High Blood Pressure During & After Pregnancy: What To Know About Preeclampsia

Preeclampsia is one of the most common conditions that can arise during and after pregnancy and can lead to severe outcomes. Learning to spot the signs and symptoms can help patients get the care they need and reduce the risk of preeclampsia-related complications.

High blood pressure & pregnancy

High blood pressure can manifest in different ways during pregnancy. Some people have chronic hypertension which means they have high blood pressure when they enter pregnancy, or they are diagnosed before 20 weeks of gestation.

Those with gestational hypertension have high blood pressure that develops in the second half of pregnancy, after 20 weeks.

Preeclampsia impacts between 5 and 7% of the obstetrical population and can occur after 20 weeks of gestation as well as during the postpartum period. The diagnosis includes elevated blood pressure in addition to symptoms or abnormal blood and urine tests.

Preeclampsia

Symptoms of preeclampsia can include:

• Headache
• Abdominal pain
• Changes in vision

Preeclampsia most commonly occurs in the third trimester and around the time of delivery, which is why prenatal visits increase in frequency towards the end of pregnancy. Many people are not aware that preeclampsia can also happen after birth. Monitoring for signs of preeclampsia is just as important after birth as it is before birth.

According to Annalies Denoble, MD, MSc, obstetrician-gynecologist, Yale New Haven Health; co-director Yale Cardiovascular Disease and Pregnancy Program and assistant professor of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, “one of the first signs that preeclampsia is developing is new high blood pressure. Whether it’s during pregnancy or after birth, teaching patients to monitor their blood pressure at home is one way we can try to catch preeclampsia early and keep new and expecting parents safe.”

This is why Yale New Haven Health developed the MITEY (Maternal In-Reach Team for Equity) postpartum remote blood pressure monitoring program, which empowers new parents to monitor their own health at home. In addition to home blood pressure monitoring, new parents meet with clinicians who can start and adjust blood pressure medications through telehealth visits. They also learn more about the warning signs of preeclampsia.

Risk factors for the development of preeclampsia can include chronic hypertension, obesity, age, use of assisted reproductive techniques such as IVF, multiple pregnancy, and a history of preeclampsia. Yet many patients who develop preeclampsia have no underlying risk factors.

The only “treatment” for preeclampsia is delivery of the baby and placenta. While preeclampsia cannot be completely prevented, there are some things patients can do to positively impact their health.

Addressing high blood pressure during pregnancy

Chronic hypertension can be managed with regular clinician visits, healthy lifestyle changes and initiation of blood pressure medication when needed. Lifestyle changes can include eating a healthy diet, decreasing salt intake, exercising regularly throughout pregnancy, and establishing healthy sleep patterns. Many blood pressure medications are well studied and are safe to take in pregnancy and during breastfeeding.

Patients at increased risk of preeclampsia are advised to take a baby aspirin starting after 12 weeks until they are full term at 37 weeks. Aspirin has been shown to lower the risk of developing preeclampsia and may delay the onset of it.

Patients may also benefit from increased surveillance or hospitalization. For those with high risk of eclampsia, a severe complication of preeclampsia, magnesium sulfate may be prescribed. It is a salt given in an IV in a highly monitored hospital setting that has been shown to reduce the risk of seizures, one of the dreaded complications of preeclampsia.

Planning for a pregnancy after preeclampsia

Most patients who have preeclampsia are low risk patients so it's usually surprising to them when they develop it.

According to Dr. Denoble, “Preeclampsia can be a really scary diagnosis, especially when someone has had a complication like a seizure or preterm birth. When a patient and their family have experienced this condition before, we try to work closely with them to develop a plan to prevent preeclampsia or recognize its signs early in a future pregnancy.”

Patients with a history of preeclampsia who want to plan for another baby benefit from meeting with a maternal-fetal medicine specialist to review their obstetrical history and see if anything needs to be done to lower risk. For example, someone who developed preeclampsia who continues to have high blood pressure after delivery may have chronic hypertension. In that scenario, it’s important for their chronic hypertension to be managed and for that patient to have regular check-ins with a health care provider.

“We also now know that patients who have experienced preeclampsia in a pregnancy have a higher chance of developing heart disease in the future. The postpartum period can be an opportunity for patients to learn more about their risk of heart disease and to find out what they can do to lower that risk,” says Dr. Denoble. Regular check-ins with a primary care provider or cardiologist after a pregnancy affected by preeclampsia can empower patients to improve their long-term health.