Risks Of High Blood Pressure During Pregnancy – Kaiser Permanente research reveals patterns associated with preeclampsia and other pregnancy-related high blood pressure conditions.
Blood pressure patterns observed during the first 20 weeks of pregnancy may offer important clues to identify patients most likely to develop high blood pressure complications during their pregnancy, Kaiser Permanente researchers report.
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Risks Of High Blood Pressure During Pregnancy
“Our study shows that a woman with normal blood pressure that increases or shows little or no fall during the first trimester is at significantly higher risk of developing hypertension during the second trimester,” said lead author Erica P. . Gunderson, PhD, MS, MPH, Senior Research Fellow, Cardiovascular and Metabolic Lifetime Research, Kaiser Permanente Northern California Division of Research.
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The study, the largest and most racially and ethnically diverse of its kind, is published in the journal Hypertension. It included about 175,000 women with no previous history of high blood pressure or preeclampsia who started receiving prenatal care before they were 14.
Gestational week and delivered at Kaiser Permanente Northern California (KPNC) between 2009 and 2019. In the study group, 63,297 patients were white; 44, 216 were Asian; 46,289 were Hispanic; and 12,708 were black.
On average, each woman had her blood pressure measured and recorded at 4 different prenatal visits during the first trimester of pregnancy. Analysis of these consecutive measurements revealed 6 distinct patterns of blood pressure variation: 3 of the examples are associated with a significantly higher risk of developing pregnancy-related high blood pressure in the second half of pregnancy. These patterns have captured almost 80% of pregnancy disorders, which include preeclampsia (sudden development of high blood pressure) and eclampsia (preeclampsia and seizures associated with high blood pressure) and gestational hypertension. In all 6 blood pressure pattern groups, black women had the highest risk of preeclampsia compared with whites, followed by Hispanic and Asian women.
“Hypertensive disorders of pregnancy are a leading cause of morbidity and mortality in the United States, and they are very difficult to predict and prevent,” said study co-author Mara Greenberg, MD, maternal-fetal medicine specialist at The Permanente Medical Group. . “There have been many studies looking for biomarkers that could predict these hypertensive conditions, but nothing that has been particularly helpful. Blood pressure measurements are readily available in medical records and could be a useful tool if we can show blood pressure patterns that can predict who will develop these conditions.”
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Hypertension-related maternal mortality in the United States affects 2.1 per 100,000 live births, with black women nearly 4 times more likely than white women to die from hypertension-related disease during pregnancy. Patients with chronic hypertension, overweight or obesity, diabetes, preeclampsia in a previous pregnancy, or smokers are known to be at greater risk of hypertension-related complications during pregnancy and were excluded from the study. A new study identified pregnant patients who were considered low-risk but later developed hypertension-related complications.
“There is a normal physiological blood pressure response to pregnancy that includes a drop in blood pressure in the second trimester,” Greenberg said. This is because when the placenta begins to develop in the first and second trimesters of pregnancy, it produces hormones that cause the blood vessels to relax to bring more blood to the uterus and fetus. “When patients don’t feel this, they may have something going on in their body that could put them at risk of developing high blood pressure later in pregnancy,” Greenberg added.
Our study shows that a woman with normal blood pressure that increases or shows little or no fall in the first trimester of pregnancy is at significantly higher risk of developing gestational hypertension in the second trimester. — Erica P. Gunderson, PhD, MS, MPH
During the study, 8,342 patients developed preeclampsia and 8,767 developed gestational hypertension. In general, patients diagnosed with high blood pressure complications were more likely to be younger, black or Hispanic, to be overweight or obese before pregnancy, and to have never given birth. They are also more likely to gain more weight during pregnancy, have a cesarean delivery or have a baby that is smaller than average, be born prematurely, be admitted to the neonatal intensive care unit or die after 22 weeks of pregnancy.
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The statistical association the researchers found between blood pressure patterns and the subsequent development of high blood pressure during pregnancy was further improved when information on patient race, ethnicity, prepregnancy body mass index (BMI), diabetes and socioeconomic status was included. was included.
“The next step is to assess how well these blood pressure patterns predict later hypertensive complications in order to target individuals for early prevention,” Gunderson said, “and we’re working on that right now.”
Preterm delivery is currently the primary way doctors manage complications from pregnancy-related high blood pressure. Earlier identification of high-risk women creates the potential to introduce new interventions that can improve maternal and newborn outcomes.
“There are many factors that contribute to a person developing high blood pressure during pregnancy, and many are related to a person’s underlying health during pregnancy,” says Greenberg. “For patients, this study confirms that you should check your blood pressure several times during the first half of your pregnancy, even if you start your pregnancy with normal blood pressure, because what we learn from those measurements can be helpful.”
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Co-authors are Mai N. Nguyen-Hyun, MD, MAS, Alan Go, MD, Stacey Alexeeff, PhD, and Wei Tao, MS, Division of Research; Dr. Cassidy Tierney of The Permanente Medical Group and Dr. James M. Roberts.
Kaiser Permanente’s Research Division conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the general public. It seeks to understand the determinants of disease and well-being and to improve the quality and cost-effectiveness of health care. Currently, more than 600 DOR staff are working on more than 450 epidemiological and health services research projects. For more information visit or follow us @KPDOR. As pediatricians, our primary goal is to influence behavior and prevent problems. Preventing preterm birth is the first step in your baby’s health and development journey. One way to prevent premature birth is to prevent preeclampsia in the mother. My current research focuses on reducing the risk of preeclampsia during pregnancy and is supported by the Gates Foundation, Purdue University, and Indiana University.
Preeclampsia is a potentially dangerous complication of pregnancy characterized by high blood pressure. Other symptoms can be caused by preeclampsia, such as protein in the urine, inflammation of the liver, low blood platelets, blurred vision, headaches, and rarely, seizures.
High blood pressure affects 25% of pregnancies, and preeclampsia affects 2-8%. Every year, 75,000 women and more than 250,000 babies die from preeclampsia worldwide. There is also a high rate of cesarean section and preterm delivery associated with preeclampsia. Premature birth can pose long-term risks to a baby’s health and development.
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Sleeping on your side can help prevent preeclampsia. A randomized trial has shown that if a pregnant woman sleeps on her side for at least 4-6 hours a day, most cases of preeclampsia can be prevented.
My analysis shows that sleeping on your side during pregnancy allows blood to flow through the kidneys as intended. When a pregnant woman sleeps or lies on her back during pregnancy, the weight of the pregnancy can interfere with blood flow out of the kidneys. Since the kidneys control the body’s blood pressure, normal blood flow is important to maintain. Side sleeping can also help prevent stillbirth and varicose veins in the legs and pelvis.
My goal is to initiate a large-scale, global advocacy campaign that educates pregnant women on Side Sleeping. Just as the Back to Sleep campaign for babies helped reduce SIDS, our hope is that the Side to Sleep campaign for pregnant women can reduce prematurity due to pre-eclampsia. Given the extensive international relationships that Seattle families maintain, we are in a unique position to advocate for pregnant women around the world by getting this simple message across: “Sleep aside.”
Tag cloud weight, questions, pediatrics, overweight, nutrition, lifestyle, jervis, healthier, feeding baby, family, exercise, community, belarmino, allegro As blood volume increases during pregnancy, women should pay special attention to diet and physical activity. exercises that affect their hearts and blood. In addition to practicing healthy habits, a daily prenatal vitamin with iron can support both mothers and babies during pregnancy.
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During pregnancy, the amount of blood pumped through a woman’s body increases by 30-50 percent.
This increase in supply contributes to her baby’s growth, as well as the weight and stress she experiences during pregnancy. All this increased blood volume naturally increases the expectant mother’s blood pressure.
The physical symptoms of high blood pressure vary from person to person. Some women have no symptoms, while others may experience swelling of the hands and feet.
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