Dr. Ahmed Gestational Hypertension is a term describing hypertension in pregnancy. Typically, new-onset hypertension that occurs after the 20th week of gestation is called gestational hypertension. However, hypertensive females may become pregnant and develop obstetric complications of hypertension. These patients may have chronic hypertension or chronic hypertension with superimposed preeclampsia.
An unhealthy pregnancy brings with it a ton of associated disorders that can pose serious threats to the health of the expecting mother.
Habits that are detrimental to health and practiced before and throughout pregnancy can complicate the process and lead to unbearable outcomes. One of such consequences is gestational hypertension that is discussed here below.
What does ‘gestation’ mean?
The time span from conception till the birth of the baby is termed the gestational period. During this time period, the baby develops and grows inside the womb of its mother. Gestational age or GA is the proper term used commonly to refer to how far along is the pregnancy.
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What is Hypertension?
Hypertension is generally defined as a blood pressure of 140/90 or more. Hypertension can be further classified as “essential hypertension” and “secondary hypertension”. Secondary hypertension affects 10% of individuals. It occurs predominantly in young individuals who are 30 years of age or younger.
Essential hypertension or idiopathic hypertension is the most common. It affects older individuals and those who are obese, have diabetes, dyslipidemia, and have a family history of hypertension.
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What is Gestational Hypertension?
This term is self-explanatory, a blood pressure range exceeding the normal 140/90 level during pregnancy, particularly after 20 weeks of gestation is termed gestational hypertension. This condition occurs in approximately 6 percent of all pregnancies.
Occurring commonly in the second half of the pregnancy, gestational hypertension is different from chronic hypertension in the sense that the latter occurs before pregnancy and the former occurs mid-pregnancy. It also varies from two other conditions called preeclampsia and eclampsia.
Gestational hypertension is typically cured by taking care of the mother’s diet and it goes away after the baby is born.
The Four Types of Hypertension Syndromes in Pregnancy:
There are four types of hypertension during pregnancy according to the mayo clinic. All of them are described here.
Gestational Hypertension:
This type exclusively occurs during pregnancy, this can occur during the 2nd half (after 20 weeks of gestation) of pregnancy and typically resolves after the baby is born. There is no sign or symptom of any organ damage or too much protein in the urine associated with this type and the patient eventually develops preeclampsia.
Chronic Hypertension:
In this case, high blood pressure is already present before pregnancy and continues to be elevated throughout pregnancy. It can also occur before 20 weeks of gestation but due to no evidence of signs of hypertension, it is not possible to pinpoint the time of its occurrence.
Chronic Hypertension with Superimposed Preeclampsia:
This type is marked by a new and sudden onset of excess protein in the urine along with elevated blood pressure. Commonly occurs in women who were already hypertensive prior to conception and developed abnormally high blood pressure levels during pregnancy.
Preeclampsia:
Characterized by the presence of protein in the urine, preeclampsia is also known as toxemia. Patients have swollen legs and hands. It can occur in the early stages of pregnancy, sometimes late or after delivery.
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This condition can, later on, lead to eclampsia which is marked by seizures and coma. At the moment the only known treatment of preeclampsia is giving birth, the symptoms of it can last for roundabout 6 weeks after delivery, nevertheless.
Preventing preeclampsia includes learning about the symptoms and receiving prenatal care early on.
Causes of Gestational Hypertension:
Although the exact cause behind gestational hypertension is still not clear, however, there are certain risk factors that elevate the chances of its incidence during pregnancy.
- A high blood pressure prior to conception
- History of gestational hypertension in a previous pregnancy
- Presence of diabetes mellitus
- Presence of kidney diseases
- Aged older than 40 or younger than 20
- Having a twin or triplets’ pregnancy
- Family history of pregnancy-induced hypertension
Symptoms of Gestational Hypertension:
If a patient who is at risk of developing gestational hypertension learns about its symptoms and takes measures to treat and avoid it then she will most likely not fall a victim to this disorder.
Such symptoms include:
- Eyesight problems like blurred vision or double vision
- Swelling in the legs and hands (edema)
- Abnormal values of liver and kidney function tests
- Pain in the upper abdomen (right side)
- Unintended or sudden weight gain
- Vomiting
- Feeling nauseous
- Little passage of urine
- Excess protein in the urine
- Elevated blood pressure
Diagnosis of Gestational Hypertension:
The diagnosis of hypertension in pregnancy is made when two or more readings of the blood pressure exceed 140/90 mmHg in pregnant females. In pregnant females with normal blood pressure readings before the 20th week of gestation who develop high blood pressure are labeled to have gestational hypertension.
All patients with chronic hypertension and gestational hypertension should be tested for preeclampsia. If the symptoms are apparent or the patient is at a high risk of falling a victim to this condition then the diagnosis should be made immediately.
- Perform urine tests to check for preeclampsia
- Renal and liver function tests
- Checking for edema
- Frequent blood pressure readings
- Frequent weight gain measurements
- Tests for blood clotting
Complications Associated with Gestational Hypertension
Having abnormal blood pressure during pregnancy is an obvious red flag and it can lead to so many complications that can be harmful to both the emotional and physical health of the mother.
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Reduced Flow of Blood to the Placenta:
A decreased flow of blood towards the placenta can deprive the growing fetus of its essential nutrients and oxygen. The placenta is basically a food source for the fetus so a reduced blood supply can lead to the birth of a low birthweight infant. Preterm birth is also a possible consequence and the infant is born with respiratory problems and a weak immune system.
Stillbirth:
Yet another consequence of uncontrolled gestational hypertension is stillbirth (dead fetus). Women with chronic or gestational hypertension are at a higher risk of having a stillbirth than normotensive women.
Placental Separation:
There is a chance of the placenta separating from the inner lining of the uterus. Preeclampsia puts one at a higher risk of it. This is a very lethal condition as it can cause heavy bleeding.
Intrauterine Growth Abnormality:
Gestational hypertension can cause restrict the growth of the fetus as it also reduces the flow of blood towards the placenta.
Premature Delivery:
As gestational hypertension resolves after delivery, so, in order to prevent the life-threatening complications of this disorder it can be necessary to induce an early delivery.
Treatment for Gestational Hypertension:
Following are the steps that can be taken to treat gestational hypertension.
Frequent Prenatal Checkups
Getting checked by your healthcare physician on a regular basis and seeking recommendations and advice as to improve your health can help you lower the chances of developing gestational hypertension.
Reduced Salt Intake
As salt plays a significant role in elevating blood pressure, it will be recommended to reduce its intake while being treated.
Drink Water
Keeping yourself hydrated is of importance and for that, a total of 8 or more glasses should be consumed.
Blood pressure Lowering Medications:
Your treating physician may advise any of the following medications depending on the tolerability, severity, and urgency of the condition:
- Methyldopa (Aldomet): It is one of the most common Blood pressure-lowering medicine that is considered as a drug of choice in mild hypertension in pregnancy because of its safety record in pregnancy.
- Beta-Blocker: Labetalol can be given intravenously or orally, depending on the urgency of the condition. It is considered the drug of choice in severe hypertension.
- Nifedipine: It is a calcium-channel blocker that can be used orally in pregnant patients who have uncontrolled hypertension as monotherapy or add-on to other medications.
- Hydralazine: It is a vasodilator drug that can be given intravenously or peroral in pregnant patients for high blood pressure.
Other medications:
Other medications that may be advised to pregnant females with gestational hypertension are aspirin and magnesium sulfate. It is important to note that these two medications are not used to treat hypertension in pregnancy, rather they are used for the prophylaxis of seizures in severe preeclampsia.
