As your heart pumps blood, the force of your blood pressing against the walls of your arteries is called blood pressure. When the force against your artery walls is too great, it is known as hypertension.¹

Hypertension can occur during pregnancy, with the blood pressure of pregnant women being above 140/90 mmHg. In general, this condition appears at about 20 weeks of gestation, however, it can also occur in early pregnancy.⁵

Hypertension in pregnancy occurs in 5-10% of pregnant women worldwide.⁵ A research study in Indonesia, showed the number of cases of hypertension in pregnant women was 6.18%. The incidence rate continues to increase, along with the increase in maternal mortality rate (MMR) during childbirth, where Indonesia was in the third highest position in Southeast Asia and South Asia as a country with MMR reaching 359 per 100,000 live births and infant mortality rate (IMR) reaching 32 per 1000 live births. In 2010, hypertension in pregnancy accounted for more than 30% of maternal deaths in Indonesia.⁶

Here are the types of high blood pressure during pregnancy:³

> Gestational hypertension. After 20 weeks of pregnancy, women with gestational hypertension acquire high blood pressure. There are no symptoms of organ damage or excess protein in the urine.

> Chronic hypertension. High blood pressure that existed before to pregnancy or occurs before 20 weeks.

> Chronic hypertension with superimposed preeclampsia. This condition affects women who already have chronic hypertension and suffer worsening high blood pressure, protein in the urine, or other blood pressure-related issues during pregnancy.

> When hypertension develops beyond 20 weeks of pregnancy, it is called preeclampsia, and it's linked to harm to other organ systems like the kidneys, liver, blood, and brain. Preeclampsia left untreated can cause catastrophic — even deadly — consequences for both mother and baby, including the onset of seizures (eclampsia). 

Symptoms of preeclampsia include continual headaches, nausea, or vomiting, swelling of the face and hands, shortness of breath, blurred vision, pain in the upper abdominal area, rapidly increasing blood pressure, and proteinuria.^1,2,3

Several factors that cause pregnant women to experience preeclampsia include first pregnancy, aged over 40 years, history of preeclampsia in previous pregnancies, family history of preeclampsia, pregnancy with more than 1 foetus, obesity and autoimmune diseases.⁵

High blood pressure during pregnancy can lead to a variety of complications, including reduced blood flow to the placenta, detachment of the placenta from the uterine wall, intrauterine growth restriction, premature birth before 37 weeks of gestation, injury to other organs in the mother such as the brain, heart, lungs, kidneys, liver, and other major organs, also heart disease and blood vessels (cardiovascular) in the future.³

 

	Systolic	Diastolic
Normal	120 – 129 mmHg	< 80 mmHg
Hypertension grade 1	130 – 139 mmHg	80 – 89 mmHg
Hypertension grade 2	> 140 mmHg	> 90 mmHg

 

The delivery process for pregnant women with hypertension can still be carried out normally, however, the delivery process must be short in time. If this is not possible, the doctor will recommend induction or surgery as long as no dangerous contraindications are found.⁴

If pregnant women have hypertension, continue to do regular check-ups with the obstetrician, obey the doctor's instructions and recommendations regarding the blood pressure-lowering drugs given, avoid taking drugs or herbal supplements, do exercise regularly, eat nutritious food, get enough rest, avoid stress, avoid smoking and alcoholic beverages. Thus, the condition of the mother and baby will continue to be monitored during pregnancy.⁵

Apart from the mother's commitment to dealing with blood pressure during pregnancy, the husband's participation is very important in this regard. Husbands must be able to invite their wives, regulate diet and lifestyle together, also actively move and exercise. What is equally important is that the husband must be wise in dealing with his wife during the first trimester of pregnancy, where the wife experiences a period of cravings.⁴ Avoid stressing the wife with all the rules.

Hypertension in pregnancy can be prevented with a strong commitment and support from the family. Let us create a healthy pregnancy without hypertension.

References:

Medline Plus. High Blood Pressure in Pregnany. Available at : https://medlineplus.gov/highbloodpressureinpregnancy.html

Centers for Disease Control and Prevention. High Blood Pressure During Pregnancy. CDC. Last review: 6 May 2021. Available at: https://www.cdc.gov/bloodpressure/pregnancy.htm

Mayo Clinics Staff. High Blood Pressure and Pregnancy : Know The fact. Mayo Clinics. Last Review: 07 Oktober 2020. Available at: https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20046098

Ivander Utama, F.MAS, Sp.OG. Memahamai bahaya hipertensi saat hamil, ini yang mesti diwaspadai ibu. Helo Sehat. Update on : 07 Januari 2021. Available at : https://hellosehat.com/jantung/hipertensi/hipertensi-pada-ibu-hamil/

Kevin Adrian. Penyebab Hipertensi dalam Kehamilan dan Cara Penanganannya. AloDokter. Last Update : 08 Maret 2021. Available at : https://www.alodokter.com/waspadai-hipertensi-kehamilan-dari-sekarang

Kartika Sari N, et al. Determinan Gangguan Hipertensi Kehamilan di Indonesia. Berita Kedokteran Masyarakat. 2016;32(9): 295-302.

Reference of Picture:

https://kingswayhospitals.com/hypertension-during-pregnancy/