Gestational Hypertension: Manage High BP in Pregnancy

Key Takeaways:

1. Gestational hypertension may happend after 20 weeks of pregnancy and affects 6-8% of pregnant women.

2. Risk factor and causes of gestational hypertension include age, previous history, family background, diabetes, immune conditions, kidney issues, multiple pregnancies, and ethnicity increase risk.

3. Complications that may occur are placental abruption, premature birth, C-section, and preeclampsia.4. Signs and symptoms are increased blood pressure, swelling, sudden weight gain, visual changes, nausea, abdominal discomfort, and altered urination patterns.

Introduction

Gestational hypertension is high BP that starts after 20 weeks of pregnancy. It may cause complications for both the mother and the child.

About 6 to 8% of women develop high BP during pregnancy. However, gestational hypertension is preventable and treatable with the proper awareness and help.

Define Gestational Hypertension

Gestational hypertension is a condition where high blood pressure arises after the 20th week of pregnancy. It is also called pregnancy-induced hypertension (PIH). It resolves shortly after childbirth.

Gestational hypertension can progress to preeclampsia, particularly in specific demographic groups such as

• First-time young mothers
• Women over 35
• Those with chronic hypertension
• African-American women
• Women with diabetes

PIH diagnosis involves blood pressure readings exceeding 140/90 mm Hg post the 20th week of pregnancy, without proteinuria (excess protein in the urine).

Causes of Pregnancy Induced Hypertension

While the exact cause of gestational high blood pressure is unknown, certain factors increase your risk. These factors include:

1. Age: Being under 20 or over 40.
2. Previous History: Having gestational hypertension or preeclampsia in prior pregnancies.
3. Family Background: A family history of gestational hypertension.
4. Diabetes: Pre-existing diabetes or gestational diabetes.
5. Immune System Conditions: Disorders like lupus affecting the immune system.
6. Kidney Issues: Pre-existing kidney disease.
7. Multiple Pregnancies: Expecting twins, triplets, or more.
8. Ethnicity: Higher prevalence among black individuals.

High Blood Pressure Complications During Pregnancy

Pregnant women with hypertension can have normal pregnancies. However, they are at a higher risk of complications. These may include-

• Placental abruption: When a placenta separates from the uterus earlier than expected.
• A premature birth: The act of giving birth before the due date.
• Cesarean section (C-section): Delivery of the baby through a surgical incision in the belly and uterus.
• Preeclampsia: Preeclampsia involves high blood pressure, along with signs such as protein in the urine and dysfunction in the liver and kidneys.

If you already have hypertension, you should consult your doctor about these risks and possible surveillance during pregnancy.

If you develop gestational hypertension, it increases your risk of developing hypertension in the future.

Signs and Symptoms of Hypertension During Pregnancy

Often, hypertension doesn't have any visible symptoms. However, the symptoms can differ among individuals. Hence, some women with gestational hypertension may experience noticeable signs.

Common symptoms of high blood pressure in pregnancy

1. Increased blood pressure: Reading higher than 140/ 80 mm Hg measured on 2 or more occasions.
2. Edema (swelling): Swelling, particularly in the extremities.
3. Weight gain: Sudden and unexplained weight gain.
4. Visual changes: Blurred or double vision.
5. Nausea and vomiting: Persistent nausea and vomiting could indicate hypertension.
6. Abdominal discomfort: Pain around the stomach or in the right-sided upper abdomen.
7. Urination patterns: Peeing small amounts at a time.

What Are the Different Forms of High Blood Pressure During Pregnancy?

During pregnancy, high blood pressure can be of three types. Understanding the specific type is crucial for tailored care and effective management. Correct identification ensures a healthy outcome for both you and your baby.

1. Chronic Hypertension in Pregnancy

Chronic hypertension is high blood pressure that is already present before pregnancy, diagnosed within the first 20 weeks of gestation, or not resolved after 12 weeks of giving birth. This type of hypertension is present in about 5% of all pregnancies.

2. Gestational Hypertension

Gestational hypertension is a new onset that starts after 20 weeks of pregnancy.

3. Preeclampsia

Preeclampsia is characterized by the development of hypertension and protein in the urine after 20 weeks of gestation. It causes for 2% to 8% of pregnancy-related complications worldwide.

The symptoms of preeclampsia are-

• Protein in urine
• Hands or face swelling
• Headache that won't go away
• Changes in vision or spots in the eye
• Upper abdominal or shoulder pain
• A feeling of nausea and vomiting (especially during pregnancy's second half)
• Gaining weight suddenly
• Breathing problems

How Does Gestational Hypertension Affect the Baby?

Having hypertension during pregnancy doesn't only affect the mother but also risks the developing baby.

High blood pressure makes it challenging for the baby to receive enough oxygen and nutrients. It could lead to your baby having a lower-than-average weight because of growth restrictions. It may also result in early delivery.

Monitoring the fetus is equally essential. To monitor the fetus, doctors may perform various tests like:

• Ultrasound: To visualize and track fetal development.
• Nonstress test: Evaluates the baby's heart rate in response to movements.
• Biophysical profile: Combination of a nonstress test with an ultrasound for a comprehensive assessment.
• Doppler ultrasound: It measures blood flow in the baby's vessels.
• Fetal movement counting: Monitoring kicks and movements to assess the baby's well-being.

How is Hypertension During Pregnancy Diagnosed?

During prenatal appointments, your provider monitors your blood pressure. If they detect a higher-than-normal reading, they may check again at later appointments.

If your BP is consistently high after 20 weeks of pregnancy, your doctor may diagnose you with gestational hypertension.

If high BP persists, your doctor may conduct additional tests.

Normal Blood Pressure Range During Pregnancy Chart

During pregnancy the normal BP range should not surpass 120/80 mm Hg during pregnancy.