I often get asked about my experiences with high blood pressure and preeclampsia, and specifically how I avoided having preeclampsia in my second pregnancy. It is surprising for people who are at risk of preeclampsia or have had it before, that there are things that can be done to help avoid it.
I have had chronic hypertension since 2016. For me it is a genetic condition that runs in my family and I manage it with medication. Over the years I have come to learn a great deal about living with high blood pressure. With my first pregnancy I had early signs of preeclampsia at the end of the third trimester, and I had postpartum preeclampsia that required a 3 day hospital stay.
Because of my chronic condition, with my first pregnancy I had resolved to simply accept that I would need medical intervention, that I would need an induction and that it was likely that the high blood pressure was going to create issues for me. I believe that this mindset was a contributing factor in the way things worked out, because I probably would have made different choices, had I thought differently.
When I decided to have a second pregnancy there were a lot of things that I was going to do differently. Avoiding having preeclampsia again was one of them. I had heard some things about supplements that I could take amongst other things and so I dove deep into the knowledge and research that was out there. I learned a lot about what had potentially worsened my situation the first time. I also learned information that is readily available to doctors, but my doctor apparently had no knowledge of.
According to my local statistics, high blood pressure affects about 6% to 7% of all pregnancies and preeclampsia affects around 1% to 2% of pregnancies. High blood pressure that only occurs during pregnancy is called Gestational Hypertension, or "Pregnancy Induced Hypertension” (PIH). Pre-existing high blood pressure is called “Essential Hypertension”, just another item on the list of health conditions with silly names.
High blood pressure during pregnancy is a relatively uncommon but serious condition. The cause of PIH is unknown, however it is thought to be related to the placenta and how it functions. If you come across a doctor who isn’t telling you everything you need to know about PIH and preeclampsia, the reason is probably because they don’t know either.
Before we move on I want to take a minute to tell you that this article is providing you with information based on my own experiences and research and is not intended as medical advice. Individual situations vary wildly, especially when it comes to blood pressure. As always, we recommend a good working relationship with a qualified care provider who facilitates informed consent and supports your individual choices.
PREVENTATIVE CARE
DIET
Diet during pregnancy is far more important than you may have been led to believe. I took a deep dive into Real Food for Pregnancy by Lily Nichols, as well as relied heavily on her blog articles. Lily Nichols is one of the top experts in gestational diabetes and pregnancy nutrition.
The dietary recommendations are all encompassing and are recommended for avoiding a whole variety of possible prenatal medical conditions. Some recommendations of note are:
Protein - Protein requirements are higher in pregnancy, as well as specific amino acids, especially glycine, which is found in meat. Increasing your protein intake is also recommended for high blood pressure.
Sodium - Studies have found that previous recommendations of a low salt diet do not help prevent preeclampsia and salt is important for other bodily functions. This doesn’t mean that you should stop avoiding processed foods. The quality of salt you are consuming is also important.
Potassium - Potassium goes hand in hand with sodium and needs to be consumed in adequate levels as well. It is recommended to eat a rainbow of produce, which will provide you with enough potassium as well as needed antioxidants. Please note that potassium supplements are not recommended when taking certain blood pressure medications.
Calcium - People with preeclampsia tend to have lower levels of calcium. There are research studies that recommend calcium supplementation. Consuming a calcium rich diet is a good thing to do as well.
Magnesium - Magnesium supplementation has also been shown to reduce the risk of preeclampsia.
Choline - Choline is a very important micronutrient. It is found in organ meats, egg yolks, other meats and seafood.
Balancing your blood sugar - This means pairing your carbs with protein. The same dietary recommendations for gestational diabetes, also help to manage blood pressure. In my second pregnancy I ate a low carb diet, limiting my carbs to 30 grams per meal, and never eating them on their own. Carbohydrate needs vary from person to person, so you will need to experiment and discover what ratios work best for you.
For more information about nutrition, without having to read the whole book, check out: Preeclampsia: 5 Ways Nutrition Supports Blood Pressure In Pregnancy
SUPPLEMENTS
Vitamin D - At least 1000 iu daily is recommended. Preeclampsia rates have been found to be lower in people living in sunnier climates.
Calcium - Recommendations range from 500-1500 mg daily depending on which practitioner you are speaking to. When deciding how much calcium to supplement, you should also consider the amount that you consume in your diet.
Magnesium - I am unsure of the recommended dose. I was taking 200 mg daily.
Melatonin - This supplement should be discussed with your care provider to determine dosage. I was taking a low dose of 3 mg daily. People who have preeclampsia have been found to be lacking in melatonin. Melatonin is not usually recommended in pregnancy. You will need to consider risks vs benefits in this situation.
CoQ10 - This was prescribed to me by my naturopath. I was taking 100mg twice daily. I don’t know much about it other than it is an antioxidant that is used to support cardiovascular health.
EXERCISE
Exercise is often recommended for many health conditions and is generally recommended for overall well being. I personally do not actually know much about exercise but I can pass on some tips I learned from my personal trainer. She said that most women do too much cardio and not enough strength training (weight lifting). She designed postpartum workouts for me that were heavy on the weight lifting and had very little cardio. Working with her, I reached my goal in just 3 months so there is something to it.
For me, exercise in pregnancy looked like this: Daily 4 km walks for as long as I was physically able, prenatal workouts I found on YouTube twice a week, and the yoga routine from Spinning Babies twice a week. During my second pregnancy, staying active was more challenging because my time was mostly occupied by looking after my toddler, and because I sprained my ankle at 34 weeks.
MORE RECOMMENDATIONS FROM THE PROFESSIONALS
To read more about the evidence based medical recommendations from The Society of Obstetricians and Gynaecologists of Canada (SOGC) go here: https://www.jogc.com/article/S1701-2163(22)00234-1/fulltext
For more information about some other natural preventative measures have a listen to the Birthing Instincts Podcast episode #244 Hypertension & Preeclampsia: What You Should Know and go to the 28:45 mark to skip past the preamble.
SYMPTOMS
Preeclampsia can come with any of the symptoms below, but it is important to note that it can also have no symptoms at all.
Swelling of the face or hands
Sudden weight gain
Headache that won’t go away
Changes in vision, spots, flashing lights, partial loss of vision
Sudden nausea
Upper right belly pain
Difficulty breathing
For more information check out The Preeclampsia Foundation
DIAGNOSIS
Preeclampsia is diagnosed by testing certain levels of things in the blood. I asked more about what they were testing for. The answer was that there are a number of different combinations of things that could indicate preeclampsia and so the answer was not straightforward. Testing for protein in the urine is not enough to diagnose preeclampsia, but is an indicator that a blood test should be done. Once preeclampsia has been diagnosed via a blood test, urine testing is no longer necessary.
BLOOD PRESSURE READINGS
During prenatal appointments pregnant people are told “if your blood pressure goes over 140/90, you need to go to the hospital”. And I can’t even tell you how many times I ended up racing to the maternity ward in full panic because of this. Watching the monitor readings slowly creep up is incredibly stressful, only exasperating an already bad situation.
But have you ever called the Maternity Triage number and told them your crazy high blood pressure reading, only to find that the nurse on the other end isn’t all that concerned?
Let me tell you some things that I have learned about blood pressure readings:
1) One single high reading is not concerning. Blood pressure is about taking multiple readings and noticing trends. If your blood pressure is trending upwards, this is something for your care provider to take note of and continue to monitor.
2) A number below 140/90, such as 139/89 is not the same as a number above 140/90. If you take a blood pressure reading and it is 137/88, it isn’t time to freak out yet. You can relax. In fact, relaxing will help you. Blood pressure is affected by many different factors and can change quite a bit throughout the day.
3) Blood Pressure consistently over 140/90 is urgently concerning but it is not an emergency. The reason for telling you to go to the hospital isn't because you are having an emergency, it is because they want you to see a doctor right away. According to the SOGC, it is an indication that you should either be put on medication, or have your medication adjusted. “Antihypertensive therapy is recommended for pregnant women with an average systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, regardless of the hypertensive disorder of pregnancy”. And while you are there it never hurts to also check your vital signs and baby’s vital signs. These are all things that can easily be done in the Maternity Unit.
4) A blood pressure consistently with a systolic number over 160 or a diastolic reading over 110 is when you are in “the danger zone”. This also doesn’t necessarily mean that you are having an emergency, but the need to see a doctor is more urgent than before.
MEDICATIONS
If you have chronic high blood pressure, either pre-existing or pregnancy induced, you can use medications to keep it under control. There is a lot to know about blood pressure medications and so you should discuss these with your doctor and ask them lots of questions about them.
Many doctors will recommend taking a small dose of Acetylsalicylic Acid (Aspirin) daily as a preventative measure, if they feel that you are at risk of developing high blood pressure. There are two medications that I know of that are considered safe for controlling high blood pressure. They are Nifedipine (Adalat) and Labetalol. These medications can be used either separately or together depending on your specific needs. If you are currently on blood pressure medication and are considering becoming pregnant, you should discuss this with your care provider to make sure that the medication you are on is safe to use while trying to conceive.
Midwives, in Canada, are not allowed to manage high blood pressure, even though they may have the training to do so. This does not mean that you can not have a midwife as part of your care team, but it does mean that you will need to also see a family doctor or an obstetrician.
END OF PREGNANCY BLOOD PRESSURE
If you have high blood pressure, your BP may go up towards the end of pregnancy. At the end of pregnancy your placenta may start to stiffen, and your body will raise your blood pressure in order to make sure that your baby is still receiving the same amount of blood flow. This is just something to be aware of.
CHOICES DURING BIRTH
IV fluids - When you have an IV there is a risk of something called hypervolemia or fluid overload. Excess fluids in the blood runs the risk of raising blood pressure and exasperating conditions leading to preeclampsia. It is a good idea to discuss this possibility with your care provider to make a plan regarding IV fluids and when it is appropriate or not appropriate to have them. If you choose to have an IV it is a good idea to have it in a saline lock when not in use.
Medical Induction - An induction may or may not be right for you. It is important to have all of the related information at the time when the decision is made. This may include blood test results, your Bishop score and what your intuition is telling you. It is also important to know all of the risks associated with each step of the induction process. For more information about medical inductions read my previous article Understanding Medical Labour Induction.
CONCLUSION
Preeclampsia cannot always be avoided. The above information can be used to help you lower your chances of developing preeclampsia, as it did for me, but it is no guarantee that it will completely eliminate the risk. Low, normal, high and dangerously high blood pressure levels are different for every individual. While knowing other people’s experiences with blood pressure in pregnancy is helpful for you, your own experience may be vastly different. There are many different risk factors when it comes to high blood pressure and preeclampsia, most of which are out of our control. You can lower your chances with dietary and lifestyle choices as well as supplementation. If high blood pressure and preeclampsia are a concern for you, I encourage you to do your own research and discuss preventative measures with your care provider.
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