Definition
Elevated blood pressure during pregnancy occurs in about 10% of pregnancies. Since therapy recommendations in pregnancy generally differ from the standard recommendations, there are also major differences in the treatment of high blood pressure between treatment outside and during pregnancy. In therapy, it must be remembered that not just one person is treated, but two people.
What measures can I take to lower my blood pressure?
The blood pressure can be lowered by various measures. For example, general measures are recommended for mild to moderate high blood pressure. These consist of regularly checking your body weight to ensure that you gain less than 1kg/week.
Physical protection and elimination of stress factors are the main focus of blood pressure reduction. However, strict bed rest and abstention from salt is not advisable, as it has no proven effect on high blood pressure and, above all, a low salt intake can even be dangerous for the child. Taking vitamin C and vitamin E can also have a positive effect on blood pressure. In cases of severe high blood pressure that cannot be controlled by general measures, medication is used. The only causal treatment for pregnancy-induced hypertension, pre-eclampsia and eclampsia is childbirth, a measure that depends on the week of pregnancy, blood pressure levels and the risk of eclampsia.
What drugs are available?
The drug treatment of hypertension during pregnancy is different from the treatment outside pregnancy. As there are no comprehensive placebo-controlled studies, the recommendations are based on smaller observational studies. The drug of choice in Germany is alpha-methyldopa.
In addition, the beta-blocker metoprolol and the calcium antagonist nifedipine (not in the first third of the pregnancy) can be used. Dihydralazine is also used for treatment, but has stronger side effects on the mother. Nifedipine is the first line of treatment for the acute reduction of high blood pressure. In cases of severe pre-eclampsia/eclampsia, magnesium is administered intravenously to relieve cramps. Absolutely contraindicated and therefore not to be used under any circumstances are ACE inhibitors, which are toxic for the child, especially in the second and third trimesters of pregnancy, and can lead to malformations and miscarriages.
Are antihypertensives dangerous for my baby?
There are few comprehensive placebo-controlled studies on antihypertensives in pregnancy, as drugs are not tested on pregnant women. Thus, the recommendations are mainly composed of smaller observational studies. Of these, alpha-methyldopa is the most common, as well as a study on the long-term effect on children up to 7 years of age, and as no damage has been proven there, this drug is considered the first choice in Germany.
Metoprolol may have an effect on the growth of the child, nifedipine has been shown in studies in animals to have a harmful effect on the child within the first trimester of pregnancy, which is why it is only prescribed after this time. With diuretics there is a risk of disturbed blood flow to the placenta because the blood volume decreases. These drugs are therefore only prescribed with reservations and after careful consideration of the benefits and risks. ACE inhibitors and angiotensin antagonists are dangerous for the child and should not be taken under any circumstances, as they have been shown to cause developmental disorders and possibly death of the child.
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