Posted: Fri Aug 26, 2011 11:26 pm
Interesting. I was very tightly controlled pre pregnancy (115/75) and my internist and OB have been trying to keep my BP close to that. Actually, because i had such tight control, my BP went too low after the initial drop and I had to cut my meds, but they only cut me enough so I'd stop getting dizzy when I stood (went from 200mg to 150, and stayed around 115/75 or just under after that).
I guess you could use the same logic though--because I had tight control, it's what the placenta is used to, and I don't want to go to 140/90 now.
Posted: Fri Aug 26, 2011 06:33 pm
Thanks for the info about the CHIPS trial! Here's one link I found
Our Experts have also said what Brandi said - and I've seen it repeated by ACOG and just about every other hypertension in pregnancy I've read - that doctors are worried about lowering bp too much because the placenta is used to higher pressures. I'm surprised but very interested to hear an alternate theory and very glad to hear that they're testing it - and in a well designed large study, too!! They do note that their targets bp for 'less tight' control (target diastolic blood pressure of 100 mmHg) versus 'tight' control (target dBP of 85 mmHg)
. Is your doc happy with the 70s-80s for you?
I'm glad to hear you and baby are doing so good, Rach! Thanks for the update!
Posted: Fri Aug 26, 2011 05:30 pm
Apparently there's a worldwide clinical trial going on at the moment to determine whether tightly controlled or loosely controlled BP results in better outcomes for the mothers and babies of hypertensive pregnancies. It's called the CHIPS trial, and I was offered the chance to participate when I first fell pregnant but I felt the risks were too great, especially if I was allocated to the group of women with higher pressures. I was later told I wouldn't have qualified for the trial anyway. Now that I've increased my meds, my BP is averaging 130's/70's-80's, which is good, but not too low
Posted: Fri Aug 26, 2011 01:17 pm
Wow thats the exact opposite of what my MFM's have said and done with me. They said that our bodies and placentas are used to flowing at a higher pressure and so when we go too low, baby isn't getting enough. They wanted me to stay in the 130's/80's range and were even cool with 140/90's. They didn't want me quite "normal" because baby woudln't be getting enough blood flow.
Posted: Wed Aug 24, 2011 07:16 pm
Hi there. Just thought I would update everyone on how I'm doing. I'm now at 32 weeks 5 days pregnant. Two weeks ago my doctor increased my Methyldopa to 750mg morning, 500mg middle of the day, 750mg at night because my pressures were spiking into the 150's/high 80's at night. After that, I started getting low BP episodes when I was standing up for long periods of time, worse in the mornings. So I went back to see her and she dropped the extra morning med, putting me back to 500mg, 500mg, 750mg. I had my regular antenatal visit today, and the pressures are still too high for her liking at night - high 140's/high 80's (not incredibly high, but still higher than she would like), so my meds have been increased again, but instead of taking an extra tablet in the morning, I'm taking an extra one in the middle of the day instead, so I'm now at 500mg, 750mg, 750mg. I'm hoping the dizziness issues don't make a return.
The way my doctor described it to me is that when blood pressure is sitting at an average to low level, (even though I was chronic hypertensive before falling pregnant), the blood is able to flow easily through the placenta to the baby. But if the blood pressure is high, it's being pushed through the placenta so forcefully that the baby doesn't get enough. So essentially, the lower the BP the better it is for the baby (even if Mum is feeling a bit dizzy).
Other than that, it looks as though baby is doing well. Her heartbeat is wonderful - 160bpm, and my fundal height is measuring a week ahead of dates. I have another appointment at the hospital this afternoon and I'm planning to ask for (and demand if I have to) a growth scan just to make sure she's still growing well.