In this introduction, Dr Rehan-Uddin Khan (Consultant Obstetrician and Gynaecologist and Director of Medical Education, Barts and the Royal London Hospital) tells us more about pre-eclampsia and why monitoring blood pressure during pregnancy is important.
There are several risk factors that mean some women are more likely to develop pre-eclampsia in pregnancy. These factors include:
• having pre-existing high blood pressure
• being overweight
• being an ‘older mother’ (usually defined as over the age of 35)
• having a family history of high blood pressure or pre-eclampsia in pregnancy.
Risk factors mean there is a higher chance that the woman will develop pre-eclampsia in pregnancy. However, it does not mean that she definitely will, and women without any risk factors may also develop pre-eclampsia.
Dr Khan recommended that women who are concerned about their risks “ask questions of your midwife, your GP or your obstetrician”. They can advise on any extra checks or surveillance that might be needed in the pregnancy.
Different conditions and labels
There are different conditions in pregnancy which involve high blood pressure. Examples include ‘pregnancy-induced hypertension’, ‘pre-eclampsia’ and ‘HELLP syndrome’. These conditions are not the same, but they are often thought of as being linked because they all tend to involve high blood pressure in pregnant women. However, blood pressure is not the only feature of these conditions, and some have other signs and symptoms too.
The different names and labels for various conditions involving high blood pressure in pregnancy can be very confusing. Dr Khan said that sometimes a woman’s diagnosis can shift quite quickly. Changes are identified in her symptoms and test results: “For example, a woman may be diagnosed with pre-eclampsia because she has high blood pressure and protein in the urine but it might be that 48 hours later, she is diagnosed with HELLP syndrome because blood tests show evidence of liver enzymes leaking into the circulation and of changes to the red blood cells knowns as haemolysis and a reduction in the level of platelets. These two diagnoses are not in conflict with each other but demonstrate that pre-eclampsia can progress over time”.
For our website, we talked to 41 women and their partners about blood pressure in pregnancy. We heard from a wide range of people whose experiences ranged from one end of a scale (e.g. those who self-monitored their blood pressure as part of a medical study called BuMP and did not go on to develop any high blood pressure problems) through to the middle (e.g. those who were moderately affected by high blood pressure problems) and to the other end of the scale (e.g. those who were severely affected by high blood pressure problems). The number of people spoken to with a particular severity of their experiences is not reflective of the number of cases in the population overall. For example, we interviewed quite a few women who had HELLP syndrome although, as Dr Khan explained, “Pre-eclampsia is a relatively common condition but HELLP syndrome is rare”.