Monitoring Blood Pressure During Pregnancy

Ans: About 7% to 10% of pregnant women experience
what is called pregnancy induced hypertension (PIH), a condition in which the
mother can have elevated levels of blood pressure. In India, the incidence of
preeclampsia is reported to be 8% to 10% among the pregnant women.
According to a study, the prevalence of hypertensive
disorders during pregnancy
was 7.8% with preeclampsia in 5.4% of the study population in India.

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2. What are the factors that increase the risk of PIH
during pregnancy?

Ans:
The risk of developing PIH is higher in
those women who suffer from certain medical conditions and health factors. Some
predisposing factors include

• First
  pregnancy
• Women
  older than 40 years of age
• Pregnancy
  interval of more than 10 years
• Body mass index (BMI) equal to or more than 35 at first visit
• Family
  history of pre-eclampsia
• Multiple
  pregnancies

3. Women besides limiting salt and doing gentle exercises,
is there anything else pregnant can do to limit the risks of hypertension?

Ans: There are some steps women can take to avoid the risk
of developing hypertension during pregnancy. These are also true for those with
an existing history of hypertension. Some of them are as follows.

Be aware
of the symptoms – it is important to be aware of the symptoms of
PIH and pre-eclampsia such as,
severe headache; visual problems like blurring or flashing before the eyes;
severe pain just below the ribs; vomiting; and sudden swelling of face, hands
or feet.

Consuming
anti-platelet drugs – With the advice of the doctor, make sure to take
75 mg aspirin daily from 12 weeks onward till the birth of the baby.

Some of the drugs and nutritional supplements were
earlier said to have a role in prevention of hypertensive disorders during pregnancy.
However, according to the latest guidelines, this below mentioned list does not
have a proven role

• Progesterone
• Diuretics
• Low
  molecular weight heparin (lmwh)
• Magnesium
• Folic
  acid
• Antioxidants
  (vitamin C, E)
• Fish oil
• Garlic

Do not recommend salt restriction – There are
ample number of studies which support that salt restriction has no role in
prevention or management of pregnancy induced hypertension.

4. Why are pregnant women with
PIH at a higher risk for heart disease later in life?

Ans:

This is due to the disturbances in the normal
functioning of the heart, for instance, increase in pre-load and after-load of the heart and
endothelial activation. These continue even after pregnancy in milder form in
patients with PIH.

5. Can PIH affect the growing fetus? What are ways to
prevent damage to fetus?

Ans: Women with PIH develop a resistance in their blood
vessels, which affects the blood flow throughout the body including that to the
placenta and uterus. This further
leads to problems with the growth of the fetus. PIH can also cause premature
detachment of the placenta from the uterus, affect the oxygen flow to the
placenta, or even lead to stillbirth. It is, therefore, important to detect and
treat this condition on time to avoid complications such as pre-term birth,
seizures, heart diseases later in life, or even death of the mother and the
baby. Fetal damage can be minimized with anti-hypertensive drugs, keeping blood
pressure under control, and routine Doppler ultrasounds.

6. Can PIH increase labor complications?

Ans: PIH can increase the risk of preterm births and infant
respiratory distress syndrome. If not detected and treated on time, it can even
cause maternal or infant mortality and morbidity.

7. What are the precautionary steps to prevent PIH
before pregnancy?

Ans:



The following precautionary measures can help prevent
PIH before pregnancy.

• It is important to ensure
  preconception checkup. Those with pre-existing hypertension and diabetes should keep both these parameters under
  control. If you weigh on the higher side, take steps to lose weight.
• It is good to indulge in
  physical activity even during pregnancy, with tips from your doctor. This is
  also important for those women who are trying to conceive. Lose that extra
  weight to avoid the risk of acquiring hypertension.
• Make sure that you
  consume healthy food and avoid processed foods in any form.

What are Symptoms of Pregnancy
Induced Hypertension?

Some of the
characteristic symptoms of PIH include –

• High blood pressure levels in the second
  and third trimester
• Excretion of protein in urine
• Unusual weight gain not related to
  pregnancy
• Blurred or double vision
• Vomiting and nausea
• Abdominal pain and discomfort
• Frequent urination
• Blood in urine
• Increase in heart rate
• Abnormal liver function test (LFT) and kidney function test (KFT)
• Buzzing sound in the ears
• Edema
• Fever

Role of Ambulatory Blood Pressure Monitoring for blood pressure during pregnancy &
Follow Up with General Practitioners

Dr Nandita Palshetkar, Medical Director, Bloom IVF
said, “It is imperative to
monitor fluctuations in blood
pressure during pregnancy, since not all of it can be attributed to PIH. Post
delivery, the blood pressure levels
should be monitored through ambulatory blood pressure monitoring (ABPM)
regularly. This method is more accurate in detecting blood pressure fluctuations over 24
hours and helps in taking readings on the move.

She further added that, “Women with PIH must take
adequate bed rest. In case of consistently high readings, hospitalization for
constant fetal monitoring might be needed. Many women do not take follow up
precautions post-pregnancy, particularly in monitoring blood pressure levels. Women should
follow up with their primary care doctors after giving birth as this will help
prevent the risk of heart complications later in life.”

Reference :

1. Gestational Hypertension: Pregnancy Induced Hypertension (PIH) – (http://americanpregnancy.org/pregnancy-complications/pregnancy-induced-hypertension/)

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Source: Medindia