Doc Talk: Gestational Hypertension
Uncontrolled high blood pressure that develops during pregnancy, also known as gestational hypertension, is a disorder that affects many women during pregnancy. Gestational hypertension typically goes away post-partum, but it can also cause multiple complications such as pre-eclampsia (toxemia), eclampsia, and preterm labor.
While any woman may be susceptible to developing gestational hypertension, African American women are more likely to be diagnosed with chronic and gestational hypertension compared to many women of other racial and ethnic minority groups.
What is gestational hypertension and chronic hypertension and how common are they?
Gestational hypertension occurs when high blood pressure develops after 20 weeks of pregnancy in a woman who had normal blood pressure before and then blood pressure levels return to normal in the postpartum period. Gestational hypertension occurs in about 6% to 17% of all first pregnancies.
Chronic hypertension in pregnancy is defined as hypertension already diagnosed or present before pregnancy. Hypertension that is diagnosed for the first-time during pregnancy and that does not resolve in the typical postpartum period also is classified as chronic hypertension. Chronic hypertension occurs in less than 2% of pregnant women.
What are the symptoms of gestational hypertension?
The following are the most common symptoms of high blood pressure in pregnancy. However, each woman may experience symptoms differently, and a patient with gestational hypertension may not show any symptoms.
Symptoms may include:
- Increased blood pressure
- Absence or presence of protein in the urine (to diagnose gestational hypertension vs preeclampsia)
- Edema (swelling)
- Sudden weight gain
- Visual changes such as blurred or double vision or spots noted in vision
- Nausea, vomiting
- Right-sided upper abdominal pain
How does gestational and chronic hypertension affect pregnancy?
Hypertensive disorders during pregnancy constitute one of the leading causes of maternal and perinatal (stillbirth and newborn death) mortality worldwide. Maternal risks include increased risk of cerebrovascular events (strokes), pulmonary edema (fluid in the lungs), kidney failure, gestational diabetes, cesarean delivery, and postpartum hemorrhage. Fetal risks include preterm delivery, poor fetal growth, stillbirth, or fetal death.
Why might a woman develop gestational hypertension?
Some conditions may increase the risk of developing the pre-eclampsia, including the following:
- Pre-existing hypertension (high blood pressure)
- Kidney disease
- Hypertension with a previous pregnancy
- Mother's age younger than 20 or older than 35
- Multiple fetuses (twins, triplets)
How is gestational and chronic hypertension treated or managed?
The goal of treatment is to prevent the condition from becoming worse and to prevent it from causing other complications.
Treatment for hypertensive disorders during pregnancy may include:
- Hospitalization (as specialized personnel and equipment may be necessary)
- Magnesium sulfate – a drug to prevent seizures
- Antihypertensive medications if blood pressure readings are in the severe range
- Fetal monitoring (to check the health of the fetus)
- Continued laboratory testing of urine and blood (for changes that may signal worsening of gestational hypertension or progression to preeclampsia)
- Medications, called corticosteroids, that may help to mature the lungs of the fetus, in case early delivery becomes necessary
- Possible early delivery
Are there ways women can prevent hypertension before and during pregnancy?
Women with modifiable risk factors, such as obesity and prediabetes or diabetes, may benefit from counseling on weight loss, diet, and lifestyle modifications. Women with chronic hypertension should have their blood pressure optimized before pregnancy and should avoid excessive sodium, caffeine intake, as well as smoking.
Early identification of women at risk for gestational hypertension may help prevent some complications of the disease. Education about the warning symptoms is also important because early recognition may help women receive treatment and prevent worsening of the disease.
What are the complications from gestational hypertension?
Gestational hypertension can develop into multiple serious conditions.
Pre-eclampsia is more common in first pregnancies, twin pregnancies, in women over the age of 35, in women with chronic hypertension or who had hypertension in a previous pregnancy, in African American women, and in women with diabetes. Pre-eclampsia is a sudden onset of hypertension, with the presence of any of the following severe features:
- Low platelets
- Elevated creatinine (a sign of kidney trouble)
- Elevated liver enzymes
- Severe headache
- Visual disturbances
- Pulmonary edema (fluid in the lungs)
- Protein in the urine
It has been estimated that pre-eclampsia complicates 2% to 8% of pregnancies.
Eclampsia is the occurrence of a seizure in a woman with a hypertensive disorder during pregnancy; this occurs about one in 1,600 pregnancies.
HELLP syndrome is a subset of preeclampsia which causes the breakdown of red blood cells, changes in the liver, and low platelets (cells found in the blood that are needed to help the blood to clot in order to control bleeding).
Why are African American women more affected by gestational and chronic hypertension?
In the United States, African American women are more likely to have high blood pressure compared to many women of other racial and ethnic minority groups. Researchers believe rates of gestational hypertension and chronic hypertension are so high because African American women are more likely to have a higher BMI or have diabetes, which are known risk factors.
Education and early detection can help women at risk for chronic and gestational hypertension. Women’s Health Connecticut urges all expecting mothers to attend prenatal appointments regularly, to research and ask questions of their ObGyn, and to stay as healthy as possible. If you have any questions regarding gestation hypertension, please contact your Women’s Health Connecticut provider.