hypertension

When a woman is pregnant, her body undergoes hemodilution. About 40-50% more blood is made in her body - which, as I've already written about, explains "anemia" values around 28-32 weeks. This increase in blood volume means women crave salt (sodium is a large part of making new blood) and also are prone to swelling in the last trimester of pregnancy.

Pre-eclampsia is a very valid concern and fear of providers that care for pregnant women. Not taken care of quickly enough (either through the birth of the baby and/or measures to maintain the blood pressure and subsequent organ damage), it can lead to death for both mother and baby. It is no wonder that providers are quick to jump the gun when they see any rise in blood pressure during pregnancy.

In the first 24 weeks of pregnancy the blood pressure will drop a bit from pre-pregnant levels. This is normal and a result of hemodilution. After 32 weeks, we start to see some women develop rises in blood pressure. This is normal, as many women are getting back to their pre-pregnant levels and then a bit more because of the increased vascular needs of the placenta.

With pre-eclampsia, because the blood volume is contracted instead of expanding, you won't see a drop in blood pressure around the time you'd expect the blood volume to be at its peak. The blood pressure drop you see in healthy women is nature working at its best: the increased blood volume works with pregnancy hormones to help "relax" the blood vessel walls and allow more free flowing blood...this creates a dip in blood pressure.

I've heard many providers, midwives included, refer to any gestational hypertension as pre-eclampsia. Usually because they also see trace amounts of protein and some swelling. Trace protein is not a sign of pre-eclampsia. In order for an accurate reading to be made re: proteinuria, a 24 hour urine collection MUST be done. Dipsticks are NOT reliable for this. Proteinuria is a late sign of pre-eclampsia...you're not likely to see proteinuria as an indicator for pre-eclampsia in the early stages of rising blood pressure.

Swelling in pregnancy - this can be a very reassuring sign in the late third trimester. This is a reflection of an adequately expanded blood volume and isn't an issue if it's in the lower legs/feet and transitory in the hands (heat, position, etc, all affect normal swelling). Swelling in the face and hands that is pronounced (and family members/friends comment on it, it's not something that is slight) is a different story and should be investigated further with lab tests.

In the last six weeks of pregnancy, some women have rises in blood pressure. Even slightly above 140/90. Does this mean that they're toxic or hypertensive? If all the labwork rules out pre-eclampsia (liver panel, 24 hour urine collection, CBC shows a drop in hemoglobin from the start of pregnancy), then we can assume it's the delicate communication between the placenta, baby and the mother's body. As the baby grows and puts on subcutaneous fat, it requests an increased volume of blood/nutrients from the mother. The body responds by increasing the blood pressure to meet these new needs. The same also occurs if the placenta, for whatever reason, is starting to deteriorate at any time during pregnancy - oftentimes if the placenta cannot branch out to find new sources of uterine connections, it will request an increase in blood pressure to maximize the areas that are functioning well.

Furthermore, discussing the risk of induction, transfer to the hospital, or provider stress about blood pressure concerns will only further increase a woman's blood pressure every time it is checked. We have to be careful in looking at all symptoms of pre-eclampsia and realize that a rise in blood pressure late in pregnancy is oftentimes correlated to very good outcomes. What we are treating then, like with most things in pregnancy, is a non-issue.

From Michel Odent:

The common tendency to confuse gestational hypertension -- which is not associated with proteinuria -- and preeclampsia is an obstacle to understanding the nature of the disease. Several epidemiologic studies confirm that gestational hypertension is followed by good perinatal outcomes.^[2-5] According to the most common definitions, preeclampsia implies the association of high blood pressure and the presence of more than 300 mg of protein in the urine per 24 hours (unrelated to urinary tract infection).

Many midwives recommend increasing protein (some recommend as much as 120 grams a day!) for all their pregnant clients. They tell women that this will help prevent pre-eclampsia. From the research done at the Cochrane Database, we know that protein intake (unless a woman is severely malnourished) does NOT affect the rates of pre-eclampsia. What about Dr Brewer's Diet then? Well, he recommended increasing calories and food variety for women at a time when they were grossly undernourished in pregnancy trying to reach linear weight requirements. His sample size is too small to take his "results" as proof that all we need to do to eradicated pre-e is give women insanely large amounts of protein.

Michel Odent reports that perhaps whent it comes down to it SARDINES may be the answer!

I personally have seen some sharp rises in blood pressure lowered a bit with increased protein intake - but I do not feel that these women would have developed pre-eclampsia.

Either way, we don't really know how to completely treat or prevent pre-eclampsia. What we do know is that gestational hypertension is NOT pre-eclampsia and many times what women are being induced for (called "pre-eclampsia") is a natural response of increased blood pressure to meet the needs of the growing baby.