Should a woman continue to use antihypertensive medication in pregnancy if she suffers from chronic hypertension?
Generally, yes. She should talk to her doctor when trying to conceive, and the doctor will advise her.
The reason is, while continuing to use medication is desirable, there are some types of antihypertensive drugs which have been associated with adverse effects on the growing fetus in the womb or whose safety in relation to the fetus cannot be guaranteed.
In such a situation, the accepted advice is to switch to the type of medication known to be safe in pregnancy. This should ideally be done before conception. When medication has been taken in the critical first ten to twelve weeks of pregnancy, for whatever reason, it is debatable whether advising to change at this stage is worthwhile. The exception will be those types of drugs which affect fetal development. Her doctor, together with her obstetrician, should be able to explain and discuss this with her, depending on what she is taking. There are many classes of antihypertensive drugs and no blanket rule can apply to all or even to most of them.
What should an expectant mother do if she is found to have pre-eclampsia?
The only effective treatment of pre-eclampsia is delivery.
It is therefore important to be clear that, whatever other measures the doctor may institute, the aim is to try to control the condition and not to cure it.
Pre-eclampsia can have quite devastating effects on both fetus and mother and the doctor will try to prevent those complications. The doctor will therefore try to ensure that the condition does not worsen, that the fetus continues to grow at an acceptable rate and that neither the mother's life nor that of the fetus is put at risk.
So what are they likely to do?
She will almost invariably be advised to rest.
Because one of the hallmarks of pre-eclampsia is reduced blood-flow to the uterus, the placenta and ultimately the fetus, rest is meant to make the best of a bad situation. It means that blood which would normally be diverted to the active muscles when the mother engages in physical activities is, with rest, allowed to go to the womb.
Rest is a critical component of pre-eclampsia control
Medication: She may be put on medication to try to control the blood pressure. The sole aim of using antihypertensive medication is to protect the mother from dangerously raised blood pressure, which may cause such complications as stroke. It is therefore, purely a complication prevention measure and not a treatment for pre-eclampsia. It does not prevent the core progression of the disease.
Monitoring: The blood pressure will be monitored closely. How closely will depend on how high it is, as well as how abnormal the other parameters are.
What are the other parameters?
Pre-eclampsia can only be diagnosed if the raised blood pressure is accompanied by loss of protein in the urine. This is brought about by the effects of the disease on the kidneys. The mother will, therefore, have her urine checked very frequently to monitor the level of protein loss. This is one of the principal means of determining the progression of the condition.
She may have her total urine collected for 24 hours, for a quantitative analysis of the protein loss. This is considered superior as a way of analyzing and determining the extent of the protein loss and, by implication, the severity of the condition.
Will she be hospitalized?
She might be. If the obstetrician looking after her feels it unsafe to monitor the condition at home, she may be advised to stay in hospital for a closer, continuous observation of her condition. This will include:
monitoring blood pressure
monitoring protein loss in the urine
monitoring urine output (reduction in amount is not a good sign)
a battery of blood tests.
If the condition is judged to be only mild, she will be monitored at home, probably with visits from the community midwife. The frequency of the visits could range from daily to twice weekly or so, depending on her obstetrician's assessment and opinion.
Rest will be part of any plan of management.