Potential Complication: Gestational Hypertension
When you’re pregnant, it’s common to have high blood pressure. Up to 8% of pregnant women in the U.S. have high blood pressure, usually during their first pregnancies. If you first develop it when you’re expecting, it’s called gestational hypertension or pregnancy-induced hypertension .
Most women with gestational hypertension have healthy pregnancies and healthy babies. But, high blood pressure during pregnancy can be a sign of other conditions that can be much more harmful. That’s one reason why seeing your doctor early and often is so important in keeping you and your baby healthy.
What Causes High Blood Pressure During Pregnancy
Some women have a higher chance to getting high blood pressure while theyre pregnant. These include women who:
- Are having their first baby.
- Have a mom or sister who had high blood pressure while pregnant.
- Are carrying multiple babies .
- Are older than 40 years old.
- Are African American.
- Were overweight when they became pregnant.
- Had high blood pressure before they became pregnant.
How Can It Affect My Baby And Me
High blood pressure can hurt you and your baby. The effects can be mild to very severe. It may cause no problems. Or it may:
- Damage your kidneys and other organs
- Reduce blood flow to the placenta, which means your baby receives less oxygen and fewer nutrients
- Cause your baby to be born too small or too soon. Most babies can catch up on their growth by a few months after birth, but it’s healthier if they are born at a normal weight.
- Put you at risk for heart disease or high blood pressure when you become older
Gestational hypertension can be more severe when you’re having twins. In severe cases, gestational hypertension leads to preeclampsia, also known as toxemia. It can harm the placenta as well as your brain, liver, and kidneys. With twins, there’s a higher chance that the placenta will become unattached.
Preeclampsia can lead to eclampsia, a rare and serious condition that can cause seizures and coma — even death.
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No treatment is necessary for gestational hypertension, although blood pressure medicine may be used.
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Living With High Blood Pressure During Pregnancy
Go to each of your prenatal visits with your doctor. This will allow him or her to monitor your blood pressure. Your doctor may ask you to record your blood pressure at home. He or she can give advice on how to do that. Your doctor will check your urine at each visit. High levels of protein in urine can be a symptom of preeclampsia.
Discuss all your medicines with your doctor. Also, dont start or stop taking any medicines, including over-the-counter medicines, without talking to your doctor. Some of these may affect your blood pressure.
How Do I Know If I Have Gestational Hypertension
At each prenatal checkup, your healthcare provider will check your blood pressure and urine levels. Your doctor may also check your kidney and blood-clotting functions, order blood tests, perform an ultrasound scan to check your babys growth, and use a Doppler Scan to measure the efficiency of blood flow to the placenta.
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Hypertension In Pregnancy: Diagnosis And Management
NICE guideline
This guideline covers diagnosing and managing hypertension , including pre-eclampsia, during pregnancy, labour and birth. It also includes advice for women with hypertension who wish to conceive and women who have had a pregnancy complicated by hypertension. It aims to improve care during pregnancy, labour and birth for women and their babies.
Weve created a series of visual summaries to explain assessment, treatment and other aspects of care for various conditions relating to hypertension in pregnancy. These are available to download from tools and resources.
How Is Preeclampsia Diagnosed
Your health care provider will check your blood pressure and urine at each prenatal visit. If your blood pressure reading is high , especially after the 20th week of pregnancy, your provider will likely want to run some tests. They may include blood tests other lab tests to look for extra protein in the urine as well as other symptoms.
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What Are High Blood Pressure Complications During Pregnancy
Complications from high blood pressure for the mother and infant can include the following:
- For the mother:preeclampsiaexternal icon, eclampsiaexternal icon, stroke, the need for labor induction , and placental abruption .1,4,5
- For the baby:preterm delivery and low birth weight .1,6 The mothers high blood pressure makes it more difficult for the baby to get enough oxygen and nutrients to grow, so the mother may have to deliver the baby early.
Discuss blood pressure problems with your health care team before, during, and after pregnancy.
Learn what to do if you have high blood pressure before, during, or after pregnancy.
Diagnosis And Classification Of Hypertension In Pregnancy
Using a nomenclature endorsed by the International Society for the Study of Hypertension in Pregnancy, several national and international obstetrics groups, and by the National High Blood Pressure Education Program Working Group on Hypertension in Pregnancy,10,11 we recognized four major hypertensive disorders of pregnancy. First, chronic hypertension may be either essential or secondary. Two disorders, gestational hypertension and pre-eclampsia, occur only in pregnancy. Finally, pre-eclampsia may be superimposed upon underlying chronic hypertension. Terms such as pregnancy-induced hypertension may include a mix of disorders, with differing pathophysiology and risks, and should be abandoned.
Chronic hypertension
Importantly, many apparently healthy young women have never had BP measurement before conception. Normal gestational vasodilation and relative hypotension may then mask their underlying chronic hypertension, which can then be mistaken for either gestational hypertension or pre-eclampsia if it worsens later in pregnancy.
Gestational hypertension
Pre-eclampsia
Pre-eclampsia can evolve rapidly to a convulsive and life-threatening phase, termed eclampsia. An especially threatening variant of pre-eclampsia is the HELLP syndrome, which may seem mild in its initial presentation, and then evolves over hours to microangiopathic hemolysis, severe thrombocytopenia, and hepatic necrosis with rupture.
Superimposed pre-eclampsia
Jason G. Umans, in, 2007
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How Is It Treated
Treatment depends on how close you are to your due date. If you are close to your due date and the baby is developed enough, your health care provider may want to deliver your baby as soon as possible.If you have mild hypertension and your baby is not fully developed, your doctor will probably recommend the following:
- Rest, lying on your left side to take the weight of the baby off your major blood vessels.
- Increase prenatal checkups.
- Consume less salt.
- Drink 8 glasses of water a day.
If you have severe Hypertension, your doctor may try to treat you with blood pressure medication until you are far enough along to deliver safely.
What Is High Blood Pressure During Pregnancy
A small percentage of pregnant women in the U.S. have high blood pressure at some point during their pregnancy. Some cases are mild other cases are severe. Treatment varies depending on the type you have and how far along you are in your pregnancy.
There are three main types of high blood pressure during pregnancy:
In some cases, high blood pressure during pregnancy can cause harm to you and your baby.
- You may develop gestational diabetes.
- You may experience problems with your heart or kidneys. Youre also at greater risk for a stroke.
- High blood pressure may prevent the placenta from getting enough blood. If the placenta doesnt get enough blood, your baby doesnt get enough oxygen and food. This can cause low birth weight and premature birth.
- High blood pressure can lead to placental abruption. This is when the placenta becomes unattached to the uterus. This can be a life threatening situation to both you and your baby.
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How Do Preeclampsia And Gestational Hypertension Affect My Heart Health
Having preeclampsia or gestational hypertension doubles the risk of developing coronary heart disease and stroke in the future. That doesnt mean heart disease is inevitable, but women who have these complications of pregnancy need to be followed closely by their physicians to make sure their other risk factors for heart diseaselike blood pressure, cholesterol, and blood sugarare well controlled. Also, women with preeclampsia or high blood pressure in pregnancy must maintain a heart-healthy lifestyle with regular exercise and a Mediterranean or similar diet.
Gestational Hypertension: Pregnancy Induced Hypertension
Gestational Hypertension also referred to as Pregnancy-Induced Hypertension is a condition characterized by high blood pressure during pregnancy. Gestational Hypertension can lead to a serious condition called Preeclampsia, also referred to as Toxemia. Hypertension during pregnancy affects about 6-8% of pregnant women.
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What Are The Symptoms Of Preeclampsia
Possible symptoms of preeclampsia include
- High blood pressure
- Too much protein in your urine
- Swelling in your face and hands. Your feet may also swell, but many women have swollen feet during pregnancy. So swollen feet by themselves may not be a sign of a problem.
- Headache that does not go away
- Vision problems, including blurred vision or seeing spots
- Pain in your upper right abdomen
- Trouble breathing
Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output. If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.
Chronic Hypertension In Pregnancy
Data from the National Health and Nutrition Examination Survey , indicates that the prevalence of hypertension in women aged 2044 years is 7.7%, and an estimated 4.9% of women use anti-hypertensive pharmacologic therapy, with the two most common categories of medications being diuretics and angiotension-converting enzyme inhibitors . Prenatal counseling in women with chronic hypertension is an important component of their care. The goals of the visit should be to evaluate for end-organ damage, to adjust medications as necessary, to discuss appropriate lifestyle modifications, and to consider secondary causes of hypertension. Given the teratogenic potential of ACE inhibitors , women should be counseled on the importance of birth control while on ACE inhibitors, and this class of medication should be changed prior to attempting to conceive.
Surgical specimen of the adrenal pheochromocytoma.
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Inclusion And Exclusion Criteria
Women with PIH and normotensive women in each antenatal care clinic of the hospitals were enrolled to study by reviewing their blood pressure level and proteinuria. Pregnancy-induced hypertension was defined as new hypertension that appears at 20weeks or more gestational age of pregnancy with or without proteinuria . Pregnant mothers diagnosed with PIH during the data collection period in the selected antenatal care clinic of the hospitals were included as exposed participants and women without PIH during the same period were also enrolled as a non-exposed participant. Pregnant women with chronic hypertension, critically ill women who could not give consent, women who could not respond to the interview and those pregnant women likely to become lost e.g., planning to move, unwilling to return for the prospective follow up period were excluded from this study at the time of enrollment. There were no other restrictions .
Frequently Asked Questions Expand All
Your obstetriciangynecologist should check your blood pressure at each prenatal care visit. Blood pressure changes often during the day. If you have one high reading, another reading may be taken later during your office visit.
Chronic hypertension is high blood pressure that a woman has before getting pregnant or that develops in the first half of pregnancy . If you were taking blood pressure medication before you got pregnanteven if your blood pressure is currently normalyou have been diagnosed with chronic hypertension.
When a woman is pregnant, her body makes more blood to support the fetuss growth. If blood pressure goes up during pregnancy, it can place extra stress on her heart and kidneys. This can lead to heart disease, kidney disease, and stroke. High blood pressure during pregnancy also increases the risk of preeclampsia, preterm birth, placental abruption, and cesarean birth.
High blood pressure may reduce blood flow to the placenta. As a result, the fetus may not get enough of the nutrients and oxygen needed to grow.
If your condition remains stable, delivery 1 to 3 weeks before your due date generally is recommended. If you or the fetus develop complications, delivery may be needed even earlier.
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How Do They Treat Preeclampsia In Pregnancy
Preeclampsia is dangerous and can develop gradually or come on quite suddenly. There are mild and severe forms of preeclampsia, depending on the severity of the signs and symptoms. The only cure for preeclampsia is delivery of the baby, and specifically the placenta. Women with severe preeclampsia are at higher risk for developing seizures known as eclampsia. These women usually receive magnesium sulfate during labor as well as 24 hours after delivery to decrease the chance of seizures.
What Is Gestational Hypertension
Gestational hypertension is a form of high blood pressure in pregnancy. It occurs in about 6 percent of all pregnancies. Another type of high blood pressure is chronic hypertension–high blood pressure that is present before pregnancy begins.
Gestational hypertension can develop into preeclampsia. This condition occurs often in young women with a first pregnancy. It is more common in 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.
Gestational hypertension is diagnosed when blood pressure readings are higher than 140/90 mm Hg in a woman who had normal blood pressure prior to 20 weeks and has no proteinuria .
Preeclampsia is diagnosed when a woman with gestational hypertension also has increased protein in her urine.
Eclampsia is a severe form of preeclampsia. Women with eclampsia have seizures resulting from the condition. Eclampsia occurs in about one in 1,600 pregnancies and develops near the end of pregnancy, in most cases.
HELLP syndrome is a complication of severe preeclampsia or eclampsia. HELLP syndrome is a group of physical changes including the breakdown of red blood cells, changes in the liver, and low platelets .
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Nursing Interventions In Pregnancy
Nursing Interventions in Pregnancy-Induced Hypertension.
Nursing Interventions in Pregnancy-Induced HypertensionNursing Interventions during Pregnancy Educate the woman to exercise because it reduces excessive gestational weight gain and the risk of hypertension Encourage the woman to have adequate rest to lower the blood pressure in order to increase the flow of blood to the placenta Monitor the blood pressure closely to ensure that the blood pressure does not increase to dangerous levels.Nursing Interventions in Pregnancy-Induced Hypertension.
Encourage the woman to have bed rest be in a recumbent position to promote sodium secretion Ensure good nutrition Provide emotional support and allow the woman to speak out her fears
Nursing Interventions During Labor Control environmental stressors for the mother Frequently update the mother and the family to avoid anxiety Provide the woman with emotional support to reduce the anxiety that could worsen hypertension
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Postpartum measures to decrease risk of thromboembolic disease in childbearing women Encourage early ambulation For women on bed rest ,advise or assist with turning & leg exercise every 2 hours Encourage fluids to avoid dehydration Advise no smoking
How Will This Affect My Baby
Hypertension can prevent the placenta from getting enough blood. If the placenta doesnt get enough blood, your baby gets less oxygen and food. This can result in low birth weight. Most women still can deliver a healthy baby if hypertension is detected and treated early.If your hypertension is severe, it can lead to Preeclampsia, which can have much more serious effects on mom and baby.
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Maternal Medical Risk Factors For Preeclampsia
The following are maternal medical risk factors for preeclampsia:
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Chronic hypertension, especially when secondary to such disorders as hypercortisolism, hyperaldosteronism, pheochromocytoma, or renal artery stenosis
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Preexisting diabetes , especially with microvascular disease
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Renal disease
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Use of selective serotonin uptake inhibitor antidepressants beyond the first trimester
What Is Pregnancy Induced Hypertension Or Gestational Hypertension
Pregnancy Induced Hypertension, which is also known by the name of Gestational Hypertension, is a medical condition in which there is persistent high blood pressure at the time of pregnancy. Pregnancy Induced Hypertension or Gestational Hypertension can cause a potentially serious medical condition called Preeclampsia. Around 10% of pregnant females suffer from Pregnancy Induced Hypertension or Gestational Hypertension.
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Treatment For Pregnancy Induced Hypertension Or Gestational Hypertension
Treatment of Pregnancy Induced Hypertension or Gestational Hypertension is dependent on the date of delivery. If the delivery date is pretty close and the development of the baby is normal then an earlier delivery can be considered. In case of the baby has not fully developed then the following treatments can be done:
- Adequate rest making sure to lie on the left side to take pressure off of major blood vessels due to the fetus
- Increased frequency of prenatal checkup
- Salt restriction
- Increased water consumption
How Is Pih Diagnosed
If you are pregnant, your blood pressure will be checked at every antenatal appointment because a rise in blood pressure can be the first sign of pre-eclampsia. Pre-eclampsia can also be diagnosed by checking whether there is protein in the urine.
If your doctor or midwife is concerned about pre-eclampsia, they may order blood tests, an ultrasound or monitor the babys heart rate.
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