Preeclampsia and High Blood Pressure During Pregnancy - Treatment Overview

Treatment Overview

If your blood pressure begins to rise during pregnancy, you will need close monitoring until after your baby is born. Your blood pressure may remain mildly elevated (transient hypertension), which is not considered dangerous for you or your fetus. However, it can become dangerous if it turns out to be a sign of preeclampsia or if it progresses to more severe high blood pressure (hypertension).

High blood pressure (hypertension) during pregnancy

If you have high blood pressure during your pregnancy, your treatment will include:

• Close monitoring by a doctor for signs of preeclampsia.
• A balanced diet, mild aerobic exercise, and possibly blood pressure medicine. Management with a balanced diet and mild aerobic exercise (such as walking) may be sufficient treatment for high blood pressure during pregnancy. Some women with ongoing (chronic) high blood pressure stay on antihypertensive medicine but are prescribed a lower dose during pregnancy if their blood pressure improves.

Mild high blood pressure in pregnancy usually only requires close monitoring. If you have high blood pressure that is rapidly increasing or has reached moderately high levels (above 140/105 mm Hg, or millimeters of mercury), you may be treated with blood pressure medicine.

Severe high blood pressure (higher than 160 mm Hg systolic or 110 mm Hg diastolic) can result in poor fetal growth (intrauterine growth restriction) and is likely to be treated with an antihypertensive medicine.

Some high blood pressure medicines are dangerous during pregnancy.¹⁷ If you take high blood pressure medicines, talk to your health professional about the safety of your medicine before you become pregnant or as soon as you learn you are pregnant. Make sure that your health professional has a complete list of all medicines that you are taking.

Preeclampsia and eclampsia

If you show any signs of preeclampsia, you will be closely monitored, either with frequent office visits or in the hospital. The goal of treatment is to prevent preeclampsia from becoming life-threatening to you and your fetus while prolonging the pregnancy long enough for your fetus to be mature and healthy at birth.

Your treatment will last for the rest of your pregnancy, your delivery, and your first postpartum weeks and will depend on how severe your condition is. Treatment options include an anticonvulsant medicine; blood pressure medicine if your blood pressure is dangerously high; and delivery, which is the only known "cure" for preeclampsia.

• For mild preeclampsia that is not rapidly getting worse, you may only have to reduce your level of activity, monitor how you feel, and have frequent office visits and testing.
• For moderate or severe preeclampsia, or for preeclampsia that is rapidly getting worse, you will require hospitalization, where expectant management typically includes bed rest, medicine, and close monitoring of you and your fetus. Severe preeclampsia or an eclamptic seizure is treated with magnesium sulfate. This medicine can stop a seizure and can prevent seizures. If you are near delivery or have severe preeclampsia, your doctor will plan to deliver your baby as soon as possible.
• If your condition becomes life-threatening to you or your fetus, magnesium sulfate to prevent seizure and delivery are the only treatment options. If you are less than 34 weeks pregnant and a 24- to 48-hour delay is possible, you will likely be given antenatal corticosteroids to speed up fetal lung development before delivery.

After childbirth

If you have moderate to severe preeclampsia, your risk of seizures (eclampsia) continues for the first 24 to 48 hours after childbirth (in very rare cases, seizures are reported later in the postpartum period). You will therefore continue magnesium sulfate for 24 hours after delivery.¹

Unless you have chronic high blood pressure, your blood pressure is likely to return to normal a few days after delivery. In rare cases, it can take 6 weeks or more. Some women still have high blood pressure 6 weeks after childbirth yet return to normal levels over the long term. If your diastolic blood pressure reading (the lower, second number) is still over 100 mm Hg when you leave the hospital, you will likely be prescribed a high blood pressure medicine.¹ You will then have regular checkups with your health professional to monitor your recovery.

Taking high blood pressure medicine while breast-feeding

There are several commonly used high blood pressure medicines that have no reported effects on the breast-feeding baby. These medicines include labetalol and propranolol, which are most commonly recommended, as well as hydralazine and methyldopa. Nadolol, metoprolol, and nifedipine are detectable in mothers' milk, but they have no known effects on the breast-feeding baby.¹⁸

What To Think About

To prepare for a talk with your doctor or nurse-midwife about your condition, see questions to ask your doctor about high blood pressure and pregnancy.

Anticonvulsant medicine

Moderate or severe preeclampsia or an eclamptic seizure is treated with intravenous magnesium sulfate to prevent seizures. For mild preeclampsia, magnesium sulfate is sometimes used to prevent seizures (eclampsia). Research has not yet clarified whether magnesium sulfate is beneficial or needed for the treatment of mild preeclampsia.^{9, 19}

High blood pressure medicine

Lowering blood pressure with medicine:

• Does not prevent preeclampsia from getting worse, because high blood pressure is only a symptom of the condition, not a cause.
• Can reduce blood flow to the placenta if blood pressure is lowered too rapidly, causing problems for the fetus. Medicine is therefore reserved for preventing severely high blood pressure levels that are potentially life-threatening to you or your fetus.

Delivery

A vaginal delivery is usually safest for the mother and is attempted first if she and the baby are both stable. If preeclampsia is rapidly getting worse or fetal monitoring suggests that the baby cannot safely handle labor contractions, a cesarean section (C-section) delivery is needed.

Ongoing issues

Preeclampsia usually does not cause long-term problems. Healthy habits, such as regular exercise and eating a healthy diet, may help prevent future health problems. If you have had preeclampsia, talk to your doctor about what you can do to stay healthy.