Recent research supports obstetric efforts to treat hypertension before or during the early stages of pregnancy to reduce health impacts on mom and baby.
High blood pressure, or hypertension, is the term used to describe the force of blood as it moves through your arteries and vascular system. Blood pressure that is too high damages the lining of delicate vessels. As dietary fat streams through the bloodstream, it can collect in and around damaged tissue in blood vessels and arteries, lead to loss of elasticity and narrowing of the vessel. Damaged blood vessels can cause stroke, heart disease, aneurysm, and contribute to other chronic conditions like dementia and major organ damage.
There are several types of hypertension, including chronic hypertension, and hypertension that occurs during pregnancy. When pregnant, a woman may suffer a sudden rise in blood pressure called preeclampsia, usually around the last three months of pregnancy, or even after delivery. Preeclampsia is a serious pregnancy complication for both mom and baby. Gestational hypertension begins earlier in a pregnancy and may escalate to preeclampsia as the months pass.
Hypertension is dangerous to the mother and the child she carries. Untreated hypertension reduces blood flow to the placenta, depriving the developing fetus of nutrients and oxygen. This slowed growth of the fetus is called intrauterine growth restriction (IUGR). Hypertension can be a factor in the abruption of the placenta from the uterine wall—causing chronic or heavy bleeding that can be life threatening to baby and to mom.
Hypertension during pregnancy is a major cause of maternal and fetal morbidity. Women who suffer hypertension during their pregnancies may be at higher risk of cardiovascular disease in later life.
Sometimes a physician caring for a pregnant women may not recognize, or dismiss potentially damaging blood pressure readings. A recent study using data from the Chronic Hypertension and Pregnancy (CHAP) trial evaluated whether blood pressure targets recommended for non-pregnant adults are safe and effective for pregnant women and their babies.
The study is the largest trial currently exploring hypertension in pregnancy, using data from 2400 pregnant women from 61 medical facilities in the US between 2015 and 2021. Study authors defined hypertension as systolic blood pressure of 140 over diastolic blood pressure of 90. Normal adult readings are 120/80. Divided into two groups, each participant was enrolled prior to 23 weeks of pregnancy and followed until post-partum six weeks. One group received medication to control blood pressure at 140/90, while the other group received medication if their blood pressure rose to 160/105.
The findings offer good news for more standardized treatment of women who suffer hypertension during pregnancy. Approximately 70 percent of those receiving medication suffered no serious pregnancy outcome. Of those receiving medication at the lower blood pressure range, 30 percent suffered serious impacts from hypertension including placental abruption, preeclampsia with severe features, preterm birth, and fetal or neonatal death—compared to 37 percent in the control group. Additionally, the medication did not affect birth weight. Noting additional clinical trials to come, the authors suggest “a lower treatment threshold than currently proposed by the ACOG has the potential to decrease serious hypertensive end-organ complications.
The research also states “the United States has one of the highest hypertension-related maternal mortality rates and increasing maternal morbidity and mortality from cardiovascular conditions and cerebrovascular accidents” among high-income countries. A change in practice standard may help address the disability and death caused by ineffective treatment of hypertension during pregnancy.
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