4P Clinic
The 4P Clinic is for high-risk women who experienced complications during their pregnancies, particularly high blood pressure. The clinic's physician and dietitian are able to address risks that may impact subsequent pregnancies, as well as long-term cardiovascular health.
At this time we can only schedule appointments with women who delivered their babies at Sunnybrook. To schedule an appointment, please ask you care provider for a referral.
Pregnancy & high blood pressure:
information for patients & families
Download this information as a PDF brochure or read below
Diet, exercise and lifestyle
To control blood pressure and help with weight management, eat a healthy, balanced diet that is low in salt and high in fiber. This includes:
- 7 servings of fruits and vegetables per day
- 2 servings of dairy per day
Incorporating physical activity into your day is important for blood pressure, weight control, improved mood, and maintaining healthy bones. Canadian physical activity guidelines recommend 150 minutes per week of moderate exercise. This can be done in bouts as short as 10 minutes at a time! Ten minutes can be incorporated into your daily activities.
Quitting smoking is very important to reduce risk of heart disease and stroke. Adequate calcium, ideally from dietary sources, decreases chances of high blood pressure returning next pregnancy.
Medications
All women planning pregnancy should include a multi vitamin with folic acid prior to getting pregnant. If you are on medications for your blood pressure you need to be seen regularly and make sure the medications are safe when you get pregnant. Your doctor and pharmacist are there to help.
Low dose aspirin is currently recommended for women with increased risk factors such as preeclampsia before 34 weeks and/or women whose babies were born early and small (growth restricted babies). Low dose aspirin needs to be started at 12-16 weeks of pregnancy so talk to your doctor about whether this is right choice for you next pregnancy.
Hypertensive disorders of pregnancy
High blood pressure is the most common medical problem in pregnancy, impacting up to ten percent of pregnancies.
Women can have high blood pressure alone, known as gestational hypertension. When high blood pressure is combined with other conditions, such as protein in the urine, kidney or liver problems, or babies who are growth restricted, this is known as preeclampsia. If you have high blood pressure before becoming pregnant, you are at higher risk of developing preeclampsia.
High blood pressure in pregnancy can lead to problems for both mother and baby. You are more likely to be admitted to hospital for observation and/or treatment, and you are more likely to give birth early to protect your health or your baby's health. This can be frightening for everyone involved.
If you have questions about your pregnancy, talk with your doctor or midwife.
After delivering your baby
Schedule an appointment to see your doctor or midwife within a week of giving birth, to check your blood pressure. Visit them again at six weeks post birth.
Women can also visit Sunnybrook's Breastfeeding Clinic on M5. Breastfeeding has many benefits for both mother and baby, especially if there was a medical issue like high blood pressure.
Women with high blood pressure in pregnancy are referred to Sunnybrook's 4P Clinic on M4. This inter-professional team will help you plan for your next pregnancy, and your long-term health.
Prevention for next pregnancy
Once you have had a pregnancy with high blood pressure, you are at higher risk next pregnancy of it coming back again. Let your family doctor know you had high blood pressure in pregnancy, as he/she needs to know to look after you. You should see your family doctor for blood pressure monitoring at least yearly after a pregnancy with high blood pressure (or more frequently if your blood pressure was still high at the 6-week visit).
Wait 2 years, but no longer than 10 years, to have your next baby to lower your chances of having high blood pressure your next pregnancy.
Future health implications
Heart attacks and strokes affect women differently, more women than men die of heart disease and stroke every year. A key goal is to improve cardiovascular health for you and your family. Standard risk factors (overweight/obesity, smoking, inactivity, poor diet, family history, high cholesterol) are the same for men and women.
Women have unique pregnancy related risks, making it even more important to make changes to be as healthy as you can be. Risk factors include a history of pre-eclampsia, gestational hypertension, IUGR (babies with poor growth), preterm labor or gestational diabetes and polycystic ovary syndrome (PCOS).
The good news is that many deaths from heart disease and stroke can be prevented by a healthy life style (normal weight; meeting exercise requirements; quitting smoking; alcohol in moderation) and dealing with preexisting risk factors (high blood pressure; diabetes; obesity).
It is important that women and their doctors are aware of these risks to prevent future heart attacks and strokes.
Heart health for mother and baby starts before pregnancy!
