High blood pressure during pregnancy, also known as hypertension, is a common concern that can pose risks to both the mother and the baby. It's crucial to understand the different types of high blood pressure during pregnancy, the potential risks, and how dietary and lifestyle changes can help manage it. This guide provides comprehensive information on dietary recommendations to help reduce blood pressure during pregnancy, along with other helpful tips for maintaining a healthy pregnancy.
Understanding High Blood Pressure in Pregnancy
High blood pressure is not just an “old person’s” disease. It is one of the most common problems women experience in pregnancy, with many pregnancies being complicated by high blood pressure even among women who had normal blood pressure before becoming pregnant. While having hypertension before pregnancy often means the problem will persist during the pregnancy, many cases of pregnancy-associated hypertension (PAH) occur without any preexisting disease. The cause of PAH is poorly understood.
Types of High Blood Pressure During Pregnancy
High blood pressure in pregnancy is not a single entity. There are four different disorders in pregnancy that have high blood pressure as one of the main features:
- Chronic Hypertension: This is a condition you may have had before becoming pregnant, where high blood pressure develops either before pregnancy or during the first 20 weeks of pregnancy. Your body will adapt somewhat during pregnancy by having lower blood pressure in the early stages; however, later in pregnancy, you may need medications or bed rest to account for blood pressure elevations. Not all medications for high blood pressure are safe during pregnancy, so your doctor may recommend some changes in those you currently take. Chronic hypertension with superimposed preeclampsia occurs when chronic hypertension leads to worsening high blood pressure during pregnancy.
- Gestational Hypertension: This is hypertension during pregnancy only. It means you don’t have high blood pressure before becoming pregnant but develop it during pregnancy, usually in the second trimester or early third trimester, typically diagnosed after 32 weeks. People with gestational hypertension have high blood pressure that develops after 20 weeks of pregnancy. There's no excess protein in the urine and there are no other signs of organ damage. You will not generally need medications unless the blood pressure is markedly high and will usually have normal blood pressure after you deliver your baby.
- Preeclampsia: This is high blood pressure in pregnancy along with fluid retention and protein in your urine. Preeclampsia occurs when hypertension develops after 20 weeks of pregnancy. It is important to take this very seriously, see your doctor regularly, and follow their recommendations to avoid developing eclampsia (seizures) and other severe pregnancy complications. Previously, preeclampsia was diagnosed only when both high blood pressure and protein in the urine were present.
- HELLP Syndrome: This is the most severe form of preeclampsia. The term “HELLP” means “hemolysis, elevated liver enzymes, and low platelets” and it can be deadly. Your chances of dying are as much as 24%, while your baby’s chances of death can approach 70%.
Risks Associated with High Blood Pressure During Pregnancy
Hypertension in pregnancy is risky for you and your baby. It can lead to preeclampsia, which is one of the most severe types of PAH. Preeclampsia causes seizures, poor fetal growth, prematurity, and possible fetal and maternal death. High blood pressure during pregnancy carries potential risks. Having high blood pressure (hypertension) during pregnancy needs close monitoring. Lowering your blood pressure is essential for your health and the health of your baby. If you are unable to manage your blood pressure elevations or develop preeclampsia, the complications can be many.
Obstetrical complications include short-term issues with your pregnancy, such as slow fetal weight gain, seizures, fetal death, preterm birth, and death from HELLP syndrome.
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Non-obstetrical complications, which affect your health outside of pregnancy, include heart failure, pulmonary edema (fluid in the lungs), enlarged heart, risk of heart disease later in life, stroke, kidney failure (acute or chronic), liver failure, and internal bleeding.
Dietary Recommendations for Lowering High Blood Pressure During Pregnancy
Fortunately, you can reduce blood pressure while pregnant by eating certain foods and avoiding those that can make it worse. Both the Mediterranean diet and the DASH diet have demonstrated effects on lowering blood pressure. They are also healthy in other ways because they have the healthy fats you need during pregnancy. You can use these simple dietary and lifestyle changes to help contain your blood pressure within a healthy range.
Foods That Help Lower High Blood Pressure
There are foods that lower blood pressure simply by having them in abundance in your diet. Many contain electrolytes that help the kidneys get rid of fluids in your blood vessels. This naturally reduces the pressure inside them. Here is a good selection of food to choose from. Aim to eat foods that are rich in potassium, calcium, and magnesium, including fruits, vegetables, nuts, whole grains, legumes, fish, and vegetable oils.
- Fresh Fruits: Most fruits are high in potassium and naturally lower blood pressure. The fruits with the highest potassium content include bananas, passionfruit, jackfruit, apricots, oranges, nectarine, cantaloupe, and grapefruit.
- Juices: Fruit juices are also great options for reducing blood pressure. Orange juice, prune juice, and most vegetable juices contain lots of potassium.
- Avocados: These have nearly the same blood-pressure-lowering properties as bananas and have healthy monounsaturated fats. Avocado and Salmon can be combined to create the perfect, nutritious, and delicious breakfast or brunch option! Add a poached egg to further incorporate yet another good fat. Eggs will also inject your meal with another key source of protein alongside the salmon.
- Dried Fruits: Because fruits are dried, you get concentrated doses of potassium to lower your blood pressure. Dried bananas and apricots have the highest potassium content; however, you can eat raisins, dried apples, prunes, papaya, and figs as well.
- Vegetables: Many vegetables are packed with as much potassium as fruits. Eat them fresh for the best benefit. Among veggies with potassium, spinach tops the list. Other great blood-pressure-lowering vegetables include beets, sweet potatoes, russet potatoes (peels included), carrots, acorn squash, and broccoli. The best sources of calcium and magnesium are green leafy vegetables such as broccoli, collard greens, kale, and spinach. Other good vegetable sources include asparagus, carrots, celery, garlic, green beans, onions, peas, squash, sweet potatoes, and tomatoes.
- Beans and Lentils: These are great for soups or mashed into a dip for crackers or tortillas.
- Coconut Water: Instead of water, try cold and refreshing coconut water, which contains potassium to lower your blood pressure.
- Dairy Products: These are not incredibly high in potassium but will still be good choices for snacking. Yogurt and plant-based milk (soy or almond milk) have been shown to reduce blood pressure in research studies. Try fermented milk products, as there is overwhelming evidence to suggest that certain bacterial strains can help lower your blood pressure.
- Meat and Fish: Among these, chicken and salmon are the best options. Oily fish such as salmon, mackerel, sardines, and herring are great sources of essential fatty acids (EFAs), which are clinically proven to lower blood pressure.
- Nuts: Both almonds and cashews are excellent to snack on. Mix them with dried fruit for added blood pressure-lowering effects. Great sources of essential fatty acids also include Brazil nuts, chia seeds, hazelnuts, nut butter, pumpkin seeds, and walnuts. Just remember these should all be free from added salt and avoided if you are allergic to nuts! Aim to eat two to three portions of EFAs every day. One portion equates to a handful of nuts, a salmon steak, or a tablespoon of oil.
- Whole Grains: Whole grains are a rich source of soluble fiber, which has been shown to improve blood pressure control and reduce the need for medication. Try to eat four portions of whole grains each day, such as brown rice, buckwheat, millet, oats, spelt, rye, quinoa, and wholemeal flour.
Foods to Avoid with High Blood Pressure During Pregnancy
There are foods that will not help you reduce your blood pressure and may make it more difficult to keep your blood pressure down if you consume them. Avoid salty foods, including canned goods and processed foods that are high in sodium.
- Salty Snack Foods: Salty snack foods contain sodium, which causes fluid to build up in your arteries, raising your blood pressure. Some of these may not even taste salty. Avoid chips, French fries, popcorn, tacos, and burritos.
- Processed Bread and Sandwiches: Bread, pizza, and rolls are higher in sodium than you’d suspect by tasting them. Sandwiches with cured meats, bacon, and cold cuts have added salt by virtue of the processed meats. A peanut butter sandwich has the added sodium (salt) that comes from the peanuts.
- Soups: Canned soups and some you make at home are also higher in sodium than they taste. If you are making soup, you can adjust the salt content of the soup-something you can’t do with canned soups.
- Processed Desserts: These do not necessarily raise your blood pressure, but they do cause unintended weight gain. A higher weight means you will be more likely to suffer from hypertension or high blood pressure during pregnancy.
- Packaged Meals: These are easy to make but contain much more sodium than you’ll get in foods you make at home.
- Red Meat: Red meats are metabolized in the body in ways that raise your blood pressure, even if you don’t salt your meat. Beef, lamb, veal, venison, and pork are to be avoided if you want to keep your blood pressure down.
- High-Sugar Drinks: These include sodas and energy drinks. Sugar promotes weight gain, and caffeine brings on high blood pressure by constricting your arteries.
- Saturated Fats: Saturated fats cause weight gain and are known to raise your blood pressure. Foods to avoid include chocolate desserts, pastries, pies, cakes, donuts, and full-fat dairy products. Lard, butter, ghee, and margarine also have saturated fats. It’s worth noting that eating a keto diet isn’t generally considered safe during pregnancy. Healthy fats should be limited to 2-3 servings per day.
- Condiments: We don’t often think of condiments as sodium-containing foods; however, ketchup, soy sauce, fish sauce, chili sauce, and salad dressings have a lot of added sodium. Reduce sodium intake and read labels.
- Caffeine: Caffeine will raise your blood pressure and should be avoided if your blood pressure is already elevated. Sodas, black tea, and coffee can be replaced with green tea to help you lower your blood pressure. Do not drink alcohol.
Other Dieting Tips for Those with High Blood Pressure During Pregnancy
There is no reason you need to lose weight while pregnant, even when you have high blood pressure. There are some helpful tips, however, that will make it easier for you to eat well and stay healthy while pregnant.
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- Eat Several Small Meals Daily: You can also have snacks in between to keep you feeling full. The goal here is to stay within the weight recommendations for your pregnancy.
- Pack Snacks with You: Because most snacking outside of the home involves highly-salted fast food, you would do better to bring food from home to snack on. Plan healthy snacks at the beginning of the week so you have plenty of snacks for your work week.
- Salt Your Food Sparingly: If you leave salt off the table or use half the salt you would normally use for cooking, you will adjust to the change in taste quickly. Lower salt will help reduce your blood pressure naturally.
- Use Potassium-Containing Salt Products: Potassium salts are milder in taste compared to sodium chloride (table salt). There are salts you can buy that have mostly potassium or a mix of sodium and potassium chloride for use in cooking or at the table.
- Spice It Up: Generally, you will be less likely to require salt of any kind if you add extra spices. Spices are healthy additives to food and add flavor without adding extra table salt.
The Role of a Prenatal Nutritionist
It can be challenging to know which foods will raise your blood pressure or to determine healthy alternatives to your favorite foods. If you find yourself struggling to put together healthy meal plans or shopping lists of foods to buy, consider seeing a prenatal nutritionist or high blood pressure nutritionist.
A prenatal nutritionist is trained in nutrition during pregnancy. They can study your diet and determine the foods that will help keep your blood pressure controlled. They can help with recipe planning and teach you to read food labels, so you can count sodium and potassium amounts in your diet.
If you are already on a restricted or alternative diet, your nutritionist can help optimize your daily diet while keeping in mind your restrictions. You can see the nutritionist throughout your pregnancy to help you stay within the recommended food guidelines for lowering blood pressure.
A prenatal nutritionist can help with many other things such as managing gestational diabetes or heartburn and acid reflux, making sure you’re getting enough protein during pregnancy, and helping you figure out how many calories you need in each trimester.
Other Ways to Lower High Blood Pressure During Pregnancy
Maintaining your blood pressure in the normal range is not only about your dietary choices. There are things you can do in other areas of your life to remain healthy, even if you have higher than normal blood pressure values.
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- Follow Your Doctor’s Activity Recommendations: Your doctor will generally recommend that you remain active during your pregnancy; however, if you already have high blood pressure or preeclampsia, they may recommend bed rest or modified bed rest. In such cases, you’ll need to avoid heavy activity and perhaps modify your schedule to include bedrest or “couch rest.” Check in with your provider about how much movement and exercise you should be getting during pregnancy. Exercise can help manage stress, which can lower blood pressure.
- Reduce Daily Stress: Stress will usually raise your blood pressure, even when you’re healthy and not pregnant. If you already have high blood pressure, added stress will only cause elevations in blood pressure you can’t afford to have. Aim to manage stress, which can lower blood pressure.
- Get Plenty of Sleep: Sleep is the time when your heart rate and blood pressure drop. If your blood pressure doesn’t drop long enough during the night, you will have more difficulty maintaining normal blood pressure during the day. Lack of sleep is an added stress to your body in the daytime, while seven to eight hours of good sleep will help reduce your daytime blood pressure and pulse.
- Take Medications If Needed: If your doctor recommends low-dose aspirin or other medications to reduce complications of high blood pressure, be sure to take them. The American College of Obstetrics and Gynecology says that low-dose aspirin is safe if your doctor recommends it to avoid this pregnancy complication. Follow the doctor’s orders. This includes attending every checkup that is scheduled with your provider and taking any medications if you are prescribed them. Stay on top of checking your blood pressure at home and check in with your provider to help manage your readings.
- Hydrate: Drinking water throughout the day can be a piece of the puzzle when it comes to managing blood pressure. Aim for at least six to eight glasses of water per day.
- Get Enough Vitamin D: NICE Guidelines state that all pregnant and breastfeeding women should take a vitamin D supplement, as typically we do not get enough through diet or sunshine in the UK. Vitamin D deficiency is a key player in hypertension, along with many other pregnancy complications.
- Maintain Your Pregnancy Weight Gain Within Recommended Limits: If you have excess weight gain during your pregnancy, it will put added stress on your body that will result in more elevations in blood pressure than you can risk later in pregnancy. This doesn’t mean dieting-as losing weight during pregnancy isn’t safe-just remain within the guidelines your healthcare provider recommends. Body mass index is proportionally correlated with pre-eclampsia risk, therefore women should aim for a healthy pre-pregnancy body weight and avoid excessive gestational and interpregnancy weight gain.
The Importance of Monitoring and Professional Guidance
Pregnant women need to have their blood pressure monitored regularly throughout the pregnancy. Monitoring your blood pressure is an important part of prenatal care. If you have high blood pressure, schedule a preconception appointment with a health care provider who has expertise in managing pregnancies complicated by hypertensive disorders. Also meet with other members of your health care team, such as your primary care provider or cardiologist. They'll look at how well you're managing your high blood pressure. During pregnancy, you'll see your health care provider often. Your weight and blood pressure will be checked at every visit. Your health care provider will closely monitor your baby's health, as well. Frequent ultrasounds might be used to track growth. Fetal testing might be used to evaluate your baby's well-being.