By Brittany Berens, DO, Obstetrics & Gynecology
OB Hospitalist, Blanchard Valley Hospital

Hypertensive disorders in pregnancy (HDP) account for 32% of maternal deaths in the United States, according to the Centers for Disease Control and Prevention (CDC). One in seven hospital deliveries may be affected by this complication of pregnancy. What are these disorders? How are they managed during and after pregnancy? Can a person do anything before becoming pregnant to decrease their risk factors?

First, let’s examine what is considered high blood pressure. Normal blood pressure is less than 120/80. High blood pressure is greater than 140/90. 

There are different types of HDP. Chronic hypertension is a diagnosis of hypertension that is present before the person becomes pregnant. It can also be diagnosed if elevated blood pressures are found before 20 weeks of gestational age. Gestational hypertension is the diagnosis of hypertension that is made after 20 weeks of gestational age. 

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The diagnosis of preeclampsia is made after 20 weeks of gestational age when the pregnant person has gestational hypertension and protein in their urine. Preeclampsia with severe features is when the pregnant person has high blood pressure plus a “severe symptom.” These include lab evidence of liver or kidney dysfunction, neurologic changes like unrelenting headache and vision changes, or heart or lung dysfunction. Alternatively, the pregnant patient can be diagnosed with this disorder if their blood pressure is greater than 160/110. 

The last disorder is eclampsia. This is when the person has high blood pressure and has a seizure. 

Hypertension in pregnancy is a special set of disorders because it involves more than just hypertension. We know that hypertension can ultimately damage blood vessels like those in the placenta. HDP also includes neurologic, kidney, liver, and cardiopulmonary dysfunction. It is this entire syndrome that is dangerous for the patient and the fetus. 

The point in the pregnancy when high blood pressure is noted will help determine the patient’s diagnosis. Any pregnancy complicated by HDP is considered high risk. Therefore, extra monitoring will be performed for the patient and the fetus. This plan is developed with the patient’s healthcare provider and usually involves things like checking blood pressure at home, extra ultrasounds, and monitoring the patient’s bloodwork. The specific type of hypertensive disorder in pregnancy and the clinical situation of the individual patient will determine if the patient needs to deliver before their due date. 

Despite the name, the chances of developing hypertensive disorders in pregnancy can be influenced by factors that are present before becoming pregnant. Pre-existing conditions like diabetes, lupus, and kidney disease are risk factors. Other risk factors are elevated BMI, age over 35, or carrying twins. However, there is no way to prevent HDP. These disorders can also impact a person’s health long after their pregnancy. Patients with preeclampsia are at risk of having hypertension, kidney disease, heart attack, and stroke in the future. 

It is recommended that any person planning to become pregnant see their healthcare provider for a routine checkup, especially those with preexisting chronic hypertension. Before pregnancy, the patient and their healthcare team can work to optimize their blood pressure and overall health. This can help decrease the risk of developing a hypertensive disorder in pregnancy.