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Hypertension%20in%20pregnancy Patient Education
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, heart failure, stroke), metabolic syndrome and chronic or end-stage renal disease in the future is increased in women with hypertensive disorders of 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
- After a hypertensive pregnancy, patient should be counseled regarding a healthy diet and lifestyle and control of risk factors for long-term cardiovascular and metabolic diseases for herself and her child
- Encourage home BP monitoring for hypertensive women
- Self-measured BP identifies nonsustained elevations in BP including masked and white coat hypertension
- Counsel patient on the long-term perinatal and neonatal complications associated with preeclampsia: Cerebral palsy, low intelligence, visual and hearing disturbances, metabolic problems (eg insulin resistance and diabetes), neonatal hypertension and coronary artery disease
Lifestyle Modification
- Pregnant women without contraindications should exercise to prevent 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
- BMI should be kept within the normal range prior to the next pregnancy in women with previous preeclampsia
- Limit salt intake in diet
