How to handle low blood pressure in pregnancy

This condition is common for expectant moms but is easily treated with at-home remedies

If you’re pregnant, and feeling faint, lightheaded, or a little off balance, low blood pressure might be to blame. Although we usually think of high blood pressure as a complication of pregnancy, low blood pressure during pregnancy is quite common as well—especially in the first 24 weeks of pregnancy. Thankfully, experiencing low blood pressure while pregnant usually doesn’t cause severe complications and can be treated with at-home remedies. Here’s what to know about low blood pressure and pregnancy, including causes, typical symptoms, and preventive strategies.

What causes low blood pressure during pregnancy? 

Low blood pressure (hypotension) in pregnancy is common, especially in the first two trimesters, says Mitchell S. Kramer, MD, the chairman of the department of obstetrics and gynecology at Huntington Hospital in New York. “This is partly due to increased blood flow to the fetus as well as dilation of blood vessels, which occurs in pregnancy from pregnancy hormones.”

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Adi Davidov, MD, associate chair of OB-GYN at Staten Island University Hospital in New York elaborates: “This phenomenon is poorly understood, but it is thought to be due to progesterone-mediated relaxation of the muscles that surround the blood vessels.” Other possible contributing factors to low blood pressure in pregnancy include:

  • Anemia
  • Blood loss, such as from an accident
  • Ectopic pregnancies, when the egg implants outside the uterus; low blood pressure is a possible symptom of this serious and life-threatening condition

Normal blood pressure for pregnant women

Blood pressure is measured using two numbers. Systolic blood pressure (top number) measures how much force your blood is exerting against your blood vessels as your heart beats. Diastolic blood pressure (bottom number) measures how much force your blood is exerting against your blood vessels during the pauses between heartbeats. Normal blood pressure during pregnancy is the same as in non-pregnant people—when systolic blood pressure is lower than 120, and diastolic blood pressure is lower than 80 (or 120/80 mmHg), according to the American Heart Association.

You’re considered to have low blood pressure when your readings dip below 80/50. If your blood pressure gets to this level, you may also notice symptoms, such as faintness or lightheadedness, Dr. Davidov says. 

Symptoms of low blood pressure during pregnancy 

Typical signs of low blood pressure in pregnancy may include:

  • Feeling dizzy, lightheaded, or faint
  • Feeling clammy
  • A sense of dread or something is wrong
  • Fainting
  • Feeling overheated
  • Experiencing headaches
  • Experiencing blurred vision
  • Feeling nauseous
  • Having a racing heartbeat

You are more likely to notice these symptoms when you stand up from sitting down or when you’ve just showered. “Sometimes pregnant women in the first or early second trimester feel faint or dizzy when they shower,” explains Lindemann. “It’s a combination of low blood sugar, motion sickness, and low blood pressure.”

Although these symptoms are typical low blood pressure symptoms, you should report any signs of low blood pressure to your family physician, obstetrician or midwife. While low blood pressure during pregnancy is considered normal, some of the symptoms of low blood pressure, such as headache and blurry vision, resemble symptoms of other, more serious conditions like preeclampsia.

Your blood pressure will be monitored closely during all prenatal checkups using a blood pressure monitor. If there are signs that your blood pressure is deviating from normal, and is either too high or dangerously low, your healthcare provider may ask you to check your blood pressure even more frequently, such as with at-home blood pressure readings. 

What pregnancy complications can low blood pressure cause?

Low blood pressure rarely causes complications for pregnant people or their babies—and only if blood pressure is extremely low, says Dr. Kramer.

Alan Lindemann, MD, OB-GYN, and maternal mortality expert, agrees, “Pregnancy hormones cause the vascular system to enlarge in preparation for more blood volume, which is necessary for a healthy pregnancy.” Rather, gestational hypertension is more concerning. “Although low blood pressure might be annoying, it is high blood pressure that can cause injury or death,” says Dr. Lindemann. 

That being said, low blood pressure may very rarely cause serious pregnancy complications. 

Premature birth or stillbirth

There are very few studies about how low blood pressure affects babies during pregnancy. However, there is some evidence that, in extreme cases, low blood pressure may pose risks to babies. For example, a study from 2012 found that low blood pressure during pregnancy may increase the risk of stillbirth. 

Falling and accidents

Dr. Lindemann says that one of the greatest risks of low blood pressure during pregnancy is the increased risk of falling and injuring yourself or your fetus. That’s because some of the main symptoms of low blood pressure include feeling dizzy, lightheaded, and off-balance, which can increase the risk of fainting or falling. This risk increases if you stand up suddenly.

Increased morning sickness 

Many of the symptoms of low blood pressure mirror the symptoms of morning sickness, such as feeling faint and dizzy. Interestingly, an older study from 2010 found that people with hypotension are at higher risk of developing severe morning sickness during early pregnancy.

Shock

Anyone who experiences extremely low blood pressure is at risk of going into shock. During shock, your blood and organs aren’t getting enough oxygen, which could put both you and the fetus in danger. Signs of shock include clammy skin, rapid breathing, and skin turning bluish. If you are experiencing any of these signs, you should seek immediate emergency care.

How to prevent low blood pressure during pregnancy 

Although low blood pressure can’t be completely avoided during pregnancy, due to the hormonal and physical changes of pregnancy that trigger low blood pressure, there are things you can do to prevent its more serious symptoms. Here is what experts recommend.

Treat the underlying conditions

Although low blood pressure in pregnancy is usually caused by hormonal and vascular changes that are normal for pregnancy, occasionally, an underlying medical condition causes low blood pressure. The most common condition is anemia, which affects more than half of pregnant people. Most physicians will take your blood during pregnancy to check for anemia. If you have anemia, iron supplements are usually recommended. 

Ask your provider about your medications

Certain medications you are taking may lower blood pressure. For example, medication for high blood pressure may cause your blood pressure to dip too low during the first two trimesters of pregnancy, says Dr. Davidov. Make sure you share any medications you are taking with your prenatal care team in case adjustments need to be made.

Exercise

Doing exercises that raise your heart rate for 30-60 minutes a day helps increase your overall heart health. It can also help to boost your blood pressure if it’s too low. It also improves circulation.

Increase fluid intake

Being dehydrated can lower your blood pressure. “Low blood pressure can be minimized by drinking the recommended 2-3 liters of fluid a day,” Dr. Davidov says. If you have trouble drinking enough plain water, you can supplement it with decaffeinated tea, electrolyte drinks such as Pedialyte, or seltzer.

Stand up slowly

Low blood pressure in pregnancy can make you feel lightheaded when you stand up, says Dr. Kramer. For this reason, he recommends taking your time as you stand up from lying down or sitting. You should also drink a glass of water before getting out of bed in the morning. When possible, avoid standing for long periods of time. Compression stockings can also help by preventing blood from pooling in the feet and increasing blood return to the heart.

Eat a meal before showering

Many pregnant people feel dizzy after showering, especially if they haven’t eaten recently. “The development of low blood pressure during pregnancy sometimes has annoying manifestations, including feeling faint in the shower,” Dr. Lindemann says. “For that reason, I recommend eating a complete breakfast and letting it digest for 20 or 30 minutes before the shower.” If you feel dizzy or weak when you get out of the shower, do so slowly, and sit down for a bit after you’ve exited the shower. Also, be sure not to skip meals—even if you are feeling queasy.

Add extra salt to your diet

Certain dietary tweaks may help low blood pressure during pregnancy. Try maintaining a healthy diet consisting of small, frequent meals and staying well-hydrated. Sometimes adding a little extra salt to your diet can help low blood pressure, but you shouldn’t go overboard. You can pack salty snacks like pretzels, popcorns, sunflower seeds, and salted nuts in your bag to have available in the event that you feel dizzy or lightheaded.

How to treat low blood pressure during pregnancy 

“Most pregnant women with low blood pressure do not need treatment, especially if they are asymptomatic,” Dr. Davidov says. “For patients who are symptomatic, it is recommended that they increase their fluid intake.” If you have serious symptoms, you should have a thorough examination by a healthcare provider to rule out other causes of low blood pressure, not related to pregnancy.

In the rare case that low blood pressure during pregnancy requires treatment, the following would be considered, according to Dr. Davidov:

  • Intravenous fluids (IV)
  • Medications that raise blood pressure

There are several different types of medications used to raise blood pressure, including fludrocortisone (contraindicated in the first trimester) and midodrine (adverse events observed in animal reproduection studies). However, many of the medications used to address low blood pressure aren’t completely safe for pregnancy and may include risks to the fetus. However, sometimes the risk is justified if the life of the expectant mom or fetus is in danger. These medications should only be prescribed and closely monitored by your prenatal care provider. 

In most cases, however, low blood pressure is just a fact of life when you are pregnant and isn’t something you need to worry about. In fact, it’s a normal part of gestation. While the symptoms of low blood pressure can be uncomfortable, most people find that taking it slow when they stand up, eating regular meals, and increasing fluid intake work wonders. As the saying goes, “this too shall pass.” You should see your blood pressur



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