Pregnant women, as a special group, are generally extremely cautious with medication, so how should I respond to hypertension found during pregnancy?
[What is hypertensive disorders of pregnancy].
Hypertensive disorders of pregnancy is a group of hypertensive disorders seen during pregnancy, including.
1, hypertension in pregnancy: blood pressure ≥ 140/90 mmHg, first detected during pregnancy and return to normal blood pressure within 12 weeks after delivery, no urine protein, patients may be accompanied by epigastric discomfort or thrombocytopenia, and the diagnosis can be confirmed only after delivery.
2. Pre-eclampsia: divided into mild and severe pre-eclampsia. Mild: blood pressure ≥140/90mmHg, urinary protein ≥0.3g/24h or urinary protein (+) for the first time after 20 weeks of pregnancy; severe:those who achieve any one or more of the following: blood pressure ≥160/110mmHg, urinary protein (++), proteinuria ≥5.0g/24h, blood creatinine >106μmol/L, platelets <100×109/L, lactate dehydrogenase rising, liver enzymes rising, persistent headache or other neurological or visual disturbances in the brain. Patients with gestational hypertension are classified as preeclampsia once they develop proteinuria.
3, eclampsia: Pregnant women with pre-eclampsia have convulsions or coma that cannot be explained by other causes.
4, chronic hypertension complicated by preeclampsia: pregnant women with chronic hypertension without urinary protein, appearing after 20 weeks of pregnancy with urinary protein ≥ 300mg/24h; sudden increase in proteinuria after 20 weeks or further increase in blood pressure or the presence of platelets <100×109/L.
5, pregnancy combined with chronic hypertension: blood pressure ≥ 140/90mmHg, hypertension diagnosed before pregnancy or before 20 weeks of pregnancy and persisted after 12 weeks postpartum.
Daily diet for hypertensive disorders in pregnancy
1.Control of caloric energy and weight
High energy intake during pregnancy can easily lead to obesity, and obesity is an important risk factor for gestational hypertension, so the amount of food should be properly controlled during pregnancy, not “eat as much as you can” uncontrolled eating, should be adjusted to the normal weight gain during pregnancy as the standard amount of food. The actual fact is that the actual person who is overweight before the pregnancy, should try to eat less or no candy, snacks, sweet drinks, fried food and high-fat food. It is appropriate for pregnant mothers to not exceed 12 kg throughout pregnancy.
2.Reduce the intake of saturated fat
The caloric ratio of food fat should be controlled at about 25%, and the maximum should not exceed 30%, and saturated fat should be reduced and the intake of unsaturated fat should be increased accordingly. That is, eat less animal fat, and vegetable oil instead, about 20 grams of oil for cooking every day. In this way, not only can provide the fetal baby with the essential fatty acids needed for growth and development, but also increase prostaglandin synthesis and help eliminate excess fat.
3, to prevent insufficient protein intake
Poultry and fish proteins can regulate or lower blood pressure, and the proteins in soybeans can protect the cardiovascular. Therefore, eating more fish, poultry and soybeans can improve blood pressure during pregnancy. However, pregnant mothers with abnormal kidney function must control protein intake to avoid increasing the burden on the kidneys.
4, to ensure the intake of calcium
The Chinese Nutrition Society recommends a daily calcium intake of 800 mg, 1000 mg, 1200 mg and 1200 mg for the early and middle stages of pregnancy and lactation, respectively. Pregnant mothers should ensure that they drink milk every day. Milk and dairy products are rich in easily absorbed calcium and are good foods for calcium supplementation, with low-fat or nonfat dairy products being appropriate. Studies have shown that increasing the intake of dairy products by pregnant women can reduce the occurrence of gestational hypertension.
5, the intake of salt to moderate
If you have too much salt, it will easily lead to water and sodium retention, which will raise the blood pressure of the pregnant mother, so you must control the salt intake. It is generally recommended that pregnant mothers should consume less than 5 grams of salt per day to help prevent gestational hypertension. Soy sauce should also not be consumed in excess, 6 ml of soy sauce is equal to about 1 gram of salt. If you are used to a saltier taste, you can use some potassium salt instead of sodium salt, which can improve the taste of cooking with less salt to a certain extent, and you can also use onion, ginger and garlic to season.
Pregnant mothers should not eat cured meat, pickles, pickled eggs, cured fish, ham, squash, pickles, etc. However, pregnant mothers, because of the acidity of the stomach, can, if necessary, appropriate intake of hairy food, soda crackers, baked film, dried bread and other foods to reduce the discomfort of excessive stomach acidity.
6.With rich vegetables and fruits
Ensure daily intake of more than 500 grams of vegetables and 200~400 grams of fruits, with a variety of vegetables and fruits. Because vegetables and fruits can increase the intake of dietary fiber, which is beneficial for preventing constipation and lowering blood lipids, and can also supplement a variety of vitamins and minerals, which is conducive to the prevention and treatment of gestational hypertension.
[Treatment characteristics of hypertension in pregnancy].
1. Hypertension during pregnancy is considered an important cause of maternal and in utero fetal death and neonatal death. The use of antihypertensive drugs during pregnancy should take into full consideration the effects of the drugs on the mother and on the fetus through the blood of the placenta.
2. Antihypertensive drugs can lead to a rapid decrease in perfusion pressure in the organs, which leads to low maternal cardiac output as well as a decrease in uteroplacental blood flow and may induce fetal asphyxia, and therefore must be applied with caution.
3. The aim of treatment is to enable the patient to avoid the emergency state of severe hypertension as well as chronic hypertension and to continue the pregnancy, thus requiring a gentle lowering of blood pressure.
[Pharmacological treatment of hypertensive disorders during pregnancy
1.Central antihypertensive drugs: The drug recommended by the British Hypertension Society (BHS) for the treatment of pregnancy combined with chronic hypertension is methyldopa, which is still the first-line drug for hypertension in pregnancy.
2. Calcium antagonists: It is still controversial whether the use in early pregnancy (within 3 months) increases the risk of fetal malformation. However, when nifedipine is used to treat hypertension in pregnancy, it has a moderate antihypertensive effect, does not reduce cardiac output, has the effect of suppressing contractions, and can be used as a first-line antihypertensive drug, and mostly tends to use controlled-release or extended-release dosage forms to smoothly lower blood pressure. New generation drugs such as irradipine, nimodipine and nicardipine are highly vascular selective and have weak effects on uterine contractions during and after delivery, and can be used more confidently in the treatment of hypertension in pregnancy. However, it should be noted that calcium antagonists can not and commonly used in the treatment of eclampsia magnesium sulfate combined, because the role of magnesium sulfate can be enhanced by calcium antagonists, may lead to sudden and severe hypotension.
3, beta-blockers: the effectiveness of gestational hypertension has been confirmed, and the short-term use in late pregnancy is considered safe. However, because they can pass through the placenta and reduce the blood supply to the uterus and placenta, they can cause intrauterine growth retardation, neonatal respiratory impairment and hypoglycemia. Indololol and atenolol have the above-mentioned effects and should not be used in the early and middle stages.
4, vasodilator: hydrazinepyridazine is a direct vasodilator drug, which has obvious dilating effect on small arteries and reduces diastolic blood pressure, does not affect the uteroplacental circulation and has no adverse effect on the fetus. Intravenous medication in foreign countries as the drug of choice for severe hypertension in pregnancy.
5, diuretics: the antihypertensive effect is relatively weak, and the application of diuretics in early pregnancy, so that the maternal blood volume can not be expanded to the normal pregnancy level, which may contribute to the occurrence of pre-eclampsia. Thiazide diuretics have the presence of adverse reactions leading to fetal and neonatal jaundice, hypokalemia, thrombocytopenia, etc. In principle, excessive use should be avoided.
6, angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARB): in the middle and late pregnancy with drugs, ACEI can lead to fetal abnormalities, such as low amniotic fluid, pulmonary insufficiency, fetal growth retardation, renal insufficiency, neonatal anuria and neonatal death. ARBs should not be used during pregnancy because they can cause fetal malformations and stillbirths.