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Hospitals and doctorsโ rooms may not feel like the safest place to be right now, but if youโre pregnant, you still need to be having all your antenatal checks, writes Dr Enrico Maraschin.
A professor of Obstetrics from Cape Town University recently hosted a webinar on the current Covid-19 situation and its impact on pregnant woman. It was extremely informative but also highlighted a serious problem. Pregnant woman are missing their ante-natal appointments for fear of the virus.
Yes, COVID 19 is scary. There are risks. Bbut what must be emphasised is that pregnancy is a very delicate time for a woman. There are so many changes taking place that are both wonderful and critical to the outcome of a healthy baby.
Understanding these changes and the importance of antenatal care will perhaps help mothers to be make the right choice about attending their follow-up appointments.
What changes are taking place in the body during pregnancy?
One of the major changes occurs in the cardiovascular system. By the time a woman is around 34 weeks pregnant, she will have as much as an additional 1ย 250ml of blood. ย As you can imagine, the heart has to work very hard to pump the extra volume throughout the body and especially to the placenta. This is essential for normal growth and development of the foetus.
The kidneys also make changes during this time. They release more of a hormone known as vasopressin, and this results in the body retaining more water.
These two factors, together with other underlying issues, may lead to high blood pressure. High blood pressure can lead to serious health problems for the mother and infant, but the important thing to know is that in most cases it is preventable and treatable.
What causes high blood pressure during pregnancy?
- Drinking alcohol or smoking
- Lack of exercise
- Being overweight
- First-time pregnancy
- Woman who have had in vitro or other assistance with falling pregnant
- Multiple pregnancy
- A family history of pregnancy related high blood pressure
- Chronic illnesses like diabetes or auto-immune issues
Why is high blood pressure dangerous?
Uncontrolled, high blood pressure has serious consequences for mom and baby.
- Prematurity or poor growth: high blood pressure affects the motherโs blood vessels and makes it difficult for oxygen and nutrients to pass through the placenta. The foetus doesnโt get all that it needs to develop normally, resulting in slow growth, low birth weight and prematurity. A pre-term baby runs the risk of lung problems.
- Placental abruption: with increased pressure on the motherโs vessels the placenta may tear away from the uterus wall and cause the mother to bleed profusely.
- Damage to organs: poorly controlled blood pressure may damage the motherโs kidneys, heart, lungs or brain.
- Future illness for the mother:-A mother who has suffered pre-eclampsia has a higher risk of cardio-vascular diseases later in life.
What illnesses occur as a result of high blood pressure?
- Gestational hypertension: This usually starts at about 20 weeks of pregnancy. Gestational hypertension needs to be monitored closely, but generally it is a condition that settles after the baby is born.
- Pre-eclampsia: This is a more serious condition and it can have severe consequences. It usually occurs in the third trimester. A woman with pre-eclampsia will usually experience numerous symptoms including high blood pressure, protein in the urine, water retention, severe headaches, shortness of breath, vomiting, dizziness and blurred vision. If the pre-eclampsia is left untreated, the woman may have seizures as a result of the condition or develop eclampsia.
- Gestational diabetes: poorly controlled blood pressure may also lead to gestational diabetes. This affects both the mother and foetus.
- HELLP syndrome: In very severe cases of pre-eclampsia, a life-threatening liver and blood condition may develop. H stands for Haemolyses. When this occurs the red cells in the blood are broken down. The E relates to raised liver enzymes which indicate damage to the liver. The first L forms part of the liver involvement while the second L and P relate to the low platelet count in the blood. Platelets allow our blood to form clots. If they are too low, a patient runs the risk of bleeding. A woman who develops HELLP syndrome is truly a medical crisis and something that every doctor fights to prevent in their patient.
What can I do to protect myself?
High blood pressure is also known as the โsilent killerโ. A large number of people do not have any symptoms. For this reason, the most important thing is for pregnant woman to attend their antenatal check-ups, where blood pressure can be properly monitored along with the other necessary checks.
Along with antenatal checks a pregnant woman should:
- Eat healthy foods
- Do moderate exercise
- Drink adequate water
- Avoid alcohol and cigarettes
- Try to control stress. Small changes in a womanโs life can affect blood pressure, so under current Covid-19 conditions this is a real risk.
- Women who have pre-existing conditions or where there is a history of blood pressure problems, must inform their healthcare professional.
If I do develop high blood pressure what treatment will I receive?
Treatment for high blood pressure will be at the discretion of the doctor. Some high blood pressure medications are not recommended during pregnancy so it is really important that treatment is prescribed by a doctor.
In severe cases a woman might need medication to prevent seizures. The doctor may opt to give medication which will help speed up the lung maturity of the baby in case it becomes necessary to deliver the baby before the due date.
Pregnancy is a very exciting time, but is also a time when women become anxious and worry more than usual. The current pandemic has left woman isolated from family and friends and afraid of medical facilities. It is understandable, but even during this time antenatal checks are vital.
Your doctor will take every precaution possible to prevent the risk of Covid- 19 infection, but attending these appointments is ultimately up to the mother. If she understands the importance, then she will be able to make the decision that will safeguard her health and that of her unborn child.
