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Is blood pressure rise during pregnancy just a temporary, transient phenomenon or does it have anything more to it than that meets the eye? Does it continue or bother us later in life or is it just only an effect pertaining to pregnancy?
Let us look at this problem in retrospection. After reading some recent research evidence, I decided to perform a small exercise in my practice of asking women present in their late 30s or early 40s ( with abnormal menstruation, raised blood pressure, diabetes, obesity etc ) about their antecedent pregnancies. Out of the 66 odd women I questioned, nearly 36 mentioned that they had transient or sometimes severe HTNP. Some of them even suffered some complications such as seizures, ICU admissions, need of blood and component transfusions, need of medicines to control BP for a long time etc : Some of them had conceived immediately after marriage and before they were 18 years of age and most of them had variants of obesity or were overweight. Nearly all of these abnormal BMI (Body Mass Index ) women gave history or post delivery weight retention which was carried forward to the current state.
These above-made observations about long-term issues of HTNP are indeed enlightening and worth a serious thought. This write up is dedicated actually to my own cousin who suffered a lifelong lasting consequence of HTNP and this I will narrate at the end of this note.
Does HTNP have lifelong consequences?
Yes, even if a woman develops a transient rise in blood pressure (even during delivery or post delivery), can increase her susceptibility for having HTNP in the subsequent pregnancy and landing into raised blood pressure disorder in the next 5 years.
What are these lifelong consequences?
Developing blood pressure disorder for all life. Increased susceptibility to suffering a heart attack or kidney diseases in future.These are the result of certain abnormal stimuli to the blood circulation regulating a system which can get triggered with the slightest insults such as infection, anemia etc and therefore it has to be overcome by certain measures.
Can these consequences be avoided or prevented?
Yes, definitely they can be prevented but not entirely always. But definitely, some lifestyle modifications can go a long way in reducing the serious and the severe complications
What are the important steps to be taken to prevent the long-term consequences?
First and foremost, if you have been given blood pressure control medicines, see that you take them as prescribed and go for regular checks and record your blood pressure. Even after returning to normal levels, take periodic checks and annual checks thereafter.
Return to pre-pregnancy weights and try to achieve ideal BMI by the end of one-year post delivery.
Inculcate healthy eating habits and indulge into a regular physical exercise program.
When planning the next pregnancy see that you are having ideal BMI, you are vaccinated and have no anemia, hypothyroidism or diabetes and start on a folic acid supplement.
The story I had promised. Mrs. Seema had undergone two miscarriages at 12 weeks and 14 weeks and was diagnosed with raised BP then. She was advised to undergo evaluations and preconception optimisation and BP control which she did not do and conceived the third time and reported at 12 weeks. This time at 24 weeks of pregnancy her BP started rising and her evaluations revealed that she has a thrombophilia by the name of APLA syndrome a condition which is associated with raised blood pressure, miscarriages and is due to its autoimmune nature. She was kept under close vigilance and at 34 weeks she had a massive internal hemorrhage for which she had to be operated. Her womb had to be removed to save her life as there was torrential bleeding and also the baby couldn’t be saved. She was given massive blood and blood component transfusions.She needed ICU admission and care for 72 hours and later needed dialysis for 2 months for acute kidney failure. Later she was stable and recovered over a period of one year. However about 12 years down the line at the age of 39 she has developed kidney failure and needing dialysis.
Only if we had diagnosed her early and she would have planned her pregnancy better after stabilization we could have avoided this malady.
Let us all join together to put our efforts to evolve as healthy women and pass on the legacy of heath to our daughters and future generations.
Lots of best wishes
Dr. Girija Wagh, MD (Obstetrics & Gynaecology), FICOG, FICP, Diploma (Endoscopy, Infertility), Fellowship of Indian College of Ob-Gynec, Women health care specialist, Academician, Acclaimed Orator & Researcher, B. J. Medical 1990-1992, Topper University Of Pune 1992
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