Postnatal information for women with hypertension (raised blood pressure) in pregnancy

Gestational hypertension

Having raised blood pressure in pregnancy with no protein in the urine is known as gestational hypertension. Of women who develop this condition, between 16 and 47 in every 100 are likely to do so again in future pregnancies. We also know that these women are about three times as likely to develop raised blood pressure in later life. Risk of future heart disease is also slightly increased; it is one and a half times more likely than for women who have not developed raised blood pressure in pregnancy.

Pre-eclampsia

Having raised blood pressure with protein in the urine during or immediately after pregnancy is known as pre-eclampsia. Of women who develop pre-eclampsia, between 16 and 55 in every 100 develop pre-eclampsia again in future pregnancies. We also know that these women are around four times more likely to develop raised blood pressure in later life. Risk of future heart disease is also slightly increased (it is twice as likely as for women who have not developed raised blood pressure in pregnancy). High blood pressure increases the risk of stroke and heart attack in later life and must be monitored and treated.

Risk of developing pre-eclampsia in a future pregnancy

• The risk of developing pre-eclampsia in a future pregnancy is around 16% (16 women in every 100).
• If your baby was delivered before 34 weeks gestation, the risk is about 25% (25 women in every 100)
• If your baby was delivered before 28 weeks it is higher, about 55% (55 women in every 100) of these women will develop pre-eclampsia in future pregnancies.

Monitoring after you leave hospital

You should ensure that your blood pressure is monitored carefully over the first few weeks following the birth of your baby and also in the longer term by your GP. Initially your blood pressure should be monitored frequently by your midwife or GP (every one to two days) but as your blood pressure settles it will be checked less often. When you are discharged home you will be given a plan for when your blood pressure should be checked.

Advice about blood pressure tablets (anti-hypertensives)

If you are on antihypertensive medication, it is usual to be able to stop them once the blood pressure is less than 130/80mmHg. For most women, this is in the first couple of months following birth.

Women who require blood pressure tablets to continue several months following birth may require specialist assessment of their raised blood pressure. Please discuss this with your GP.

Postural hypotension

Postural hypotension is a fall in blood pressure that occurs when changing position from lying to sitting or from sitting to standing. Some people experience this when taking blood pressure tablets. Common symptoms are feeling dizzy or lightheaded on standing up, visual changes or fatigue. You should try to avoid becoming dehydrated and getting up quickly from lying down or sitting. If any of these symptoms persist, please contact your GP and/or midwife to get your blood pressure re-checked and for advice regarding treatment.

Breast feeding

The blood pressure tablets usually given following childbirth (commonly labetalol or nifedipine) have no known adverse effects on babies receiving breast milk.

For other less commonly used drugs such as enalapril, there is less experience and although they are generally thought to be safe, the baby should receive some additional monitoring. There should be additional consideration by the staff about breast feeding if the baby is born prematurely.

When to seek medical help

If you have had raised blood pressure or pre-eclampsia in pregnancy, there is still a small risk of complications in the few weeks following delivery. If you feel unwell during this time, you should seek medical advice from your GP or the maternity assessment unit at the Rosie (clinic 23). Symptoms that may suggest a problem are severe headache, disturbance in your vision, upper abdominal pain or vomiting and shortness of breath.

Follow up appointments

Your blood pressure medication should be reviewed 6-8 weeks after the birth, most women can see their GP for this. For some women, appointments may be arranged at the hospital, you will be advised if you need this.

Future pregnancy advice

Low dose aspirin (150mg once a day) may be recommended in a future pregnancy starting at 12 weeks to reduce the risk of you developing blood pressure problems.

Other lifestyle advice

Manage your weight so that it is appropriate for your height. Knowing your body mass index (BMI) will help you to do this. Normal is between 18.5-24.9 kg/m2.

Ask your midwife, practice nurse or GP or you can use the internet to calculate this when you know your height (in metres) and weight (in kilograms).

Eat a low fat diet. This will help you manage your weight and keep your blood vessels (arteries) healthy.

Regular moderate to vigorous exercise (30 minutes) every day will help to keep your heart healthy.