UCHealth Ask an Expert: Postpartum Hypertension

UCHealth Ask an Expert

When you choose UCHealth for your labor and delivery, you have access to some of the top obstetric providers in the country, as well as specially trained nurses who provide expertise, compassion and comfort based on decades of experience. UCHealth is proud to welcome thousands of babies into the world each year. 

Childbirth brings with it many questions. That is why we teamed up with UCHealth for this special edition of Ask an Expert: Postpartum Hypertension. Several of you submitted your hypertension questions and UCHealth maternal-fetal medicine specialist Mark Alanis, MD, provided expert insight and advice. 

Here are his answers:

Q. What are the signs of hypertension after birth? Are they different than while pregnant? How long do I need to be concerned about hypertension after birth?

It is important to understand how your blood pressure can be affected by pregnancy.  Your blood pressure has two numbers. The top number is called the systolic blood pressure, and the bottom number is called the diastolic blood pressure.  Systolic blood pressure is the pressure inside your blood vessels when your heart is contracting (the “heartbeat”), while your diastolic blood pressure is the pressure inside your blood vessels when your heart is at rest (the time in between heartbeats).  

Pregnancy induced hypertension (PIH) is the most common medical complication in pregnancy and affects up to 10% of first-time mothers.  The most common form of PIH is preeclampsia, which can be mild or severe and affect either the mother or fetus, or both. Usually, PIH is diagnosed towards the end of pregnancy.  However, it occurs either preterm (before 37 weeks of gestation) or postpartum about 25% of the time.  

Hypertension usually has no symptoms, whether you are pregnant, postpartum, or not pregnant.  So, unless you are having it measured, you may not be aware that you have elevated blood pressure.  Symptoms of severe PIH can include headache, sudden changes in vision, or persistent right-sided upper abdominal pain with or without nausea or vomiting.  

Hypertension in pregnancy is more dangerous compared to hypertension in the non-pregnant patient.  In the pregnant patient, the rise in blood pressure may occur suddenly and severely. The brain, heart, kidneys, and other organs cannot handle the sudden and severe rise in blood pressure.  As a result, severe complications can occur in the setting of PIH, including stroke, cardiac failure, kidney failure, and even death.  

Postpartum hypertension is particularly dangerous, because most affected patients have already been discharged home from the hospital and assume that they are no longer at risk.  However, blood pressure tends to increase 2-4 days after childbirth. Combined with the minimal symptoms experienced by patients with hypertension, diagnosis and treatment may be delayed or missed.  Pregnancy induced hypertension can continue to affect patients up to 6 weeks postpartum, although the most dangerous period appears to be the first 7 days after delivery.

Q. Are there any types of food that I can eat that will reduce postpartum hypertension?

Not really.  Low salt diets are not appropriate for pregnancy.  Part of a successful pregnancy is an increase in total body water, and salt is necessary for this to occur.  In general, a balanced diet is recommended in pregnancy, which includes about 40-50% of calories derived from carbohydrate sources, 20-25% from protein sources, and 30% from fat sources.  Vitamin and mineral dietary supplements also appear to not help reduce the risk of PIH. Many clinical research studies have been performed, and magnesium, calcium, vitamin E, vitamin C, and vitamin D supplements do not protect women at either low-risk or high-risk for PIH.  However, avoidance of excessive weight gain in pregnancy is important. Women who have excessive weight gain in pregnancy are at an increased risk for PIH. The appropriate amount of weight gain depends on the pre-pregnancy weight and height. For patients with normal weight by body mass index (BMI 18.5-22.9), 25-35 lb are recommended.  For overweight women (BMI 25.0-29.9), the recommended weight gain is 15-25 lb, and for obese women (BMI 30.0 or more), the recommended weight gain is 11-19 lb.

Q. What are the signs that I may need to go have my blood pressure checked? How will I know at home if it may be increasing?

Risk factors for PIH should be assessed by your obstetric provider early in pregnancy.  As we already discussed, women carrying their first pregnancy past 20 weeks of gestation have up to a 10% chance of developing PIH.  Unfortunately, African-America women may have up to a 2-fold risk of developing PIH, compared to Caucasians. Other women who are vulnerable to develop PIH include those with preexisting hypertension, chronic kidney disease, preexisting diabetes mellitus, sickle cell anemia, multifetal gestation (twins, triplets, or more), and certain autoimmune conditions like systemic lupus erythematosus.  Patients with a previous history of PIH and those with a sibling or mother who experienced PIH are also at increased risk. These risk factors may additive, so the more you have the greater the risk of developing PIH.  

If you have 1 or more of these risk factors, you may want to pay close attention to your blood pressure after 20 weeks of gestation.  Prior to 20 weeks of gestation, PIH is extremely rare. The best way to determine if you are developing PIH is to have your blood pressure measured accurately in the office or at home.  It is very easy to get an inaccurate reading, whether at home or in the medical office. To measure the blood pressure accurately, you should make sure the blood pressure cuff fits around the upper arm snugly, but not too tight.  You should be in a sitting position, with your arm resting on a table or arm of a chair, and your feet on the floor and uncrossed.

If your blood pressure was noted to be elevated at your obstetric provider’s office, it may be a good idea to purchase a home blood pressure monitor.  Home kits are available over the counter and have improved in quality and cost over the years. A good pressure monitor can be purchased at most major drug stores for around $50.  If your systolic blood pressure (the top number) is 160 mm Hg or higher or your diastolic blood pressure (the bottom number) is 110 mm Hg or higher, you should go to the emergency room at your local hospital or call your doctor’s office without delay.  

If you do not have a blood pressure monitor at home, but concerned you may have PIH, remember the symptoms of PIH discussed above: headache, sudden visual changes, or right upper quadrant abdominal pain with or without vomiting.  Unfortunately, none of these symptoms are very specific for PIH. Most headaches are benign and not related to PIH. You should take acetaminophen for headache, and it does not resolve, call your doctor’s office or go to the emergency room.  Many women have harmless visual changes in pregnancy, including a tendency to see bright or flashing spots when getting up from bed or bearing down. Seeing black, fixed spots (spots that track with your vision as you move your eyes), however, require immediate medical attention.  Right upper quadrant abdominal pain is also frequently sporadic and benign. However, when the pain is constant and persistent, this could be a sign of PIH and requires immediate medical attention.

Q. If I have preeclampsia, is postpartum hypertension something that I will also need to be concerned about?

Absolutely.  As we discussed above, postpartum hypertension is particularly dangerous, because women have often been discharged home from the hospital before the blood pressure goes up.  In these cases, continue to use your home blood pressure monitor to check your blood pressure and monitor your symptoms.

Q. Will breastfeeding help to decrease hypertension?

Unfortunately, reduction in the risk for postpartum hypertension is not one of the many benefits of breastfeeding.

Q. Are there medications that can assist with postpartum hypertension and if so, are they safe to use while nursing?

The most important aspect of care for postpartum hypertension is to regulate the blood pressure with antihypertensive medications.  Most of these medications are safe to take while breastfeeding. The actual prescribed medicine may depend on your individual medical history and current condition.  However, the most common and safe antihypertensive medications prescribed in pregnancy and postpartum mothers who breastfeed are labetalol, nifedipine, and hydralazine.

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About Mark Alanis, MD

Mark Alanis UCHealth

Dr. Alanis joined the UCHealth Maternal-Fetal Medicine team and cares for patients at 1400 E. Boulder in Colorado Springs.

He is excited to be a part of a team-based approach that is centered on excellence, quality, and patient satisfaction. “This highly specialized field of medicine allows me to stay on top of a knowledge base that is ever increasing and then help those patients who find themselves facing challenges in their pregnancy,” he said.

He earned his medical degree from University of Texas Health Science Center, Texas. He completed his residency in Obstetrics and Gynecology at Carolinas Medical Center in Charlotte, North Carolina, and his fellowship in Maternal-Fetal Medicine from the Medical University of South Carolina, Charleston, SC.