High Blood Pressure Medication in Pregnancy

High blood pressure can attack women before pregnancy and during pregnancy. Pregnant women who already have high blood pressure (hypertension), since and before becoming pregnant, need special treatment from a doctor. Here are some types of hypertension in pregnancy:

• Gestational hypertension. Occurs after 20 weeks of pregnancy. There is no excess protein in the urine or signs of organ damage. Some women with gestational hypertension usually experience preeclampsia.
• Chronic hypertension. Occurs before pregnancy or before 20 weeks of pregnancy. Because it does not have specific symptoms, this high blood pressure may be difficult to know in the beginning.
• Chronic hypertension with preeclampsia. This condition occurs in women with chronic high blood pressure before pregnancy. High directional pressure deteriorates and protein in the urine and other health complications are found during pregnancy.
• Preeclampsia. In some cases, chronic hypertension or gestational hypertension can turn into preeclampsia. Preeclampsia is a complication of pregnancy characterized by high blood pressure and signs of damage to other organ systems, usually after 20 weeks of pregnancy. If left untreated, preeclampsia can cause serious, even fatal, disorders for the mother and baby. In the past, preeclampsia was only diagnosed if pregnant women had high blood pressure and there was protein in their urine. However, a recent study found that pregnant women remain at risk of developing preeclampsia even though no protein is found in their urine.

High blood pressure during pregnancy risks causing the following conditions:

• Reduced blood flow to the placenta. If the placenta does not get enough blood, the baby will lack oxygen and nutrients. As a result, the baby's growth slows, the weight shrinks, or is at risk of premature birth. Prematurity can cause respiratory problems for babies.
• Placental abruption. Preeclampsia increases the risk of placental abruption, the condition of detachment of the placenta from the uterine wall before labor. Severe abruption can cause severe bleeding and damage to the placenta which can threaten the safety of the mother and baby.
• Premature birth. Because of medical reasons, preterm birth needs to be done to prevent complications that can be life threatening.
• Cardiovascular disease. Preeclampsia increases the risk of heart and blood vessel disease (cardiovascular) in the future. This risk will be greater for pregnant women who have experienced preeclampsia more than once or have had premature labor. To minimize this risk, try to maintain ideal body weight after giving birth, consuming fruits and vegetables, exercising regularly, and avoiding cigarettes.
• Preeclampsia sometimes appears asymptomatic. High blood pressure as a symptom of preeclampsia may come slowly but more often attacks suddenly. Make sure you always monitor blood pressure during pregnancy because the initial symptoms of preeclampsia are generally an increase in blood pressure. Check blood pressure by taking two samples with an interval of 4 hours. The abnormal range of blood pressure is at a mercury level of 140/90 millimeters (mm Hg) or more.

Other symptoms of preeclampsia include:

• Excessive protein found in urine (proteinuria) or signs of kidney disorders
• Severe headache
• Vision problems, including loss of temporary vision function, blurred vision, or light sensitivity
• Upper abdominal pain, usually below the right rib cage
• Nausea or vomiting
• Decreasing the amount of urine
• Decreased platelet count in blood (thrombocytopenia)
• Liver disfunction
• Shortness of breath, which is caused by the presence of fluid in the lungs

Short-term weight gain and swelling (edema) in the face and hands are thought to be symptoms of preeclampsia. But this one symptom cannot be used as a benchmark because many pregnant women with healthy medical conditions experience these symptoms.

Medications consumed during pregnancy can affect the development of the baby. Although considered safe, some blood pressure-lowering drugs such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and renin inhibitors, should generally be avoided during pregnancy.

However, treatment is still important. The risk of heart attack, stroke, and other problems associated with high blood pressure does not just disappear during pregnancy.

If needed, the doctor will prescribe the safest medicines at the right dosage. Therefore, make sure you take the drug according to the rules of use. Do not stop taking medication or adjust your own dosage.

You can also meet with medical staff and other health teams, such as family doctors or cardiologists. Doctors and experts will evaluate how well the mother controls high blood pressure and recommends further treatment that may need to be done before pregnancy. For those who are overweight, your doctor may recommend you go on a diet before becoming pregnant.

During pregnancy, it's natural that you will go back and forth to visit health services. At each visit, your weight and blood pressure will be checked, even blood and urine tests will also be done more often.

While for babies in the womb, doctors will often do an ultrasound to monitor the growth and development of the baby, for example by recording the fetal heart rate. Your doctor may recommend that you monitor the active movements of your baby everyday.

Caring for yourself is the best way to care for babies, for example in the following ways:

• Perform a routine health check. Visit your doctor regularly during pregnancy.
• Take blood pressure medications as recommended by your doctor. The doctor will prescribe the safest drug in the most appropriate dose.
• Stay active. Follow the various physical activities recommended by the doctor.
• Eat healthy food. Choose low-sodium foods.
• Know self limits. Avoid cigarettes, alcohol and illegal drugs. Consult with a doctor before taking certain medicines.

Although various studies have been conducted, so far the researchers have not found the most effective way to prevent preeclampsia. The doctor may give daily low-dose aspirin (between 60-81 milligrams) starting at the end of the first trimester if the mother had previously had a preterm labor (before 34 weeks' gestation), or several times had preeclampsia in a previous pregnancy.

To avoid complications, the doctor may recommend induction of labor a few days before the date of birth prediction. Induction may be needed earlier if the mother shows symptoms of preeclampsia or other complications. In the case of severe preeclampsia, the doctor will give medication during labor to help prevent seizures. Does not rule out the possibility of a caesarean section.

After the baby is born, mothers are encouraged to breastfeed even if they have high blood pressure or even are on medication. Discuss adjustments to drug dosages and alternative blood pressure medications with your doctor. The doctor may advise the mother not to breastfeed shortly after taking medication.

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