The Pressures of Pregnancy

Women are delaying parenthood until later and more women age 40 and over are having babies; chronic hypertension becomes more common as women get older.  In addition, more women are overweight or obese when they become pregnant, and they too may have a higher rate of chronic hypertension.  A recent article and an accompanying editorial in the British Medical Journal found that high blood pressure before pregnancy or diagnosed early in pregnancy is associated with increased risks to mother and baby.  (Chronic hypertension is not preeclampsia, although women who already have high blood pressure when they become pregnant are more likely to develop preeclampsia.)  The editorial states that chronic hypertension in pregnancy is a “surprisingly under-researched area.”  The systematic review conducted by Kate Bramham and colleagues found that women who are hypertensive before or at the start of pregnancy are more likely to have “all adverse outcomes of pregnancy.”  In other words, anything that can go wrong with mother or baby is more likely to go wrong if the mother has chronic high blood pressure.  More research is needed to answer the questions of how to define chronic hypertension in pregnancy; how hypertension produces pregnancy complications; at what level high blood pressure becomes worrisome and requires treatment; and how chronic hypertension and its complications can be prevented, reduced, or treated.