High Blood Pressure and Pregnancy: What Expecting Moms Need to Know

Women who are pregnant or who plan to have children need to pay close attention to their blood pressure – before, during and after pregnancy, according to Heather Johnson, M.D., a preventive cardiologist with the Christine E. Lynn Women’s Health & Wellness Institute in Boca Raton, part of Baptist Health South Florida.

This has always been the protocol for expecting moms at Lynn Women’s Institute, Dr. Johnson says, but it is even more important now in light of new draft recommendations from the U.S. Preventive Services Task Force, which expressed concern about a rise in maternal mortality among pregnant women in America – particularly among women of color.

“Pregnancy-related deaths in the United States are the highest among industrialized nations, and hypertensive disorders of pregnancy are among the leading causes,” writes Roni Caryn Rabin in a recent article in the New York Times. “Blood pressure disorders in pregnancy have doubled in prevalence in the past three decades, affecting one in 10 pregnancies now, up from one in 20 in 1993.”

According to the article, such disorders pose a high risk of stroke to Black and Hispanic women. “These disorders are a leading cause of death during and after pregnancy among Native American women and the leading cause of death among Black women,” Ms. Rabin says, adding that the Task Force found that these groups face maternal mortality rates “up to three times as high as those among white women.”

At Lynn Women’s Institute, Dr. Johnson says the goal is to care for all women across the entire age spectrum. “We recognize women are often busy caring for others and not focusing on themselves,” she says, adding that heart disease is under-detected in women. “It’s one of the more common misdiagnoses so we strive to make sure every woman is aware of their heart health.”

Heather Johnson, M.D., preventive cardiologist with the Christine E. Lynn Women’s Health & Wellness Institute in Boca Raton

Women have more subtle symptoms when it comes to heart disease, including fatigue, shortness of breath, or gastro-intestinal symptoms such as nausea. “They may walk away with a diagnosis of anxiety, asthma or indigestion and be told to get more rest,” Dr. Johnson says. “We want to make sure that all women are aware of their risk for heart disease, including expecting moms at Toppel Family Place [Boca Raton Regional Hospital’s maternity center].”

Cardio-obstetrics – decreasing the risk of high blood pressure (HBP) and heart failure and other cardiovascular effects related to high blood pressure – is an emerging field that focuses on the collaborative care of women during pregnancy and postpartum, according to Dr. Johnson.

“Our goal is to understand women who are at risk for pre-eclampsia or eclampsia and decrease their risk of heart failure and hospital readmission,” she says. “But pregnant or not, we help women of all ages identify their individual risks in relation to heart disease.”

Pre-eclampsia and other risks of HBP

Women who become pregnant already having HBP or who develop HBP during the first 20 weeks of pregnancy are said to have chronic HBP, Dr. Johnson explains, while those who develop the condition after 20 weeks of pregnancy are said to have gestational HBP.

Close attention is paid to expecting mothers’ blood pressures because high blood pressure, or HBP, can lead to pre-eclampsia. “This is where we begin to see excess protein in the urine, swelling and other issues,” Dr. Johnson says. “If left untreated, it can progress to eclampsia, a medical emergency that can result in seizures, coma and heart failure, posing great danger to both mother and child.”

Women who may not be at their goal weight or who are overweight or have diabetes when they become pregnant are at a much higher risk for developing HBP during pregnancy, Dr. Johnson says. She adds that HBP during pregnancy may be a predictor of developing HBP in the future, as well as a predictor of abnormal arteries within the body.

“Pregnancy is like a nine-month stress test for your cardiovascular system,” Dr. Johnson says. “When we see abnormal or elevated blood pressure during pregnancy, that tells us there may be artery changes which, down the road, can be associated not just with HBP but also an increased risk for heart attack or stroke.”

For women who may already be on medications for HBP before pregnancy, Dr. Johnson says they may need to be transitioned to safer medications during pregnancy. “Also, some women may have borderline HBP before becoming pregnant but aren’t on medication, so we watch them closely and if needed we can start them on medications during pregnancy,” she adds.

Keeping an eye on blood pressure

Monitoring the blood pressure of expecting moms throughout their pregnancy is critical, Dr. Johnson stresses, and that doesn’t end the day the baby is born. During delivery and the mother’s hospital stay, Dr. Johnson says a team of specialists is there for both mother and baby every step of the way.

“It really is a team approach, with the obstetrician, fetal medicine specialists, cardiologists and sometimes critical care teams all working together in supporting the care of the patient,” Dr. Johnson notes. Then, once mother and baby go home, she says nurses and patient navigators from Toppel Family Place and Lynn Women’s Institute reach out to offer information and answer questions.

A primary cause of hospital readmission

Dr. Johnson says new mothers must be extra-vigilant about checking their blood pressure once they get home, as some women are at risk for developing postpartum HBP, a condition that can occur even in those patients who didn’t have elevated blood pressures during pregnancy.

“In the days and weeks after the baby is born, we want to see the mother’s blood pressure drop back down to more normal levels – below 140/90,” Dr. Johnson explains. “For some patients, that doesn’t happen and for others, their blood pressure may increase dramatically after delivery,” Dr. Johnson explains, adding that postpartum HBP is one of the primary causes of hospital readmission for new mothers.

New mothers are educated on the warning signs that could indicate HBP or perhaps something more serious, she continues. “Symptoms such as swelling, headaches, vision changes, shortness of breath or dizziness are common with HBP,” says Dr. Johnson. “If you’re experiencing any of these symptoms during or after pregnancy, contact your OB and get yourself to the emergency department immediately. Do not wait.”

In addition to keeping a close eye on their blood pressure, Dr. Johnson advises expecting moms to embrace a heart-healthy lifestyle. “That starts with a lower sodium diet, which plays a huge role in helping stabilize and lower your blood pressure,” she says. “During pregnancy, your body naturally retains more fluid so a lower sodium diet can help with that, too.”

Dr. Johnson strongly urges a preconception visit for women who have HBP, diabetes or high cholesterol and are therefore at high risk for developing pre-eclampsia or eclampsia during their pregnancy. She also says new research holds promise for some women who are at risk for experiencing pre-eclampsia during pregnancy.

“Recent studies have shown that aspirin therapy can help decrease the risk of pre-eclampsia and eclampsia in select women,” Dr. Johnson says. “Only your OB can determine if you would benefit from aspirin therapy, however. Do not just start taking aspirin on your own without first checking with your OB.”

Getting back to pre-pregnancy weight is key

Once the baby has been delivered, Dr. Johnson says it’s important for new moms to lose those pregnancy pounds and get back to their pre-pregnancy or goal weight. “Weight loss after pregnancy is key. Retaining weight one year after pregnancy has been shown to increase blood sugar and it can also contribute to high blood pressure and a higher risk of heart disease down the road,” she says.

Among the most important things a new mom can do – aside from caring for their new baby, of course – is to take care of themselves, Dr. Johnson says. “That means snapping back to preventive healthcare mode, getting checked for cholesterol and diabetes in addition to your regularly scheduled screenings, and embracing a heart-healthy lifestyle,” she says.