hypertension%20in%20pregnancy
HYPERTENSION IN PREGNANCY
Hypertension in pregnancy is defined as an average diastolic blood pressure of ≥90 mmHg, based on at least 2 measurements ≥4 hours apart or systolic blood pressure of ≥140 mmHg taken at least 6 hours apart.
Diagnosis of severe hypertension is made when blood pressure is ≥160/110 mmHg.
Measurement should be repeated after 15 minutes for confirmation of severe hypertension.

Patient Education

  • Patient should be advised on the following effects of hypertension in pregnancy and vice versa to plan potential lifestyle and treatment changes before and during pregnancy:
    • Women with preexisting hypertension and TOD should be made aware that pregnancy may exacerbate the condition
    • Chronic hypertension with early proteinuria may increase risk of adverse neonatal outcomes, whether or not preeclampsia occurs
    • Increased risk of fetal loss and deterioration of maternal renal disease if serum creatinine >1.4 mg/dL
    • A tenfold increase in risk of fetal loss in uncontrolled hypertension with impaired renal function during conception as compared to pregnancy with controlled hypertension or without hypertension
    • Risk of developing cardiovascular disease (eg hypertension, ischemic heart disease, stroke) in the future is increased in women with hypertensive disease in pregnancy or puerperium
  • Patient should be informed about the risk of recurrence of hypertension or preeclampsia in the next pregnancy and that preeclampsia is more common in women with chronic hypertension
    • Risk of hypertension recurrence in the next pregnancy is higher with early-onset hypertension in first pregnancy

Lifestyle Modification

  • Restrict activities at work and home
  • Refrain from aerobic exercises based on the theory that inadequate placental blood flow may increase the risk of preeclampsia
    • For patients with well-controlled chronic hypertension who are used to exercising, moderate exercise during pregnancy is recommended
  • Avoid smoking
    • Increases risk of placental abruption in addition to fetal growth restriction
  • Avoid alcohol
    • Excessive consumption may cause or exacerbate maternal hypertension and lead to congenital anomalies
  • Weight reduction is not recommended for management of chronic hypertension in pregnancy
    • It is advised that women with BMI ≥30 kg/m2 should not gain weight of >6.8 kg
  • Calcium supplement of 1.5-2 g/day decreases incidence of preeclampsia and hypertension among all women and also reduces severe preeclamptic complication in pregnant women with low daily calcium intake
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