Prenatal care increases the safety of pregnant women against the risk of hypertension

Hypertensive syndromes are complications that can arise during pregnancy, affecting both the health of the mother and the fetus. These conditions can affect pregnant women of all ages, but those aged 35 or over are in the highest risk group. “These conditions are the most common clinical complications of pregnancy. Pre-eclampsia can affect up to 16% of pregnancies worldwide, and can affect, in some low-income countries, up to around 25% of pregnancies. In Brazil, it is the main cause of maternal death”, points out the specialist in High-Risk Pregnancy and Fetal Medicine from the Department of Health (SES-DF), Sâmia Luiza Paiva.

Both gestational hypertension and pre-eclampsia and eclampsia can be treated in the public health system. Prenatal care must begin at the reference basic health unit (UBS), where the diagnosis of hypertensive pregnancy syndrome is made and the patient is evaluated, classified based on her symptoms and exams. Then, the most appropriate treatment is initiated at the UBS itself and the patient is referred to high-risk prenatal consultations. In them, the obstetrician continues the treatment according to the priority and risk of the pregnancy. In urgent situations, the pregnant woman is immediately referred to the obstetric emergency at the referral hospital.

“Ideally, every woman should undergo a pre-pregnancy assessment, so that she can start prevention even before becoming pregnant, controlling her underlying diseases, body weight and changing her lifestyle. Early prenatal care is also essential, as in the first trimester it is already possible to identify pregnant women at higher risk of pre-eclampsia and take appropriate preventive measures”, warns the specialist.

Gestational hypertension occurs from the 20th week onwards, when there is an increase in blood pressure levels without other associated complications. On the other hand, pre-eclampsia, which appears during the same period as hypertension, involves not only an increase in blood pressure, but also changes in other organs and systems, such as the kidneys, liver, lungs and central nervous system. Eclampsia represents a severe form of pre-eclampsia, characterized by generalized convulsions.

Some of the serious complications for the mother include kidney, heart and liver failure, cerebrovascular accident (CVA) and clotting disorders. Doctor Priscila Morato, 38 years old, had pre-eclampsia during her two pregnancies. In the first one, in 2017, she had no symptoms, discovering the condition during prenatal care.

“Early prenatal care is essential, as in the first trimester it is already possible to identify pregnant women at higher risk of pre-eclampsia and take appropriate preventive measures”, explains the specialist in high-risk pregnancy and fetal medicine at the Department of Health (SES- DF), Samia Luiza Paiva | Photo: Jhonatan Cantarelle/Agência Saúde-DF

“During a routine ultrasound, a change in the uterine arteries was identified and, when they measured my pressure during consultation, it was already quite high.” With the diagnosis received in the 22nd week of pregnancy, the effects of the syndrome had already affected the baby, who was born prematurely. “My baby went into severe fetal distress and had to be born at 26 weeks, weighing 525 grams, remaining in the neonatal ICU for 100 days,” he says.

During the second pregnancy, in 2022, during prenatal care, several measures were taken to avoid a repeat of the previous situation. However, the baby also experienced fetal distress, leading to premature birth at 26 weeks.

The risks for the baby are, in most cases, related to the need for premature birth, bringing the possibility of infection, respiratory failure, hemorrhage and brain damage.

The cause of pre-eclampsia is unknown, however there are some factors that can increase a pregnant woman’s risk of developing the disease:

Art: Disclosure/SES-DF

Although some women with preeclampsia may be asymptomatic, signs such as headache or neck pain, swelling in the face and hands, difficulty breathing, nausea or vomiting after the first three months of pregnancy may indicate the presence of the syndrome. If diagnosed, the pregnant woman must be hospitalized immediately. Symptoms of eclampsia include headache, stomach pain and vision changes.

*With information from SES-DF