I have chronic high blood pressure. What do I need to know before I get pregnant?

I have chronic high blood pressure. What do I need to know before I get pregnant?

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Should I see my healthcare provider before getting pregnant?

Yes. Discuss your plans to have a baby with the healthcare provider who manages your high blood pressure (hypertension). Your provider will want to review the blood pressure medications you take to control your condition.

Most drugs used to treat high blood pressure haven't been shown to cause birth defects and are considered safe to take during pregnancy. But some high blood pressure medications, such as angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs), may raise your baby's risk of developmental problems if you take them while you're pregnant. These medications can affect a baby's kidneys or cause a low level of amniotic fluid (oligohydramnios).

Untreated high blood pressure is also bad for you and your baby, so consult your provider before you stop taking your medication. Your provider can lower your dose, if possible, or switch you to a different blood pressure medicine if there's a safer option available.

Your provider will also review your medical history. She'll check that your high blood pressure isn't caused by an underlying condition, and do tests to see if other organs (such as your heart, kidneys, and eyes) have been affected by high blood pressure.

These tests are a good indication of your current health and give your provider a useful baseline. Comparing the results of tests you have during pregnancy with these baseline numbers helps identify any changes in your health as early as possible.

Your provider can also recommend steps you can take to improve your health before you become pregnant. The more you do now to get your blood pressure to a healthy level, the better your chance of having a healthy pregnancy.

What can I do to reduce blood pressure before getting pregnant?

A lot! And now is the time to do it. Lifestyle changes can make a big difference in controlling high blood pressure before you become pregnant.

Eat well. Make sure your diet includes plenty of whole grains, nuts, seeds, lentils, chickpeas, fresh fruits and vegetables, low-fat dairy products, lean meat, poultry, and fish low in mercury. Limit sugary and salty foods as well as red meat.

Lose weight. If you're overweight, getting your body mass index (BMI) to 25 or less can also help lower your blood pressure. Losing even a small amount of weight – 5 to 10 pounds – can make a big difference.

Limit alcohol. That means having just 5 ounces of wine, 1.5 ounces of 80-proof distilled spirits, or 12 ounces of beer before you're pregnant. Since it's not possible to predict exactly when conception occurs, consider giving up alcohol as soon as you stop using contraception. (Stop drinking entirely once you're pregnant.)

Quit smoking. If you smoke, this is a good time to give it up. Quitting will improve your health now and your baby's health when you become pregnant. Talk to your provider about how to quit.

Exercise regularly. Check in with your provider first to put together a personalized plan. Any amount of exercise can have a positive effect on your health. Choose an exercise you enjoy, and try to fit in a 40-minute session most days of the week.

Note: If you haven't been exercising regularly, or if your heart or other organs have been affected by high blood pressure, check with your provider before doing any intense aerobic activities. Also, talk to your provider about how your exercise regimen may change once you're pregnant.

Reduce salt. Getting less sodium in your diet may lower your blood pressure. Most salt in your diet comes from processed foods.

What problems could high blood pressure cause during pregnancy?

Most women who have high blood pressure are able to have a normal pregnancy, but the condition does increase the risk of certain complications. The likelihood of any complication depends on the severity of your condition and whether it affects any other parts of your body, like the heart or kidneys. High blood pressure is more likely to cause complications, such as:

Preeclampsia: This serious complication usually occurs late in pregnancy. Preeclampsia increases blood pressure, and severe cases can affect many organs in the body. In addition to putting a woman's health at risk, preeclampsia can also negatively impact how well the placenta delivers oxygen and nutrients to a baby.

Having a small baby: High blood pressure can make a baby grow more slowly than normal (intrauterine growth restriction or IUGR).

Placental abruption: In this condition, the placenta separates from the wall of the uterus, which can affect the nutrients and oxygen a baby gets. Symptoms also include bleeding and pain.

Preterm birth: Having high blood pressure increases the chance of delivering a baby early (premature).

Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.

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