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Hypertension in Pregnancy

What is hypertension?

Hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 160/110 during pregnancy.

Can people with hypertension have a normal pregnancy?

Yes. Most people with high blood pressure will have a normal pregnancy.

If I have hypertension, is there anything I need to do before I become pregnant?

Yes. You should work with your healthcare provider to control your blood pressure before becoming pregnant. This may involve changing your medication to one that is safe to take during pregnancy.

Can hypertension cause pregnancy complications?

Women with hypertension can develop preeclampsia (a condition with hypertension that can also affect other organs), preterm birth, miscarriage, stillbirth, growth problems for the baby, and placenta abruption (when part of the placenta detaches from the uterus).

Can hypertension cause birth defects?

Yes. People with hypertension have a higher risk for having babies with heart and other birth defects.

What kinds of tests are recommended during pregnancy for women with hypertension?

Your healthcare providers will follow the health of you and your developing baby closely during the pregnancy. They will talk with you about the correct screening tests for your pregnancy. Some screening options that might be discussed are:

  • Blood screening: Measures certain proteins the baby makes that cross into the mother’s blood. The levels of these proteins can give information on a baby’s chances of having certain birth defects such as spina bifida.
  • Ultrasound: Looks at the baby, the placenta, and the fluid around the baby. Pregnant women with hypertension will need to have ultrasounds to evaluate the anatomy, monitor the growth of the baby and look at amniotic fluid levels.
  • Heart exam: Mothers with long term hypertension may have abnormal function of the heart and your doctor may order an electrocardiogram (ECG) or an ultrasound of your heart.
  • Nonstress tests or biophysical profile: May be recommended in the third trimester to monitor the baby and amniotic fluid levels.
  • Other blood test: May be ordered to make sure your kidneys, liver and other organ systems are healthy.
If I become pregnant unexpectedly, should I stop taking my antihypertensive medications?

Two types of antihypertensive medications can cause birth defects and should be stopped if you are considering becoming or are pregnant:

  • Angiotensin converting enzyme inhibitors (ACE inhibitors): Include Benazepril (Lotensin), Captopril (Capoten), Enalapril/Enalaprilat (Vasotec oral and injectable), Fosinopril (Monopril), Lisinopril (Zestril and Prinivil), Moexipril (Univasc), Perindopril (Aceon), Quinapril (Accupril), Ramipril (Altace), and Trandolapril (Mavik).
  • Angiotensin II receptor blockers (ARB): Include azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis), valsartan (Diovan, Prexxartan), losartan (Cozaar), olmesartan (Benicar), entresto (sacubitril/valsartan), and byvalson (nebivolol/valsartan)
Which antihypertensive medications are safe to take during pregnancy?

Talk to your doctor before starting on new medications during pregnancy.  The most common antihypertensive medications used in pregnancy include labetalol, nifedipine, and methyldopa.

Are other medications recommended during pregnancy in people with hypertension?

Taking low-dose aspirin during your second and third trimesters (after 12 weeks) can lower your risk of preeclampsia. Do not start taking aspirin before talking with your doctor to make sure it is safe for you.

If I have hypertension will I be able to breastfeed my baby?

Yes. There are many health benefits of breastfeeding and people with hypertension should be encouraged to breastfeed. Nifedipine, labetalol, and methyldopa are considered safe in breastfeeding.

When should I call my doctor or nurse?

Call your doctor or go to the hospital if:

  • You don’t feel your baby move as it usually does
  • You have pain in your abdomen
  • You have vaginal bleeding
  • You have a bad headache, changes in your vision, or problems breathing

Diabetes in Pregnancy

What is diabetes?

Diabetes is a condition where the body either does not make enough insulin or cannot use insulin correctly. Insulin is a hormone that is necessary to move sugar (glucose) from the bloodstream into the cells. When glucose cannot enter our cells, it builds up in the blood (hyperglycemia) and can lead to damage of organs like the eyes and kidneys, and can damage blood vessels and nerves.

Are there different types of diabetes?

Yes, there are type 1 and type 2 and gestational.  In type 1 diabetes, the insulin producing cells in the pancreas have been destroyed so the body does not produce any or very little insulin. In type 2 diabetes, the body either does not produce enough insulin or the insulin does not work well. Gestational diabetes is diabetes that is diagnosed for the first time during pregnancy.

If I have diabetes, is there anything I need to do before I become pregnant?

Yes, you should speak to your healthcare provider to have a plan to control your blood glucose levels before becoming pregnant. This may require a personalized diet and exercise program.  If you have type 1 diabetes, you will also require insulin in order to control your blood glucose levels.  People with type 2 diabetes many times will also require insulin or oral medications to control their glucose levels. The hemoglobin A1c (hgbA1c) is a blood test which looks at the average glucose levels over the past 2 to 3 months.  Ideally, the hgbA1c level should be in the normal range before becoming pregnant. Ideal glucose levels are:

  • Fasting, Premeal, and bedtime glucose of 60-99 mg/dL
  • Peak after meal glucose of 100-129 mg/dL
  • A1c <6.0%
Can diabetes cause birth defects?

Most babies born to women with type 1 and type 2 diabetes are not born with birth defects. However, high glucose levels, especially very early during pregnancy increase the chance that a baby will be born with birth defects. The higher the hgb A1c level, the higher the risk. For pregnant women with poor control of their diabetes, the chance for a baby to be born with birth defects is about 6-10% (about 1 in 16 to 1 in 10). For those with extremely poor control in the first trimester, there may be up to a 20% (1 in 5) chance for birth defects. These birth defects can include spinal cord defects (spina bifida), heart defects, skeletal defects, and defects of the urinary, reproductive, and digestive systems.

Can diabetes cause pregnancy complications?

Women with type 1 and type 2 diabetes whose glucose levels are not in control have an increased chance for miscarriage and stillbirth. There is also a higher chance of pre-eclampsia (dangerously high blood pressure), more amniotic fluid around the baby then usual (polyhydramnios), and delivery before 37 weeks of pregnancy (preterm delivery). Babies born to women with diabetes may also have trouble breathing, low blood sugar (hypoglycemia) and jaundice (yellowing of the skin and the whites of the eyes) at birth.

 

Women with poorly-controlled diabetes are more likely to have very large babies (called macrosomia), some weighing over 10 pounds. In some cases, the healthcare provider may advise the woman to deliver the baby by cesarean section (C-section) rather than by vaginal delivery in order to reduce the chance of injuries to the mother and baby. On the other hand, babies of mothers with complications from long standing diabetes may not get the nutrition they need before birth to grow normally, and may be born smaller than usual. Chances for growth complications are lower when women have normal blood sugar levels.

Women with type 1 or type 2 diabetes who also have other medical issues such as high blood pressure or obesity may also have a higher chance for pregnancy complications.

Can having type 1 or type 2 diabetes in pregnancy cause long-term complications for the baby?

Infants of mothers with diabetes have an increased risk of developing diabetes later in life. This is thought to be caused by both genetics and diabetes management during pregnancy (whether glucose is controlled). There are some studies suggest that poorly-controlled diabetes during pregnancy could affect neurodevelopment, although the data from these studies is limited.

What kinds of tests are recommended during pregnancy for women with diabetes?

Your healthcare providers will follow the health of you and your developing baby closely during the pregnancy. They will talk with you about the correct screening tests for your pregnancy. Some screening options that might be discussed are:

  • Blood screenings measure certain proteins the baby makes that cross into the mother’s blood. The levels of these proteins can give information on a baby’s chances of having certain birth defects such as spina bifida.
  • Ultrasounds can look at the baby, the placenta, and the fluid around the baby. Pregnant women with type 1 or type 2 diabetes may need to have more ultrasounds than a woman without diabetes to screen for birth defects and monitor the growth of the baby and look at amniotic fluid levels.
  • Fetal echocardiograms are special ultrasound to screen for heart defects in the baby.
  • Hgb A1c blood test can be done to check glucose levels throughout pregnancy.
  • Nonstress tests or biophysical profiles in the third trimester may be recommended to monitor the baby and amniotic fluid levels.
  • Eye exams are recommended before pregnancy and in the first trimester because women with diabetes may develop an eye problem called retinopathy, which can lead to vision problems. Women with poorly controlled diabetes may find that this condition worsens during pregnancy.

 

If I become pregnant unexpected, should I stop taking my diabetes medications?

No, you should continue your diabetes medication until you talk with your healthcare provider. Diabetes that is uncontrolled or not well-controlled can cause miscarriage, birth defects, pregnancy complications, and stillbirth. Your provider can go over the benefits of medication versus the risk of an untreated condition.

If I have diabetes will I be able to breastfeed my baby?

Yes. There are many health benefits of breastfeeding and people with diabetes should be encouraged to breastfeed. It is important to continue maintaining control of your glucose levels as diabetes can slow down the production of milk. Insulin is necessary for milk production, so this may partly explain why people with diabetes are slow to produce milk.

I take medication for my diabetes. How will breastfeeding affect the health of my baby?

Insulin is a normal part of breastmilk. It does not cross over into breast milk in large amounts, and is not expected to cause problems for the breastfed baby. Oral medications do go into the breast milk, but in very low amounts. You should monitor the baby for jitteriness, signs of hypoglycemia. If the baby has symptoms, contact the child’s healthcare provider.

How will breastfeeding affect my blood sugar levels?

Insulin requirements usually decrease after birth and women will often experience lowered blood sugar especially after nursing. It is suggested to eat a snack with carbohydrates and protein before nursing to help avoid low blood sugar. You may need to monitor your blood sugar more carefully and adjust your insulin dose.