Hypertension in Early Pregnancy: Who Should My Primary Caregiver Be?

I am 36-years-old, newly pregnant and have primary hypertension. I take hydralazine three times a day. No one wants to manage my care. My reproductive endocrinologist and obstetrician say to go to an internist. The internist says to go to my obstetrician! Who should I turn to?

Question:

I assume that your blood pressure is currently under control. You need to see a perinatologist (high-risk OB subspecialist or maternal-fetal medicine subspecialist). This is different from a regular OB, so ask if he or she has had subspecialty training (extra training in high risk OB) or at least where they did their fellowship in maternal-fetal medicine. If there are none in your area, the next best thing would be to see your obstetrician for the OB care and the internist to keep your blood pressure in control, checking any med changes with the OB before starting them.

Your pregnancy should be monitored with the usual visits, plus extra blood pressure checks, extra ultrasounds for the growth of the fetus (sometimes they don't grow as well with hypertension) and nonstress tests later (after 32 weeks usually) to be sure your baby is doing okay. Toward the end of pregnancy (or sooner in some cases), you are at higher risk for developing preeclapmsia, so your physician will be watching for that. With proper monitoring, you should be able to have a fairly normal pregnancy, and, if there is a problem, most likely it will be noticed in the earliest stages.

In terms of your blood pressure, we would normally start with aldomet as that has been used the most in pregnancy, with apparent safety. The medication you are on is also used, so if it is working, I would not change your meds for now. There are many other blood pressure meds you can take, such as labetalol or nifedipine in combination with your current meds if needed. The goal is to keep your blood pressure less than 140 for the upper number and 90 for the lower number, as much as possible, while not getting it too low, as that will affect the blood supply to the baby. Many times, you will need less medication (or even none) in the middle of pregnancy, as the pregnancy itself tends to lower your blood pressure.

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