Blood pressure and pregnancy: What you need to know

Blood pressure and pregnancy: What you need to know

by: American Heart Association

The risks of high blood pressure during pregnancy extend beyond those nine months, posing significant threats to both mothers and babies. The Centers for Disease Control and Prevention estimates that 9% of women of childbearing age in the U.S. have high blood pressure, and, unfortunately, nearly 41% of those women are not managing it. Almost 17% don’t even know they have it.

Who is at risk

Research shows that structural, institutional and systemic factors contribute to racial disparities in pregnancy outcomes and cardiovascular disease risk. Non-Hispanic Black women face higher risks of pregnancy complications linked to increased heart disease risk than white women. Also, more Black women die from pregnancy-related issues than women from other racial groups.

To better understand how pregnancy problems, race and heart disease risks are connected, researchers are calling for further studies with more diverse groups of people and longer follow-up times.

In a 2023 study of 1.2 million women up to age 49 who gave birth between 1997 and 2016, researchers examined the connection between chronic hypertension and later heart issues. Over an average of nine years, they found that women with high blood pressure before pregnancy had double the risk of cardiovascular problems.

Those with both high blood pressure and complicated pregnancies faced the highest risk. Even compared to women with ongoing high blood pressure but no pregnancy issues, those with both had twice the risk of coronary heart disease. Additionally, women with pregnancy complications but no prior hypertension had a 50% higher risk of future heart problems.

What you and your care team can do

The research shows how important checking blood pressure is for women who can – and plan to – have babies. It also adds to the existing evidence that being pregnant might reveal or speed up heart problems that were already there, said study co-author Fergus McCarthy, a perinatal researcher and senior lecturer in the Department of Obstetrics and Gynecology at University College Cork in Ireland. But, he said, it is unclear whether the complications are due to high blood pressure or if there are additional reasons for the increased risk of heart problems.

“It’s possible that women who have an adverse pregnancy outcome activate several different biologic pathways that might not turn off after pregnancy,” said Dr. Nisha Parikh, an associate professor of clinical medicine at the University of California, San Francisco. “Similar to if you have a heart attack, your physiology isn’t the same after that.” This research emphasizes the importance of health care professionals screening women who are considering becoming pregnant. That way, women can manage their blood pressure before getting pregnant, said Parikh, who was not involved in the research. “Often, women don’t even know they have high blood pressure until they get pregnant and have it measured during prenatal visits,” she said.

Similarly, she mentioned that it’s important to try to stop problems during pregnancy in women who have had high blood pressure before. One way to do this is by giving them a small amount of aspirin early in the pregnancy. Studies have shown that this can help avoid a problem called preeclampsia in women who are at high risk. Preeclampsia is when a pregnant woman develops severe high blood pressure and has protein in her urine after the 20th week of pregnancy.

Because women often delay pregnancy until their later childbearing years, chronic hypertension – which becomes more prevalent as women get older – is a growing problem among new mothers. “It’s not surprising if women give birth at older ages that they would have a higher prevalence of hypertension. Detecting and screening for this is really important,” said Parikh.

Lifestyle choices that can help

There are things women can do to help lower their blood pressure before, during and after pregnancy. According to a 2021 AHA scientific statement about adverse pregnancy outcomes and cardiovascular disease risk, care teams should offer women with a history of pregnancy complications health systems recommendations that could enhance their long-term cardiovascular health as well as improve the health of their future pregnancies. Some options include:

  • Eating well. Establishing healthy eating habits before pregnancy, such as doing the DASH (Dietary Approaches to Stop Hypertension) diet, can help to lower the risk of hypertensive disorders, gestational diabetes and preterm delivery. The DASH eating plan sets goals for daily and weekly intake, focusing on fruits, vegetables, whole grains, lean proteins such as fish and poultry, low-fat dairy, nuts and beans, while restricting saturated fats, sodium, sugar-sweetened beverages and sweets.
  • Moving more. Regular moderate-intensity physical activity during pregnancy and postpartum can promote cardiovascular health. You should aim for at least 150 minutes of moderate-intensity activity a week.
  • Not smoking. Cigarette smoking is bad for both fetal and maternal health. It can cause issues including preterm birth, a low birth weight, obesity, hypertension, Type 2 diabetes, impaired lung function and asthma.
  • Considering breastfeeding. Breastfeeding not only benefits the baby but also promotes recovery from the increased cardiometabolic stresses of normal pregnancy for the mother. The physiological effects of breastfeeding also may reduce long-term cardiovascular risk and protect against breast and ovarian cancers.

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