Patient Education

What is hypertension?

Hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 160/110 during pregnancy.

Can people with hypertension have a normal pregnancy?

Yes. Most people with high blood pressure will have a normal pregnancy.

If I have hypertension, is there anything I need to do before I become pregnant?

Yes. You should work with your healthcare provider to control your blood pressure before becoming pregnant. This may involve changing your medication to one that is safe to take during pregnancy.

Can hypertension cause pregnancy complications?

Women with hypertension can develop preeclampsia (a condition with hypertension that can also affect other organs), preterm birth, miscarriage, stillbirth, growth problems for the baby, and placenta abruption (when part of the placenta detaches from the uterus).

Can hypertension cause birth defects?

Yes. People with hypertension have a higher risk for having babies with heart and other birth defects.

What kinds of tests are recommended during pregnancy for women with hypertension?

Your healthcare providers will follow the health of you and your developing baby closely during the pregnancy. They will talk with you about the correct screening tests for your pregnancy. Some screening options that might be discussed are:

• Blood screening: Measures certain proteins the baby makes that cross into the mother’s blood. The levels of these proteins can give information on a baby’s chances of having certain birth defects such as spina bifida.
• Ultrasound: Looks at the baby, the placenta, and the fluid around the baby. Pregnant women with hypertension will need to have ultrasounds to evaluate the anatomy, monitor the growth of the baby and look at amniotic fluid levels.
• Heart exam: Mothers with long term hypertension may have abnormal function of the heart and your doctor may order an electrocardiogram (ECG) or an ultrasound of your heart.
• Nonstress tests or biophysical profile: May be recommended in the third trimester to monitor the baby and amniotic fluid levels.
• Other blood test: May be ordered to make sure your kidneys, liver and other organ systems are healthy.

If I become pregnant unexpectedly, should I stop taking my antihypertensive medications?

Two types of antihypertensive medications can cause birth defects and should be stopped if you are considering becoming or are pregnant:

• Angiotensin converting enzyme inhibitors (ACE inhibitors): Include Benazepril (Lotensin), Captopril (Capoten), Enalapril/Enalaprilat (Vasotec oral and injectable), Fosinopril (Monopril), Lisinopril (Zestril and Prinivil), Moexipril (Univasc), Perindopril (Aceon), Quinapril (Accupril), Ramipril (Altace), and Trandolapril (Mavik).
• Angiotensin II receptor blockers (ARB): Include azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis), valsartan (Diovan, Prexxartan), losartan (Cozaar), olmesartan (Benicar), entresto (sacubitril/valsartan), and byvalson (nebivolol/valsartan)

Which antihypertensive medications are safe to take during pregnancy?

Talk to your doctor before starting on new medications during pregnancy.  The most common antihypertensive medications used in pregnancy include labetalol, nifedipine, and methyldopa.

Are other medications recommended during pregnancy in people with hypertension?

Taking low-dose aspirin during your second and third trimesters (after 12 weeks) can lower your risk of preeclampsia. Do not start taking aspirin before talking with your doctor to make sure it is safe for you.

If I have hypertension will I be able to breastfeed my baby?

Yes. There are many health benefits of breastfeeding and people with hypertension should be encouraged to breastfeed. Nifedipine, labetalol, and methyldopa are considered safe in breastfeeding.

When should I call my doctor or nurse?

Call your doctor or go to the hospital if:

• You don’t feel your baby move as it usually does
• You have pain in your abdomen
• You have vaginal bleeding
• You have a bad headache, changes in your vision, or problems breathing

 A certain amount of nausea and vomiting during pregnancy is quite common. In some cases, though, it can be severe and lead to dehydration. Read on to learn how to know when you should seek treatment.

Is it normal to feel nauseous and experience vomiting at times during pregnancy?

Yes. Often referred to as “morning sickness” (even though it doesn’t only happen in the morning), some vomiting and nausea is very common during pregnancy. In fact, it’s experienced in around 75% of pregnancies.

How do I know if my nausea or vomiting is severe?

Feeling nauseous for short periods a few times a day is completely normal. So is vomiting once or twice a day during the first trimester. When it’s severe, though, nausea can last for hours per day, and vomiting might happen three or more times during the day.
If you suspect that your nausea or vomiting might be severe, it is critical to discuss with your ob-gyn so you don’t become dehydrated.
TIP: Keep track of when you vomit and for how long you experience feeling nauseous. This information will be useful for you and your doctor to determine your next steps. It will also help you identify any triggers.

How long does nausea and vomiting last during pregnancy?

For many, it can begin around 6 to 8 weeks into pregnancy. Most find that it subsides at around 14 to 16 weeks of pregnancy, but for some it can last several weeks or even months longer than that.
If your baby is positioned in a way that pushes down on your stomach and intestines, you may experience nausea and vomiting later in your pregnancy as the baby grows.
Rarely, nausea and vomiting can last throughout the entire pregnancy.

Can I make dietary changes to reduce my nausea and vomiting?

Yes. Sometimes mild to moderate cases can be lessened or resolved by adjusting what you’re eating and when you eat. However, more severe cases will require a doctor’s visit to avoid dangerous levels of dehydration.
Here are some ways you can try to relieve your nausea and vomiting through diet.

• Add protein to your diet if you aren’t getting enough, as lack of protein can lead to nausea. If you don’t eat meat, try including alternate options for protein such as dairy or legumes.
• Adjust your meal schedule. Waiting too long to eat in the morning, for example, may lead to nausea. If you aren’t hungry in the morning, eat at least a little something so you don’t start your day on an empty stomach.
• Avoid large meals that sit heavy in your stomach. Instead, opt for smaller meals and eat a healthy snack in between.
• Exercise. Low-impact movement such as prenatal yoga and a brisk walk may help reduce nausea that’s caused when your baby is positioned in a way that’s pressing on your stomach. Don’t overdo it and discuss major changes in your activity levels with your doctor.
• Eat bland foods that don’t irritate your stomach such as plain toast or crackers. Many who experience nausea and vomiting find that following the BRATT diet helps (bananas, rice, applesauce, toast, tea).
• Incorporate snacks into your day. Eat healthy snacks such as fruits, vegetables, or nuts in between meals to avoid an empty stomach.
• Try ginger to make the vomiting and nausea subside. You can add freshly grated ginger to hot water to make a ginger tea or drink ginger ale—just be sure it’s one that’s made with real ginger.

If these ideas don’t work for you, try other foods until you find something that sits well with you. Your goal should be to keep down food and liquid so you and your baby stay hydrated and healthy.

Other ways to reduce feelings of nausea during pregnancy

In addition to making small adjustments to when you eat and what you eat, there are small changes you can make throughout your day that might help your nausea subside. Here are some things to try:

• Avoid standing up quickly, especially after laying down.
• Be conscientious of what triggers your nausea and vomiting. Is there a particular smell that makes your stomach turn? Do your best to avoid it.
• Control your breathing with long, slow, deep breaths. Try breathing in through your nose and out through your mouth.
• Drink plenty of water—at least 8 cups per day. Avoid drinking lots of water in one sitting, which can cause an upset stomach. Instead, sip it throughout the day. Try setting calendar reminders or timers to stay on track.
• Diffuse scents that are calming and reduce feelings of nausea such as lavender, ginger, and lemon.

Should I take a prenatal vitamin?

Yes. It is important for the health of you and your baby to take a prenatal vitamin, so try to take it at a time that will allow the vitamins to absorb into your body. So, for example, if you find that you typically vomit in the morning, take your prenatal vitamin after that.

Some people find that certain brands of prenatal vitamins make them feel more nauseous than others. Discuss with a doctor to find one that’s right for you.

What is hyperemesis gravidarum?

Hyperemesis gravidarum is diagnosed when a pregnant person loses a significant amount of pre-pregnancy weight, experiences dehydration, or loses important bodily fluids due to severe vomiting. In these cases, typical at-home treatments don’t help the nausea and vomiting subside, and the assistance of a doctor to restore bodily fluids is required.

Hyperemesis gravidarum is rare, occurring in less than 5% of pregnancies.

What causes hyperemesis gravidarum?

Though there’s not a specific known cause associated with hyperemesis gravidarum, there are factors that can increase your chances of experiencing it:

• Genetics (if you have a mother or sister who experienced mild to severe nausea or vomiting during their pregnancy)
• Migraines or motion sickness prior to pregnancy
• Pregnant with more than one fetus, or pregnant with a female fetus
• Previous pregnancy with frequent nausea or vomiting

Does severe nausea and vomiting always indicate hyperemesis gravidarum?

Not necessarily, which is why it’s important to discuss your symptoms with a doctor. It’s possible that there’s something else wrong that needs to be addressed such as an ulcer or gallbladder disease. Your healthcare provider should check for other symptoms that aren’t consistent with hyperemesis gravidarum to rule out other issues.

How can I tell if I’m dehydrated?

Too much vomiting can lead to dehydration if your fluids aren’t being replaced. Your baby needs your fluids, so it’s important to see a doctor if you think you might be dehydrated. Here are some signs you might be experiencing dehydration:

• Dizziness upon standing
• Fainting upon standing
• Heartbeat racing or pounding
• Inability to keep down liquids
• Infrequent urination or inability to urinate
• Urine is dark yellow

Will nausea and vomiting affect my baby?

Some nausea and vomiting is fine for your baby. However, severe cases can become a risk because they can lead to dehydration or weight loss which affects your baby’s development.

• If you are dehydrated and can’t keep liquids down, it can impact your levels of amniotic fluid. Low levels of amniotic fluid can cause developmental issues and preterm labor.
• Weight loss for you can mean weight loss for your baby, which is not ideal. This is one of many reasons you should always be weighed at your routine ob-gyn appointments.

Is medication prescribed for severe nausea and vomiting?

After attempting to make changes to the time you eat and the types of foods you consume, and after ruling out other medical issues that might be causing nausea or vomiting, your doctor may decide to try medication.
Doctors sometimes prescribe one of the following to treat severe nausea and vomiting:

• Doxylamine (an over-the-counter antihistamine)
• Vitamin B6 supplement
• Doxylamine and pyridoxine (a prescription medication that’s a combination of doxylamine and vitamin B6)

For very severe cases of nausea and vomiting in which none of the above options are effective and a pregnant person is dehydrated, a doctor may prescribe antiemetic—a medication that is often used to treat motion sickness.

Medication should only be used when all other treatments don’t work. Always discuss with your doctor before taking a new supplement or medication while pregnant.

A preterm birth, sometimes called a premature birth, is when a birth happens three or more weeks before the estimated due date. Read on to learn risk factors that can contribute to a preterm birth, how to minimize your chances of a preterm birth, and more.
 

What is a preterm birth?

A preterm birth occurs when a baby is born prematurely—before the pregnancy has reached 37 weeks. Premature babies have a higher chance of needing to be admitted to a hospital’s Neonatal Intensive Care Unit (NICU).

How does a preterm birth affect my baby?

A baby who is born prematurely doesn’t have as much time to develop before birth. An early birth can sometimes lead to long-term developmental delays in these areas:

• Caring for oneself
• Getting along with others
• Learning
• Physical development (beginning with low birth weight)
• Speech and comprehension

An early birth can also lead to health complications such as:

• Asthma or other breathing problems
• Dental problems
• Hearing loss
• Infections due to a weak immune system
• Intestinal issues
• Lung disease
• Vision problems

In extreme cases, preterm babies are at a higher risk for neonatal death (death within the first 28 days of life).

Do complications vary for preterm babies?

Yes. A preterm baby born at 36 weeks, for example, will typically have less complications than a preterm baby who is born weeks earlier. Here are the subcategories of preterm births, as defined by the World Health Organization:

• Moderate to late preterm: 32 to 37 weeks
• Very preterm: 28 to 32 weeks
• Extremely preterm: 28 weeks or earlier

How does a preterm birth affect me?

Giving birth before your expected due date can be a traumatic experience. You may experience stress caused by concern for your baby’s health. Stress may also come from not feeling mentally prepared to give birth. Additionally, if your baby needs to stay in the NICU, it may leave you feeling distressed about their well-being and your delayed bonding time with them.
If you had a preterm birth and are feeling down or depressed, you are not alone. Discuss your feelings with your doctor. Your mental health is important for the well-being of both you and your baby.

Who is at risk for a preterm birth?

There are a variety of risk factors that lead to preterm birth. If you are at risk, it’s important to be aware so you and your doctor can work together to reduce your risk.
Factors that can contribute to a preterm birth:

• Age (younger than 18 or older than 35)
• Blood clotting tendencies
• Diabetes
• High blood pressure (can lead to preeclampsia)
• Obese before pregnancy
• Pregnancy via in vitro fertilization
• Pregnant with multiple babies
• Previous preterm birth
• Reproductive abnormalities (for example, a short cervix, placental previa, etc.)
• Sexually transmitted infections
• Short amount of time between pregnancies (for example, 6 months or less between birth and conception)
• Underweight before pregnancy
• Urinary tract infections
• Vaginal bleeding
• Vaginal infections

Environmental and lifestyle factors that lead to a premature birth:

• Abuse (physical, sexual, emotional) If you are being abused, you are not alone. Call HOTLINE NUMBER? for help.
• Drinking alcohol
• Drug use
• Exposure to environmental pollutants
• Smoking
• Standing for extended periods of time
• Stress

How can I minimize my risk for a preterm birth?

Some risk factors associated with a premature birth can be prevented while other factors cannot be changed. It is important to do what you can to minimize your risks.

• Abuse. If you are experiencing any form of abuse (physical, sexual, emotional) contact HOTLINE NUMBER? for help.
• Alcohol use. Avoid alcohol during pregnancy. When you drink alcohol, it reaches your baby through the placenta and umbilical cord, affecting their development. No amount of alcohol is considered safe during pregnancy.
• Drug use. In addition to increasing your risk of a preterm birth, using illicit drugs during pregnancy can have severe impacts on the health of your baby. Please see a doctor if you need help stopping drug use.
• Medication use. Discuss with your doctor before taking any kind of medication to verify that it’s safe to use while pregnant. Even if you know that the medication is safe, you need to make sure that your dosage is correct.
• Stress levels. Many people experience stress during pregnancy. Some amount of stress is common, but it’s important to avoid severe stress, which is a contributing factor to preterm birth when it’s accompanied with another risk factor.
• Exposure to toxic chemicals. Avoid breathing in fumes from things that might be toxic such as pesticides, paint, and cleaners.
• Exposure to secondhand smoke. Even if you’re not smoking, being in the same room as someone who is smoking for long periods of time can lead to preterm birth. Avoid inhaling secondhand smoke.

Is there a medication to prevent a preterm birth?

In some cases, doctors prescribe progesterone shots to prevent preterm labor. Progesterone is a steroid hormone that prevents the uterus from contracting. It is sometimes prescribed during a pregnancy in which the person either has a short cervix or previously experienced a spontaneous premature birth. Have a conversation with your doctor to figure out if this is the right option for you.

Breastfeeding after delivering preterm

Breastfeeding has many health benefits, but in some cases a premature baby can’t breastfeed at first. Coordination of breathing, sucking, and swallowing needed for breastfeeding is typically not something a baby is capable of until around 34 weeks of pregnancy.
There are alternate ways for premature babies to get their essential nutrients:

• Feeding tube: If your baby isn’t capable of breastfeeding because of developmental delays, the NICU staff can help you get your breastmilk to your baby with a feeding tube that goes through either your baby’s nose or mouth and into their stomach.
• IV line: Very premature babies may not be able to handle a feeding tube, and in this case a doctor or nurse in the NICU can give your baby essential nutrients through an IV.

Here’s what you can do in the meantime:

• Get as much skin-to-skin contact as possible with your baby.
• Express milk using a hospital-grade double electric breast pump. Express as much as a full-term baby would eat to help your body build your supply of breast milk for when your baby is ready to breastfeed.

Pregnancy after a preterm birth

Delivering a baby at 37 weeks or earlier increases the chances that your next baby will be born prematurely. March of Dimes recommends waiting at least 18 months in between giving birth and getting pregnant again to help reduce your chances for another premature birth.
Discuss with your doctor to see if there are other precautionary measures you can take to reduce your chances of another preterm birth.

If you have epilepsy, you may have concerns about being pregnant or getting pregnant. However, if you manage the disorder properly, it is possible to have a healthy pregnancy and baby. Read on to learn more about epilepsy while pregnant.

What are seizures and what is epilepsy?

A seizure occurs when there’s sudden electrical activity between nerve cells that causes uncontrollable activity in a person’s muscles, movements, behaviors, senses, or awareness of what’s going on around them. It can last anywhere from a few seconds to a few minutes. A person is considered epileptic when they have two or more seizures.

How does epilepsy affect my pregnancy and baby?

If you have epilepsy, it is important to work with your doctor through your pregnancy to manage your seizures. Here are several risk factors that increase with epilepsy:

• Accidents such as falling, getting in a car crash, or burning yourself.
• Decreased oxygen to the fetus
• Lower fetal heart rate
• Miscarriage
• Preterm labor
• Severe bleeding for the baby
• Sleeping or feeding problems for the baby after birth
• Stillbirth

Can a seizure occur during pregnancy if I’ve never had a seizure before?

It’s rare to develop a seizure disorder during pregnancy, but it is possible for a seizure to occur in for the first time when a person is pregnant.
When untreated, preeclampsia—which is caused by high blood pressure—can result in eclampsia, which causes seizures during pregnancy.

What are the different types of seizures?

There are two main types of seizures: generalized and focal. Within each type, there are subtypes.
Generalized seizures impact both sides of the brain. There are two types of generalized seizures:

• Absence. Result in the person experiencing the seizure to appear “absent”—often staring off into space.
• Tonic-clonic (also called grand mal). This type of seizure is more noticeable to those who observe the seizure happen than an absence seizure. A person experiencing this type of seizure may have muscle jerks or spasms, fall down, lose consciousness, or cry out as if in pain.

Focal seizures (sometimes called partial seizures) impact just one part of the brain. There are three types of focal seizures:

• Simple. These seizures affect a small part of the brain and often cause changes in a person’s senses such as taste or smell. They can also cause twitching.
• Complex. A person experiencing a complex seizure may seem confused or dazed. Even after the seizure is over, they might not be able to comprehend or even respond to questions for a few minutes.
• Secondary generalized. These begin in one part of the brain, but they spread to both sides.

Do seizures increase during pregnancy?

Just as every person’s body responds differently to pregnancy, every person with epilepsy reacts differently to being pregnant. Some see a decrease in seizures. Others find that seizures happen about the same amount as before they were pregnant.
Without proper management, some find that their seizures increase during pregnancy. Here are factors that can contribute to having more seizures during pregnancy:

• High blood pressure (can lead to eclampsia)
• Inconsistently taking prescribed anti-seizure medication
• Lack of sleep
• Significant weight gain without properly adjusting your medication (discuss the appropriate dosage with your doctor)
• Stress

How can I control my seizures?

Seizures can be managed with anti-seizure medication. There are two medications that are frequently used because they are considered safe during pregnancy.

• Keppra (generic name is levetiracetam)
• Lamictal, Lamictal XR, and Lamictal ODT (generic name is lamotrigine)

Discuss with your doctor to learn which medication is best for you.

Can I take seizure medication while pregnant?

Yes, you can take seizure medication while pregnant, although it is critical that you discuss your dosage levels with a doctor. Never modify your dosage or completely stop taking seizure medication while pregnant without consulting a doctor. This can pose a risk to both you and your baby.

How do I know if my seizure medication dosage is correct?

Your doctor should order regular blood tests to measure your AED levels (AED = antiepileptic drugs). To monitor how the medication is affecting the rest of your body, your doctor may also order tests to check your electrolytes, kidney function, and more.

Should I continue taking medication after delivering my baby?

Communicating frequently with your doctor during pregnancy is important, and maintaining that communication is equally important after giving birth. Your body goes through a significant amount of stress during and after birth, your hormones change, and many people experience a range of emotions. All of this can contribute to stress and lack of sleep which can both increase your risk of seizures.
Your doctor should monitor your medication blood levels to make sure your seizure medication dosage is adequate.

Is it safe to take seizure medication while breastfeeding?

Yes, it is safe to breastfeed if you are on seizure medication. While there are trace amounts of medication in the breastmilk, it will not harm your baby and the amount of the medication the baby receives is not more than they receive during pregnancy.
Some who take seizure medication feel more comfortable taking medication right when their baby begins their longest stretch of sleep to reduce the amount of medication present in breastmilk. Another option is to take it right when you begin breastfeeding.
Monitor your baby for excessive sleepiness, inadequate weight gain, and decreased alertness. Though all these signs could be caused by other things, it is possible that they’re occurring because your medication dose is too high. Discuss the changes in your baby with a pediatrician. They can help you determine whether it’s a cause for concern. Be sure to discuss with a doctor before decreasing your dosage.

How do I keep my baby safe if I have epilepsy?

Every parent goes through the stress of worrying about their baby getting hurt, and that fear is sometimes heightened for a person with epilepsy. While it’s important to do what you can to keep you baby safe, it’s also important to find ways to balance those fears so that you don’t become too overwhelmed with stress. Here are just a few simple ways you can take precautions to ease your mind and reduce your stress levels.

• Bathe your baby with another person nearby.
• Keep your baby’s changing pad on the floor or strap your baby in while changing their diaper.
• If possible, have a partner help with night feedings to reduce your level of sleep deprivation.
• Never hold your baby while cooking or holding hot liquids.

If you find that your stress levels are getting too high, discuss it with a doctor—it’s best for the health and well-being of both you and your baby.

If I have epilepsy, will my baby have epilepsy?

If you have epilepsy, it does not necessarily mean your baby will be epileptic. There are some types of epilepsy that can be passed down generations. Other times, a person may develop epilepsy even though they do not have any relatives with the disorder.
According to the Epilepsy Foundation, a person with a first-degree relative with epilepsy has less than a 1 in 20 chance of developing epilepsy by the age of 40. Additionally, the risk of developing epilepsy is greater if the person has a first-degree relative with focal epilepsy than it is for someone who has a relative with generalized epilepsy.
Research about epilepsy and genetics is ongoing.

What should I do if I have epilepsy and am planning to get pregnant?

Discuss your plans with your neurologist and OB/GYN. They may suggest a different medication that’s safer when pregnant. For example, taking valproate while pregnant is not safe for your baby. It is known to cause developmental delays, among other issues. Close communication with a doctor when you’re planning to conceive is critical to the health of you and your baby.
Studies are ongoing on the topic of whether a person with epilepsy has a harder time getting pregnant than a person who is not epileptic. But current research shows that epilepsy does not directly affect fertility.

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