Hypertension in Pregnancy
What is hypertension and hypertension in pregnancy?
Blood pressure is the measure of the pressure exerted by blood on the walls of the artery as it flows through it. This pressure is mostly from the heart pumping blood to the rest of the body. When the blood pressure is high, it is termed hypertension. Hypertension therefore refers to having a blood pressure of that is high , usually 140/90mmHg and above. Blood pressure values are recorded as two numbers; the first one which is called the systolic blood pressure indicates the amount of pressure the blood exerts on the walls of the artery when the heart beats and the second number which is the diastolic blood pressure indicates the amount of pressure the blood exert on the walls of the artery when the heart is at rest in between beats.
Degrees of hypertension
Mild: diastolic blood pressure 90–99 mmHg, systolic blood pressure 140–149 mmHg.

Moderate: diastolic blood pressure 100–109 mmHg, systolic blood pressure 150–159 mmHg.

Severe: diastolic blood pressure ≥110 mmHg, systolic blood pressure ≥160 mmHg
Types of hypertension in pregnancy
Having a blood pressure of 140/90mmHg and above while pregnant is called hypertension in pregnancy. Hypertension in pregnancy can be described as chronic or gestational. Chronic hypertension is when a woman has high blood pressure before pregnancy or has a high blood pressure in the first 20 weeks of pregnancy. Gestational hypertension is when the first onset of the high blood pressure occurs after the first 20 weeks of pregnancy.

Chronic and gestational hypertension can lead to a more severe condition called pre-eclampsia. Pre- eclampsia is defined as hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24-hour collection of urine, 1+ protein on urine dipstick, arising anew after the 20th week of pregnancy in a woman with previously normal blood pressure and resolving completely by the sixth week after giving birth.
What causes hypertension in pregnancy?
The following are causes of chronic hypertension;
Idiopathic(unknown).
Essential hypertension.
Vascular disorders.
Renal artery stenosis.
Coarctation of the aorta.
Renal disease.
Polycystic disease.
Diabetic nephropathy.
Chronic glomerulonephritis; Nephrotic and nephritic syndrome.
Collagen vascular disease; Systemic sclerosis.
Systemic lupus erythematosus; Rheumatoid disease.
Endocrine disease-Phaeochromocytoma, Conn’s syndrome, Cushing’s syndrome, Diabetes mellitus.
Monitor your blood pressure regularly so that any abnormalities can be detected early for timely intervention.

The following factors that increase the likelihood of a woman developing preeclampsia:
First pregnancy.
Multiparous (that is a woman having borne more than one child) with a previous history of pre-eclampsia.
Pre-eclampsia in any previous pregnancy.
10 years or more since last baby.
Age 40 years or more.
Body mass index (BMI) of 35 or more.
Family history of pre-eclampsia (in mother or sister).
Multiple pregnancy.
Renal disease.
Diabetes.
Exercise regularly but ask your health worker about the type(s) of exercises that are appropriate for you.

How common is it?
It occurs in about 5% to 10% of all pregnancies. This means approximately 1 in 10 women will have it during pregnancy. It is more common in developing countries.
What are the effects on the mother?
High blood pressure during pregnancy can place extra stress on your heart and kidneys and can increase your risk of heart disease, kidney disease, and stroke. It can also affect the liver. Some effects on the mother include:
Preeclampsia—This condition is more likely to occur in women with chronic high blood pressure than in women with normal blood pressure.
Eclampsia – tonic-clonic or grand mal seizures (a type of seizure involving loss of consciousness and violent muscle contractions)
Placental abruption—This condition, in which the placenta prematurely detaches from the wall of the uterus, is a medical emergency that requires immediate treatment.
Cesarean birth—Women with hypertension are more likely to have a cesarean birth than women with normal blood pressure. A cesarean birth carries risks of infection, injury to internal organs, and bleeding.
Stroke.
DIC (disseminated intravascular coagulation- a serious condition which affects the blood’s ability to clot and stop bleeding).
Acute kidney failure- a condition in which the kidney suddenly is unable to filter waste from your blood.
HELLP (hemolysis, elevated liver enzymes and low platelet counts) syndrome -it is a rare life-threatening condition in pregnancy which causes red blood cells to breakdown quickly, liver problems, bleeding and high blood pressure.
Maternal death.
Take and complete all your medications as prescribed by your doctor in order to get the desired effect. It is important to also note that self-medicating can be harmful to both mother and baby.

What are the effects on the baby?
Preterm delivery—If the placenta is not providing enough nutrients and oxygen to your fetus, it may be recommended that early delivery is better for your baby than allowing the pregnancy to continue.
Fetal growth restriction—High blood pressure can decrease the flow of nutrients to the fetus through the placenta. The fetus may have growth problems as a result.
Stillbirth- death of the baby before or during delivery
Fetal distress-it is an emergency pregnancy, labor, or delivery complication in which the baby does not get adequate oxygen supply. experiences oxygen deprivation.
Oligohydramnios – it refers to low level of amniotic fluid during pregnancy.
What are the effects on the family and nation?
Hypertension in pregnancy especially preeclampsia is a serious health problem that affect women around the world and its effect on the nation cannot be overlooked. These effects include:
Loss of caregiver and orphaned children.

Loss of breadwinner.

Increased healthcare cost on the national budget.
Loss of valuable human resource.
Aside being a contributing factor for hypertension in pregnancy, smoking and alcohol consumption during pregnancy has several other diverse negative effects on both mother and baby including fetal alcohol syndrome. It therefore very important to quit smoking and alcohol consumption during pregnancy.

How can hypertension in pregnancy be prevented?
The best way to cure most diseases including hypertension is to prevent them from happening in the first place. Although there is currently no sure way to prevent hypertension, you can control some of the factors that contribute to high blood pressure. Hence some of the things you can do to prevent hypertension in pregnancy includes;
Alcohol and smoke cessation

Limiting salt intake to about half a teaspoon a day

Avoiding foods containing caffeine

Exercising regularly

Getting enough rest

Increasing the amount of protein intake and reducing the amount of fried and junk foods.
Eat healthy; avoid foods high in saturated fat, and caffeine, limit processed foods and salt, instead eat enough fruits and vegetables, whole grains and foods high in protein.

How is it managed?
The management of hypertension in pregnancy includes controlling the blood pressure, preventing seizures and delivering the baby. This is usually dependent on how severe the disease is and the maturity of the baby.Your doctor may want to deliver the baby as soon as possible, usually at 37 completed weeks, which may be done through caesarean section (that is removing the baby through surgery) or induction of labor (that is stimulating uterine contractions to achieve vaginal birth) if it is not contraindicated. The baby may be delivered earlier if the hypertension is severe. Medications such as nifedipine and methyldopa may be prescribed to control the hypertension. If your hypertension is mild and your baby is not fully developed, the following measures can be taken to control or manage the hypertension until the baby can be delivered.
Compliance with medications; you may be feeling better after taking your medication for some time but that does not mean you should stop taking them. You should finish taking your drugs as prescribed by the doctor in order to have the desired result. Stopping some drugs in the middle of treatment may make the hypertension worse.
Monitor your blood pressure at home.
Attend all your AnC appointments with you midwife or doctor.
Limit your salt intake to about half a teaspoon a day.
Get enough rest and sleep.
Quit smoking/ alcohol consumption.
Eat healthy; avoid foods high in saturated fat, and caffeine, limit processed foods and salt, instead eat enough fruits and vegetables, whole grains and foods high in protein.

Attend all your AnC appointments with your midwife or doctor.

What is the role of AnC(Antenatal Clinic) in preventing hypertension in pregnancy?
Antenatal care is the planned examination, observation and the guidance given to the pregnant woman from the time of conception till the time of labor. The purpose of antenatal care is to ensure that the mother and the baby are in the best possible health, detect complications early and treat them appropriately, offer education to the pregnant woman and to prepare her for lactation and care for the baby after birth. Regular AnC attendance is very important in the prevention and management of most health problems in pregnancy including hypertension. This is because during antenatal care,

The pregnant woman’s blood pressure is measured at each visit.
Urine dipstick is done at each visit to monitor for protein in urine why may indicate preeclampsia.
The general wellbeing of the pregnant woman is monitored.
Ultrasound scans are done to monitor the growth and well-being of the baby.

Report to the nearest healthcare center immediately if you experience or see any of these danger signs and disorders for evaluation and timely intervention.

AnC is a perfect avenue to educate the pregnant woman on hypertension in pregnancy and other pregnancy problems as well as prepare her for care of herself and the baby after birth. Any of the danger signs of pregnancy can be detected early and actions taken to prevent complications. These danger signs include bleeding, headache, swollen feet, hands and face, convulsive fits, severe abdominal pain, persistent vomiting, increase in body temperature, dizziness, difficult breathing and fast heartbeat, the bag of water breaks before the expected date of delivery, increase/ decrease or no movement of your baby and smelly and/ or greenish water from the birth canal. When you experience or see any of these signs, it is important that you visit the nearest hospital for medical care.

Reference
ACOG.org
Obstetrics by ten teachers
http://www.cdc.gov
http://www.who.int
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