April 5, 2013
Dear Mayo Clinic:
I am 35 and have two children. My husband and I want more kids, but I had high blood pressure during both pregnancies and am now on medication to control it. Is it safe to get pregnant again?
Having high blood pressure does not mean you cannot have a safe pregnancy. But it does raise your risk of problems during pregnancy. The risk of pregnancy complications also rises as you get older. Considering your current age and medical history, you should not delay another pregnancy for long. During pregnancy, you will need to be closely monitored by your health care team, so any issues that come up can be addressed quickly.
Before you get pregnant, consider meeting with a physician who specializes in maternal and fetal medicine. These physicians are experts in caring for women who have high-risk pregnancies. A maternal and fetal specialist can discuss with you the risks you are facing and help develop a plan to manage them. He or she also can work with your obstetrician throughout the pregnancy to help guide your care.
One of the first issues to consider is the blood pressure medication you are currently taking. Some antihypertensive medications are fine to continue throughout pregnancy, while others are not. Talk to your physician about whether you need to change your blood pressure medication. Keep in mind, however, that although medication may keep your blood pressure in check, your pregnancy risks will not be eliminated.
Even if your chronic blood pressure is under control, you still may develop preeclampsia. Preeclampsia is a condition that occurs when you have high blood pressure and high levels of protein in your urine during pregnancy. This disorder can lead to serious complications. For example, preeclampsia can affect the vessels carrying blood to the placenta. If the placenta doesn't get enough blood, your baby may receive less oxygen and fewer nutrients. This can cause slow fetal growth, low birth weight and, in some cases, premature birth.
Preeclampsia also increases your risk of placental abruption, in which the placenta separates from the inner wall of your uterus before delivery. Severe abruption can cause heavy bleeding and damage to the placenta, which can be life-threatening for both you and your baby.
In addition to the risks associated with high blood pressure, your age also puts you in a higher risk category. Traditionally, 35 is considered advanced maternal age. Once you reach 37, the risk of a fetus having chromosomal abnormalities increases rapidly. These abnormalities can lead to miscarriage and birth defects.
All of this information may sound rather daunting. But be assured that it is possible for a woman in your situation to have a healthy pregnancy. Working closely with your health care team, including specialists who are experienced in high-risk pregnancies, can go a long way to catching and managing problems early.
In addition, you can take steps to stay healthy during pregnancy. Doing so will lower your risk of complications, too. For example, getting to or staying at a healthy weight before pregnancy can combat high blood pressure. Following your health care team's recommendations for weight gain during pregnancy is important, as well. Regular exercise can help you stay in shape and keep your body healthier. Your health care team can provide guidance there by offering suggestions on exercises that are best for your situation. And, finally, if you smoke, quit. That's a healthy move that will benefit you and your baby both during and after your pregnancy.
— Margaret E. Long, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.