The phrase “You’re Pregnant”, can be met with a range of mixed emotions and reactions. There are many social and personal conditions that would influence the reactions to this news. Most expectant mothers spend months leading up to the delivery of their baby considering names, appropriate clothing, and the lifestyle changes necessary to give the best care necessary to their baby. However, healthcare providers have the responsibility to promote health and healthy lifestyle options to women planning a pregnancy and those of childbearing age. A healthy pregnancy starts before conception, with a mother maintaining her baseline health, and the effective management of chronic conditions such as hypertension, diabetes, and mental health. The subject of pregnancy-induced hypertension is of particular importance to healthcare providers caring for pregnant women, and the neonatal outcomes. The focus of this blog post is to highlight the effects of preeclampsia and its compounding effects during pregnancy.
Hypertension:
The World Health Organization (2017) defines Hypertension as a condition in which the blood vessels have persistently raised pressure. Healthcare providers caring for pregnant women, need to be aware of the different ways in which hypertension presents itself during pregnancy. Three (3) common types of gestational hypertension are:
Chronic Hypertension– Women who have high blood pressure (over 140/90) before pregnancy. These women have a history of hypertension and may have a care plan in place to manage this diagnosis. They may continue to have high blood pressure levels after delivery.
Gestational Hypertension– High blood pressure that develops after week twenty (20) in the pregnancy. This diagnosis of hypertension goes away after delivery.
Preeclampsia – Both chronic hypertension and gestational hypertension can lead a pregnant woman to develop preeclampsia after week twenty (20) of pregnancy. The symptoms include high blood pressure, edema, and protein in the urine. This can have serious complications for both mother and baby if not treated effectively.
Gestational Hypertension– High blood pressure that develops after week twenty (20) in the pregnancy. This diagnosis of hypertension goes away after delivery.
Preeclampsia – Both chronic hypertension and gestational hypertension can lead a pregnant woman to develop preeclampsia after week twenty (20) of pregnancy. The symptoms include high blood pressure, edema, and protein in the urine. This can have serious complications for both mother and baby if not treated effectively.
Who Is At Risk For Gestational Hypertension?
Based on research by (Burgess & Founds, 2016), these are the women identified as having increased risk of developing gestational hypertension:
Women who had a history of high blood pressure prior to pregnancy.
First-time mothers.
A family history of Pre-eclampsia.
Obesity.
Teenage mothers and women older than 40 years of age (Extremes of maternal age).
Expectant mothers that used infertility treatment to assist with conception.
First-time mothers.
A family history of Pre-eclampsia.
Obesity.
Teenage mothers and women older than 40 years of age (Extremes of maternal age).
Expectant mothers that used infertility treatment to assist with conception.
The Impact Preeclampsia on Mothers and Infants:
The presence of pre-eclampsia has significant short-term and long-term effects on the health outcome of mothers and their newborns. These implications can be felt on an individual and population level, especially in populations that are classified as marginalized or vulnerable. It has been reported that preeclampsia has increased in the last two decades by 25%, with hypertensive disorders accounting for approximately 9.4% of maternal death in the United States (Burgess & Founds, 2016). The mothers that were diagnosed with preeclampsia were exposed to acute renal failure, pulmonary edema, and stroke (Burgess & Founds, 2016). The neonatal complications associated with preeclampsia include, but are not limited to increased incidence of fetal growth restrictions, hematologic effects, and premature delivery with significant risk for morbidity and mortality (Backes, et al, 2011).
The Responsibilities of Healthcare Providers:
The profound effects of preeclampsia need to be addressed by healthcare providers caring for pregnant women and women planning a pregnancy. The various levels of interventions need to be addressed from a prenatal level, Primary level, and postpartum care.
Primary Care:
In the phase of primary care, effective screening of the family, reproductive and medical history, the healthcare provider should identify preeclampsia. “Preconception and interconception health promotion is a key aspect to improve pregnancy outcomes, as well as long-term health of at risk women and their children”, p.5 (Burgess & Founds, 2016).
Prenatal Care:
As discussed in (Burgess & Founds, 2016), prenatal education is of vital importance at a population level. Women need to be educated early in the prenatal stage about the signs and symptoms of preeclampsia. Comprehensive initial assessments should include a family history of hypertension and preeclampsia. Further review suggests that when women understood what is preeclampsia, the signs and symptoms, approximately 75% of pregnant women took the necessary steps in seeking appropriate care.
Postpartum Care:
In the area of postpartum care and preeclampsia, careful attention should be given regarding education in the post-partum phase. The mother may continue to have elevated blood pressure levels post-partum. The healthcare team needs to ensure that appropriate education is given regarding the medication regime, outpatient follow-up appointments, and self-care. In this postpartum stage, healthcare providers need to have scheduled appointment for follow up to complete a comprehensive assessment for women with preeclampsia that remains hypertensive. The appropriate measures should be employed to receive appropriate medical treatment for hypertension (Burgess & Founds, 2016).
Olivia London contact information:
Email: olondon@lakeheadu.ca
Facebook: Public Health Entrepreneurship Network
Twitter: @HealthPromoEmp
Resources:
- Heart and Stroke Canada: http://www.heartandstroke.ca/
- Hypertension Canada: https://www.hypertension.ca/en/
- Preeclampsia Foundation: https://www.preeclampsia.org/
Citations:
- Backes, C. H., Markham, K., Moorehead, P., Cordero, L., Nankervis, C. A., & Giannone, P. J. (2011). Maternal Preeclampsia and Neonatal Outcomes. Journal of Pregnancy,2011, 1-7. doi:10.1155/2011/214365
- Bilano, V. L., Ota, E., Ganchimeg, T., Mori, R., & Souza, J. P. (2014). Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in low- and middle-income countries: a WHO secondary analysis. Plos One, 9(3), e91198. doi:10.1371/journal.pone.0091198
- Burgess, A. & Founds, S. (2016) Nursing Care for Cardiovascular Implications of Preeclampsia. MCN: The American Journal of Maternal Child Nursing, 41(1), 8-15.
- Gestational Hypertension: Pregnancy Induced Hypertension: American Pregnancy Association. (2017). Gestational Hypertension: Pregnancy Induced Hypertension. [online] Available at:http://americanpregnancy.org/pregnancy-complications/pregnancy-induced-hypertension/ [Accessed 30 Jun. 2017].
