Understanding Hypertension in Pregnancy: Insights from a Maternal-Fetal Medicine Specialist

Published Jul 10, 2024

Karen Florio is a maternal-fetal medicine specialist with a passion for understanding hypertension in pregnancy. Her journey began unexpectedly after experiencing pre-eclampsia during her own pregnancy. Despite being in peak physical health at the time, she became pre-eclamptic at 28 weeks pregnant, leading to an early delivery and extended hospital stays for Karen and her son — who are both healthy today. This personal experience ignited her dedication to researching the underlying causes of hypertension in pregnancy, hoping to improve outcomes for others in similar situations. Here, she provides some helpful advice for providers and patients who may be treating or experiencing hypertension in pregnancy.

What Patients Should Know About Hypertension During Pregnancy

Hypertension during pregnancy, including pre-eclampsia, can present in unexpected ways. It’s not always characterized solely by high blood pressure; symptoms can vary widely. It’s crucial for every pregnant person to be vigilant and aware of any unusual symptoms. I recently had a patient I could have sworn was having a heart attack, but it turns out she was having bad heartburn from pre-eclampsia. You know your body best. Trust your instincts and communicate openly with your health care provider if something doesn’t feel right.

Barriers to Treatment During Pregnancy and Postpartum

One of the challenges I’ve encountered in treating hypertension during pregnancy and postpartum is the variability in awareness among health care providers. Not all medical professionals are sufficiently trained to recognize the signs and risks associated with high blood pressure in this context. When we go to medical school and residency, we train in our chosen area and that does not often include training for other specialties. For instance, an emergency room doctor may not be suspicious for postpartum pre-eclampsia or may not even be aware that you recently had a baby. This gap in awareness can delay diagnosis and treatment, potentially leading to serious complications. As patients, advocating for yourself by expressing concerns and mentioning specific conditions like pre-eclampsia can help ensure timely intervention.

Essential Knowledge for Health Care Providers

Providers across specialties should prioritize screening for recent pregnancy when assessing patients. Asking a simple question — “Have you been pregnant in the last six weeks?”— can trigger consideration of pregnancy-related conditions, including hypertension. Early recognition and timely treatment are critical due to the physiological changes that make blood vessels more susceptible during pregnancy. Any blood pressure reading above 160/110 mmHg in a pregnant or recently postpartum patient warrants immediate attention to prevent severe complications.

Action Steps for Pregnant and Postpartum Individuals

If you or someone you know experiences high blood pressure during pregnancy or within six weeks after delivery, tell your OB-GYN or midwife right away. Elevated blood pressure in this period can lead to serious outcomes such as stroke, seizures or even death. Immediate treatment is essential for ensuring both maternal and fetal health.

Understanding hypertension in pregnancy involves proactive patient awareness and informed health care provider action. By working together to improve awareness and response, we can enhance outcomes for mothers and babies facing these challenges. If you have any concerns or questions about hypertension during pregnancy, reach out to your health care provider for guidance.

Wishing you all good health and a safe pregnancy journey.

Karen Florio, D.O., Maternal-Fetal Medicine

The Missouri PQC’s severe hypertension in pregnancy initiative focuses on the timely treatment of severe hypertension during pregnancy and the postpartum period with first-line antihypertensive medications, scheduling appropriate follow-up for people with hypertensive disorders of pregnancy, and obstetric and emergency department provider and nursing education on hypertensive disorders of pregnancy.