Infants of Mothers with Hypertension or Pre-eclampsia
What is Hypertension?
Hypertension is high blood pressure. "Pregnancy associated hypertension" occurs only during pregnancy. "Chronic" (or long lasting) hypertension is present before pregnancy and does not go away after pregnancy.
What is pre-eclampsia? Pre-eclampsia is the combination of:
high blood pressure,
edema (swelling due to extra fluid in the body)
protein in the urine. Normally there is no protein in urine.
"Pre" means before and "eclampsia" refers to seizures (convulsions, fits). If pre-eclampsia becomes severe or is not treated, seizures may occur.
How is pre-eclampsia in the mother treated? It is treated by any or all of the following:
Medicines to lower blood pressure
Medicines to prevent seizures
When pre-eclampsia is severe it may cause liver, kidney, blood clotting and other problems in the mother. If this occurs, it is called HELLP Syndrome (H-hemolysis or breakdown of red blood cells, EL- elevated values on tests of liver function, LP- low platelets). If HELLP occurs, usually the baby must be delivered, even if it is very premature. The only cure to pre-eclampsia is delivery of the baby.
How does pre-eclampsia or high blood pressure affect the baby? If high blood pressure occurs only in the last few weeks before the due date, usually the baby is fine. But, if it occurs earlier, both the mother and the baby may develop problems. The small blood vessels in the placenta tighten, allowing less blood and nutrients to get to the baby. Some problems that occur more often in infants of mothers with high blood pressure or pre-eclampsia include:
Slow growth while in the womb, called intrauterine growth retardation
Need more help breathing at birth (resuscitation)
More likely to need oxygen in the hours after birth
Low Blood Sugar
High number of Red Blood Cells
Low number of White Blood Cells
Low number of Platelets
Patent Ductus Arteriosus
Slow to feed
Low muscle tone
Low Blood Pressure
Because these babies are premature, they can have any of the common problems of premature babies.
How are these problems treated?
Intrauterine Growth Retardation
Needing more help breathing after birth and oxygen after birth - At birth babies much change the way in which blood circulates through the body. In utero (in the womb), very little blood goes to the lungs because the placenta does most of the work that the lungs would do to deliver oxygen to the blood. Immediately after birth the blood vessels to the lungs must expand allowing more blood to flow to the lungs. This process may take longer in the infant whose mother had high blood pressure. This is called persistence of the fetal circulation or primary pulmonary hypertension.
Low Blood Sugar
Patent Ductus Arteriosus
High number of Red Blood Cells - Usually this does not need any treatment. If the number is extremely high, doctors can remove some of the baby's blood and replace it with a solution that does not contain red blood cells.
Low number of White Blood Cells - Usually these will come up on their own over the first week or two. Occasionally it is treated by gamma globulin or white blood cells from the blood bank. Babies with low white blood counts at birth may be at greater risk for infections while in the nursery.
Low Platelets - Platelets help in blood clotting. If they are only a little low, no treatment may be needed; but, if they are severely low, the baby may need a transfusion of platelets to prevent bleeding.
Slow to feed, low tone, low calcium - These problems usually result from the use of magnesium sulfate in the mother. They will improve slowly over a few days. The baby may not pass stool or be able to feed for several days.
Low Blood Pressure - This may be due, in part, to the medicines given to the mother to lower her blood pressure. Low Blood pressure is a common problem is sick babies even if the mother does not have high blood presssure.
Will my baby have high blood pressure in later life? Children may be at risk for high blood pressure later in life if:
Their mother continues to have high blood pressure after pregnancy
High blood pressure runs in the family.
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