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Tag Archive for: gestational hypertension

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Geriatric Pregnancy? The Truth About Having a Baby After 35

Blog, Family Planning, Pregnancy

While it’s most common for women to get pregnant in their twenties, nearly 1 in 5 pregnant women is 35 or older. Once called a “geriatric pregnancy,” pregnancy at an advanced maternal age is typically healthy and uneventful.

First, let’s talk about that phrase ”geriatric pregnancy.” Or just as cringe-worthy, “elderly primigravida” and “multigravida.” These are outdated terms that were used to describe women who were pregnant in their mid-late thirties and beyond. Instead, we now use the term “advanced maternal age” or “AMA,” since women who are 35 (or even 45) are definitely not geriatric or elderly.

The age of 35 isn’t some kind of magical cut-off date for an uncomplicated pregnancy. Instead, it is on a gradual continuum where we see increased risks based on lifestyle, increased risk of genetic abnormalities, and declining fertility.

Even so, the main difference pregnant women over age 35 experience is that they receive more monitoring. Overall, their experiences and outcomes are often similar to that of younger women.

What Increases the Risks for Pregnancy Over 35?

Regardless of your age, every pregnancy carries some risks:

  • hypertensive disorders
  • gestational diabetes
  • premature birth
  • low birth weight
  • chromosomal abnormalities
  • miscarriage or stillbirth
  • C-section

Some of these risks increase for women over 35 if they have developed other health problems such as heart disease or obesity. Similarly, the risk of a C-section increases when women experience these health problems (also called comorbidities).

The good news is a healthy and active lifestyle can reduce the risk of obesity, which reduces the risks of diabetes, heart disorders, and even C-sections for single births. (Read more about achieving a healthy pregnancy weight.)

Another risk factor for women over 35 is giving birth to multiples. Women over 35 are statistically more likely to have multiples. Carrying multiples (twins, triplets or more) can also increase a woman’s chances of experiencing hypertension, C-section, and gestational diabetes. (Learn more about what to expect with twins and multiples.)

Finally, as a woman ages, her eggs age with her. Older eggs carry a slightly higher risk of developing chromosomal abnormalities such as Down syndrome. Genetic testing and diagnoses are always available to our OBGYN patients regardless of their age.

How Does Pregnancy Change after 35?

Energy Levels

If you’re over 30, you may already wonder what happened to your endless supply of energy from your late teens and twenties. Often, that answer could be found in your schedule, stress levels, and lifestyle. By the time you’re 35, you may already have children, a busy career, and many other responsibilities that require your time and energy. Add the side effects of the hormonal changes you experience in each trimester, and you may feel more tired than ever!

Confidence

Pregnancy after 35 also has many benefits, such as greater financial and emotional stability, previous experience with childbirth and parenting, or access to more peers who have had children and could provide support.

Women who are pregnant for the first time after 35 also tend to have a higher education level and smaller families overall. (Smaller families mean children do not have to compete for resources, including finances, time and attention.) Some studies have even shown that women who have children after the age of 35 tend to be happier overall.

Increased Monitoring and Tests

Women over 35 may need to be monitored more closely during pregnancy depending on any pre-existing health conditions they have. This would mean more ultrasounds (2-3), more tests to check for heart diseases or gestational diabetes, and non-stress tests in the final weeks of the pregnancy.

Recovering from Pregnancy after 35

Some women wonder if it will be harder to bounce back after pregnancy when they are older. Regardless of age, recovery after pregnancy varies for each individual based on how they give birth and whether they are managing other chronic conditions. For example, it takes longer to recover from a C-section than a vaginal birth.

Some women may have a harder time losing pregnancy weight when they are older or if they have already had children. Lifestyle changes that include regular activity, reducing stress, and eating a healthy diet can help you reach a healthy postpartum goal weight.

Adequate sleep will also help recovery and weight loss, but we know that sleep often feels out of reach in those first few months with a baby at home!

Pregnancy After 40

Women over 40 can also have safe, uneventful, healthy pregnancies. Quality prenatal care is especially important. They will be monitored more closely and have 1-2 more ultrasounds.

One notable difference for pregnant women over 40 is that we’re more likely to recommend induction in the 39th week of pregnancy due to the increased risk of stillbirth.

What About “Advanced Paternal Age”?

The most commonly accepted age for “advanced paternal age” is 40 years old. There is some association with increased risks for miscarriage, neural-cognitive disorders, and preterm birth when the father is older. However, no screening tools have been developed to test conclusively for these risks.

How to Ensure a Safe Pregnancy after 35 and Beyond

Most women, regardless of age, will have a normal and healthy pregnancy. To reduce the chances of developing conditions such as gestational diabetes, high blood pressure, and preeclampsia—which can all influence your baby’s health—it’s important to optimize your own health now.

If you’re near or over 35 and trying to become pregnant, set up a pre-conception consultation with your OBGYN. Ask if you have any pre-existing risk factors you can address now to have a healthier pregnancy.

  • limit alcohol when trying to conceive, especially after ovulation
  • achieve a healthy body composition and maintain appropriate weight gain during pregnancy
  • take a prenatal vitamin that is high in folic acid
  • get active — aim for a level of activity you could maintain during pregnancy
  • stop using tobacco in any form
  • stop any illegal drug use

When to See Your OBGYN

If you’re over 35 and think you’re pregnant, call your OBGYN. At Madison Women’s Health, our first step is to complete a health history with you over the phone. This will help us determine the right timing for your first prenatal visit. If you haven’t experienced complications during a previous pregnancy, and if you don’t have any complicated conditions, you can expect your first prenatal appointment to be about 3-4 weeks after your missed period.

35 is Not an Expiration Date!

We are happy to support you through your pregnancy no matter your age. We believe that every woman deserves the highest level of prenatal care. While there are risks to every pregnancy, remember that most women do have a healthy pregnancy at 25, 35 and beyond!

Sarah Juza, MD Dr. Sarah Juza joined Madison Women’s Health in 2022. She practiced full scope obstetrics and gynecology for several years prior to transitioning into the role of an OB hospitalist.  She specializes in high and low risk obstetrics, breast feeding, contraception, and postpartum care. Dr. Juza earned her Doctorate of Medicine from the Medical College of Wisconsin and completed her residency at Penn State Milton S. Hershey Medical Center.

February 6, 2023/by Sarah Juza
https://madisonwomenshealth.com/wp-content/uploads/2023/02/geriatric-pregnancy-advanced-maternal-age-baby.jpg 800 1200 Sarah Juza https://madisonwomenshealth.com/wp-content/uploads/2017/09/mwh_logo-300x177.png Sarah Juza2023-02-06 09:42:282023-02-06 09:55:37Geriatric Pregnancy? The Truth About Having a Baby After 35

Hypertension & Preeclampsia: How to Prevent and Treat These Conditions

Pregnancy, Women's Health

Because gestational hypertension occurs in women who previously had normal blood pressures — and often is without noticeable symptoms — a diagnosis of hypertension often comes as a surprise.

We understand a diagnosis of gestational hypertension can be worrisome, especially if it develops into preeclampsia. But you’re not alone. Many women have received these diagnoses. In fact, gestational hypertension and preeclampsia are some of the most common issues we take care of with our pregnant patients, complicating 5-10% of pregnancies. Both conditions have become more prevalent over the last 30 years.

Let’s take a closer look at blood pressure during pregnancy and the risk factors, symptoms, and treatment options for both gestational hypertension and preeclampsia.

What Your Blood Pressure Means

Your blood pressure tells the story of how hard your heart works to send blood throughout your body. Your arteries are under constant pressure as your blood circulates. That pressure is necessary to get the blood flowing to your internal organs, to the tips of your fingers and toes, and back to your heart again.

The ideal blood pressure is between 90/60 mm Hg and 120/80 mm Hg. The first number is called systolic pressure — that’s how much pressure your heart puts on your arteries with each pump of blood. The second number is called diastolic pressure. That’s the level of pressure that is constantly on your arteries. Blood pressure over 140/90 mm Hg is considered high.

If your systolic pressure is over 140 mm Hg, or your diastolic pressure is over 90 mm Hg, or both numbers are high at your prenatal appointment, then your doctor will want to measure it again within a short timeframe (within a few hours or sometimes the next day). Sometimes, it is just the stress or worry of a doctor’s appointment or other outside factors that temporarily raises your blood pressure. Temporarily elevated blood pressure is not considered hypertension.

Gestational hypertension is defined as either number in your blood pressure being over 140 / 90 mm Hg when measured two times at least 4 hours apart. It is diagnosed after you are 20 weeks pregnant and in women who previously had a normal blood pressure.

Why Your Blood Pressure Matters More When You’re Pregnant

Blood pressure can increase at the end of pregnancy. For that reason (and several others!), you’ll have many more prenatal appointments in the final weeks of your third trimester.

When your blood pressure is high, your heart has to work harder to pump blood through your body. Chronic high blood pressure, or hypertension, puts extra stress on your heart and arteries, and even on your eyes. When you’re pregnant, high blood pressure makes it harder for your placenta to get enough blood, which limits the nutrients and oxygen your baby receives. When there’s decreased blood flow to the placenta, your baby’s growth can slow, which can lead to low birth weight or premature birth. Hypertension can also lead to low levels of amniotic fluid and placental abruption (when the placenta pulls away from the uterus).

Gestational hypertension can progress to preeclampsia and can affect your other organs, leading to seizure, stroke, and problems with your kidney or liver. It puts you at increased risk for heart disease, stroke, and high blood pressure later in life.

The Difference Between Preeclampsia and Gestational Hypertension

The difference between gestational hypertension and preeclampsia is how they affect your other organs.

Sometimes, gestational hypertension develops into preeclampsia, which can be a dangerous condition because of how severely it affects your organs. It can happen after you’re 20 weeks pregnant but is more frequent when you’re closer to full term. It is usually, but not always, accompanied by protein in your urine (new-onset proteinuria).

Sometimes, there is no protein in the urine, but there are other lab abnormalities and symptoms such as:

  • low platelets
  • impaired liver function
  • pain in the upper right part of your abdomen
  • renal insufficiency (problem with kidney function)
  • pulmonary edema (fluid in the lungs)
  • severe headache
  • or visual changes

These lab abnormalities are known as HELLP syndrome. HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. HELLP syndrome is one of the more severe forms of preeclampsia.

Symptoms of Gestational Hypertension and Preeclampsia

Some patients have no symptoms of high blood pressure. The only reason they know their blood pressure is high is because it’s being monitored at each prenatal exam. (This is why it’s so important to attend all your prenatal appointments!)

Some patients have these symptoms:

  • increased edema (swelling)
  • headaches
  • changes in their vision
  • pain in the upper right side of their abdomen (the location of the liver)
  • nausea
  • or vomiting

It’s important to call your doctor if you experience those symptoms.

Risk Factors of Preeclampsia and Gestational Hypertension

Right now, it’s not known why some women develop gestational hypertension or preeclampsia. However, some factors put women more at risk of developing these hypertensive disorders.

Risk factors in your personal and family history include:

  • if your mother or sister had preeclampsia
  • if you had preeclampsia before
  • if you’re a first time mom
  • if it has been more than 10 years since your previous pregnancy
  • or if a previous pregnancy had complications

Risk factors in your health before pregnancy include:

  • if you have chronic hypertension
  • if you have Type 1 or Type 2 diabetes
  • if you have renal (kidney) disease
  • if you have an autoimmune disease
  • or if you have obesity

Other risk factors include:

  • if you’re having twins, triplets, or more
  • if you are Black
  • or if you are older than 35

Prevention and Treatments for Preeclampsia and Gestational Hypertension

Because the causes of gestational hypertension and preeclampsia are not entirely understood, the best way to try to prevent this from happening is to maintain a healthy lifestyle before pregnancy. For those who are at higher risk of preeclampsia, it’s also recommended to take 81 mg of aspirin (baby aspirin) daily starting at 12-16 weeks gestation. This may help prevent or delay the development of preeclampsia.

Gestational hypertension and preeclampsia are ultimately treated with the delivery of the baby. If someone is diagnosed with this condition after 37 weeks, your OBGYN will recommend delivery at that time. If these conditions develop earlier in your pregnancy, then there is more clinical decision making and monitoring involved. Sometimes, this may lead to delivery earlier than 37 weeks or close monitoring (either outpatient or inpatient) until 37 weeks.

Your OBGYN may use an antihypertensive medication to treat blood pressure during and after delivery. In the case of severe gestational hypertension or severe preeclampsia, she may also use a medication called magnesium sulfate to prevent seizures.

There is no natural remedy to treat preeclampsia. There is insufficient evidence to prove vitamin C, vitamin E, vitamin D, fish oil, garlic supplementation, folic acid or sodium restriction reduces the risk of preeclampsia.

What to Do if You’re Diagnosed with Gestational Hypertension or Preeclampsia

Most often, our patients want to know what happens next, especially when their diagnoses appears suddenly at the end of pregnancy. If you have elevated blood pressure at a prenatal appointment, it’s common for more labs to be drawn. A plan will be made for management of the condition at that time — most often, that plan includes delivery (induced labor) if you are after 37 weeks pregnant, or additional fetal monitoring if you are less than 37 weeks.

Gestational hypertension and preeclampsia are the most common reasons a woman would be induced. These are some of the most common complications we see in the day-to-day practice at our OBGYN clinic.

Any diagnosis or complication during pregnancy can be worrisome. Hearing that you need to be induced can be scary — it probably wasn’t part of your original birth plan. Please know we are here to help you understand the diagnosis and what it means for you and your baby. At the same time, be reassured that this is a relatively common diagnosis that we see almost every day.

We always want you to feel heard and that you know what your options are. We will address any fears or concerns you have and answer your questions to the best of our ability. Our goal is that you have a healthy pregnancy and the best possible outcome for you and your baby!

Dr. Sarah Yanke, M.D. of Madison Women's HealthDr. Sarah Yanke has been providing healthcare to women in Madison since 2010, specializing in high and low-risk obstetrics, contraception, management of abnormal uterine bleeding, and minimally invasive surgical techniques. She is a Board Certified Fellow of the American College of Obstetrics and Gynecology.

December 29, 2020/by Dr. Sarah Yanke
https://madisonwomenshealth.com/wp-content/uploads/2020/12/pregnant-woman-preventing-gestational-hypertension-preeclampsia.jpg 668 1000 Dr. Sarah Yanke https://madisonwomenshealth.com/wp-content/uploads/2017/09/mwh_logo-300x177.png Dr. Sarah Yanke2020-12-29 09:35:302022-07-29 08:59:05Hypertension & Preeclampsia: How to Prevent and Treat These Conditions

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