Even without complications, a new pregnancy can be as frightening as it is exciting. However, if you are going into your pregnancy with medical problems, it can be especially scary. High blood pressure affects many otherwise healthy women of childbearing age, and untreated high blood pressure can be extremely dangerous to a pregnant woman and her unborn child.

Planning A Pregnancy When You Have Chronic Hypertension

If you have been diagnosed with hypertension-- or if you've noticed while checking on your own that your blood pressure is regularly above 140/90-- you should talk to your doctor before trying to conceive if at all possible. Many medications taken for high blood pressure are not safe during pregnancy, and may harm your unborn child if used long term.

There are medicines your doctor can give you that will control high blood pressure while you are pregnant, and if you are going to need it you should start one before you conceive. Your doctor will probably prescribe either methyldopa or labetalol, both drugs that are widely considered to be relatively safe during pregnancy.

Unplanned Pregnancy With Chronic Hypertension

If you found out you were pregnant unexpectedly and you are taking medication for high blood pressure, you need to talk to your doctor as soon as possible. Chances are, the medicine you are taking is not a good choice for a pregnant woman, and your doctor will probably want to change it.

You will probably be referred to a perinatologist-- an obstetrician who specializes in high risk pregnancy-- who can talk about any risk your unborn child may have been exposed to because of the medicine you were taking. Don't worry too much, however. Most of the studies that show risk to unborn children with certain drugs assume the drug is taken throughout an entire pregnancy, and frequently at extremely high doses. The perinatologist will probably be very reassuring. This is how my own pregnancy started, and my daughter came out just fine.

What To Expect In The Beginning of a High Blood Pressure Pregnancy

You will probably start your pregnancy much like anyone else, with all the same discomfort, worries, and symptoms. There is very little you will need to worry about if your blood pressure is up during the first trimester, because at this point your future baby is small enough that it isn't really a danger. If your doctor has you on blood pressure medicine, any side effects you are experiencing will probably go away within a few weeks at the most.

Your obstetrician will probably run a few extra tests to get baselines for when you are further along. You will probably need to take a 24 hour urine test, as well as many of the standard blood tests. You also may have a few extra ultrasounds to make sure your baby is growing well.

Because hypertension during pregnancy is considered a high risk condition, your obstetrician may decide to refer you to a perinatologist either right away or sometime later during your pregnancy. One thing this specialist will be able to do for you, especially later on, is provide level two ultrasounds to make sure your baby is growing well.

While many women go into their pregnancy with chronic hypertension that has already been diagnosed, it is also possible to develope high blood pressure as a result of being pregnant.  Most of the treatment will be the same for either condition, but whether your new high blood pressure will be called chronic hypertension or gestational hypertension depends on when it developes. 

Before 20 weeks, if high blood pressure shows up your doctor will consider it chronic hypertension that has been unmasked because of the added stress pregnancy places on your body.  After 20 weeks, your doctor will consider it gestational hypertension directly caused by your pregnancy.  Either way, the only way to find out if your hypertension will stick around after the baby is born is to wait and see.

You will get more ultrasounds when you have high blood pressure during pregnancy than you thought possible.  By the time I had my full term daughter, I had more than one ultrasound for evey month she was developing.  It was exciting to get to see her grow so much, and something I considered a great upside to help compesate for all the scary parts of having a high risk pregnancy.

All those ultrasounds will happen to make sure your baby is growing well.  Your doctor needs to watch how well blood flows from the placenta to your baby, and make sure your baby's size is where it's supposed to be.

Right about halfway through the second trimester, your doctor will probably begin to increase the amount of monitoring you are getting for your pregnancy. This is because this is when the problems associated with hypertension during pregnancy start to show up. Expect more tests to make sure you're all right, and more ultrasounds and monitoring to make sure your baby is growing well and staying healthy.

Pre-eclampsia

Starting at around 20 weeks, one of the largest risks of having hypertension during pregnancy is the risk of developing pre-eclampsia. There are some things that your doctor will do to monitor you for this disease, as well as some things you need to watch out for. Pre-eclampsia is technically present if your blood pressure gets over 140/90 and you have too much protein in your urine.

When you go to the obstetrician, they should check your blood pressure and make sure it is under 140/90. If it gets above this number suddenly and stays there, you will probably need to go to the hospital for further testing. The nurse should als give you a small pee test to check the amount of protein in your urine. If your protein is too high on this test, they will send you home with another 24 hour test, unless your blood pressure is also high, at which point you should really be evaluated at a hospital.

If you end up diagnosed with pre-eclampsia, your obstetrician will work to keep your baby inside as long as it can be done safely.  Unfortunately, this is rarely more than a few weeks, though there are exceptions.  You will probably end up at the hospital being carefully monitored.  If you are close to full term, your doctor might think it is a good idea to induce labor right away.

Pre-eclampsia Symptoms

There are some symptoms of pre-eclamspia you may have at home that warrant a call to your doctor:

Blood Pressure that goes up higher than usual and stays there. You should be checking your blood pressure twice a day with a home blood pressure monitor. If your blood pressure starts to go up and stays there for the next reading, tell your doctor right away.

An unusual amount of swelling. Pregnancy causes a lot of people to swell. You should tell your doctor right away if it is more than usual, or in your face.

A headache that won't go away when you take medicine. Get seen quickly if your headache is bad or you have light sensitivity.

Sudden onset vomiting in the second or third trimester. Tell your doctor right away so you can get your blood pressure and urine protein checked.

Vision trouble. If you are having any sort of visual strangeness, like blurred vision or flashing lights, consider it an emergency. Get seen by your doctor right away, and if you can't get your doctor, go to the hospital.

Pain in your right shoulder or stomach. Call your doctor right away, this may also be an emergency.

Placental Abruption

High blood pressure increases your risk of a placental abruption, which is the term for the placenta separating from the uterine wall. If your blood pressure is controlled, it is much less likely that this will happen, but you should still be aware of the signs and symptoms since hypertension during pregnancy can rise without warning.

If you think you may be experiencing any of the signs of placental abruption, you need to get to a hospital as soon as possible. This problem can frequently put both you and the baby in danger very quickly, and needs to be considered an emergency.  Here are some things you should watch out for if you are further than 20 weeks along.  A placental abruption can cut off blood and oxygen to your baby, so don't put off care.  Because your high blood pressure increases the risk that this could happen, it is much safer for you and your baby.

Symptoms of a placental abruption:

Vaginal bleeding.  If you notice vaginal bleeding after 20 weeks, you need to get seen in a hospital.  The amount of blood doesn't matter.

Abdominal pain.  Abdominal pain should always be reported to a doctor, but if it is severe and shows up suddenly you should go to the hospital.

Back pain.  Like the abdominal pain, if it is severe and sudden, go to the hospital.

Rapid contractions.  Rapid uterine contractions or a feeling of tenderness in your uterus where it usually feels hard can indicate a placental abruption.

Having high blood pressure during pregnancy can make it feel like your outcome is completely out of your control, especially with such dangerous potential complications waiting around every turn.  There are some things you can do to increase your chance of having a healthy full term baby, however.

Monitor Your Own Blood Pressure

Get a blood pressure cuff to use at home.  They are cheap, easy to find, and may even be covered by your insurance.  Check your blood pressure twice a day and write it down.  Take the record to every doctor's visit.

Walk Every Day

Once you would have been placed on bed rest at the drop of a hat for having a high risk pregnancy, but modern studies have shown that the women with the best outcomes are the ones who get regular light exercise.  The ideal amount is about half an hour of comfortable walking each day.

Eat A Healthy Diet

High blood pressure or not, the better you eat, the better your baby will do.  This includes taking regular pre-natal vitamins and avoiding stuff like large amounts of caffeine, soda, and junk food.  Well, as much as possible.  You are pregnant, after all.

Ask Your Doctor Questions

Be in control of your medical care.  Ask your doctor what the tests mean, what the numbers are supposed to be, what your blood pressure reads, and anything else you can think to ask.  The more you know, the more likely you are to recognize it if something goes wrong in time to save your baby.

Relax and Enjoy Your Pregnancy

Having a high risk pregnancy makes it hard to take the kind of joy in being pregnant that most people take for granted.  Don't let yourself get so caught up in medical issues that you forget to enjoy the experience of being pregnant.  Growing a baby is a big, important thing, and you should let yourself enjoy it as much as possible.