rates of chronic high blood pressure in pregnant women aged 15 to 49 years were evaluated.
High Blood Pressure and Women
Blood pressure is the pressure in the blood vessels in your body. It is the force with which the blood moves through the blood vessels. Doctors and nurses measure blood pressure by putting a cuff around your upper arm.
Number of pregnant women with high blood pressure spiked over last four decades
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Лейтенант глубоко затянулся. - Долгая история.
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High Blood Pressure During Pregnancy
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Preeclampsia and High Blood Pressure During Pregnancy
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