Gestational Hypertension

Gestational Hypertension Introduction Hypertension is high blood pressure. High blood pressure that starts after 20 weeks of pregnancy is known as gestational hypertension. Approximately 8 out of every 100 pregnant women will have some form of hypertension during their pregnancy. Gestational hypertension can be dangerous for both the mother and baby. Getting diagnosed and treated can help prevent complications. This reference summary will help you understand gestational hypertension, how it is diagnosed, and its treatment options. High Blood Pressure The cells of the body need oxygen and food to survive. Oxygen and nutrients are carried to all parts of the body through the blood. The heart pumps blood out of its chambers through blood vessels. The blood vessels that carry fresh blood from the heart to the body are called arteries. Blood pressure is the force of blood as it presses against the walls of the arteries, like the pressure of water in a garden hose. The blood pressure is measured in mm of mercury or mmhg. Two numbers are used to describe blood pressure. The top number, called systolic blood pressure, measures blood pressure when the heart pumps. A normal, healthy top number is less than 120. The second number is lower than the systolic pressure and measures blood pressure when the heart rests. It is known as diastolic blood pressure. A normal, healthy bottom blood pressure number is 80 or below. 1

For example, a patient may have a blood pressure of 125/70, typically pronounced one twenty-five over seventy. This means that the patient has a reading of 125 systolic and 70 diastolic blood pressure. Blood pressure varies all the time. It is common for it to differ by 10 to 20 units when it is measured at different times, even minutes apart. For instance, exercise or emotional stress can increase the blood pressure. Increased blood pressure allows more blood to be pumped to the body to help the body cope with increased activity or stress. The body can tolerate a temporary rise in blood pressure. Because of these normal variations, doctors do not diagnose a patient with high blood pressure unless repeated measurements show it to be consistently high. If the top blood pressure number (systolic) is consistently equal to or higher than 140 or if the bottom blood pressure number (diastolic) is consistently equal to or higher than 90, then the doctor will diagnose a patient as having high blood pressure, or hypertension. Gestational Hypertension When a pregnant woman develops high blood pressure after 20 weeks of pregnancy, she has gestational hypertension. Gestational hypertension usually goes away after the baby is born. If you are diagnosed with hypertension during pregnancy, you will need more frequent checkups and possibly treatment. You will be watched closely during your pregnancy for any signs of preeclampsia. Preeclampsia is when you have high blood pressure with high levels of protein in your urine. Patients with preeclampsia may have seizures that are dangerous for the mother and her baby. This is known as eclampsia. If preeclampsia or eclampsia happens, your doctor may recommend delivery of the baby early. 2

Risk Factors The causes of gestational hypertension are not known. However, scientists and doctors know factors that can increase the chances of having gestational hypertension. These are known as risk factors. Several risk factors increase the chances of having gestational hypertension. Women without any risk factors can also have gestational hypertension. You are much more likely to develop gestational hypertension during your first pregnancy. The risk for gestational hypertension is also higher if you are older than age 35. Being overweight increases the likelihood that you will develop hypertension during pregnancy. If you are carrying twins or triplets, gestational hypertension is more likely. Having diabetes or kidney disease also raises a woman s risk for gestational hypertension. If you are African American you are at a higher risk for developing gestational hypertension. Chronic hypertension also makes you more likely to develop gestational hypertension. If you have certain immune disorders, such as systemic lupus or blood diseases, you are at an increased risk for developing gestational hypertension. A previous history of gestational hypertension also increases your risk for developing it again. 3

Symptoms Symptoms of high blood pressure include: Swelling of the hands, face and feet Rapid weight gain of more than 2-3 pounds in one week Pounding headaches, especially early in the day Spots in your eyes, blurred vision or seeing stars Pain in the upper right side of your abdomen Make sure to contact your healthcare provider if you experience symptoms of high blood pressure. Untreated gestational hypertension may lead to complications for the mother and baby. Diagnosis Only your healthcare provider can diagnose gestational hypertension. However, there are some symptoms of high blood pressure. Your healthcare provider will evaluate your blood pressure frequently during your prenatal visits. Frequent evaluation of your blood pressure is necessary to diagnose gestational hypertension. Gestational hypertension is when your systolic blood pressure is repeatedly higher than 140 and/or your diastolic pressure is repeatedly higher than 90. Blood work may be collected to evaluate your blood count, as well as liver and kidney function. These lab studies will help your healthcare provider take care of you and your baby. Your urine may also be tested for protein. Kidney problems cause the protein level to be high when a woman has preeclampsia. If the level of protein in your urine is high, your health care provider may want you to perform a 24-hour urine collection. 4

A 24-hour urine collection will help to distinguish between gestational hypertension and preeclampsia. Preeclampsia is diagnosed if the 24-hour urine collection shows that the protein level is high and the patient has high blood pressure. If the protein level in your urine is normal and you have high blood pressure, you will be diagnosed with gestational hypertension. Treatment Treatment for gestational hypertension depends on how difficult your blood pressure is to control. You will likely have frequent appointments with your doctor to check your blood pressure and to watch for signs of preeclampsia. A good place to start in treating gestational hypertension is cutting back on salt. A noadded-salt diet may be effective in lowering blood pressure if it is started early enough after diagnosis. Talk to your doctor before making any changes to your diet. When blood pressure increases slightly before the end of pregnancy, bed rest may help reduce your blood pressure. Your healthcare provider may prescribe medications to lower your blood pressure. Your healthcare provider may recommend delivery if your blood pressure remains high. High blood pressure can be dangerous for the mother and the baby. You may also be placed on an intravenous, or IV, medication called magnesium sulfate. This will help prevent you from having seizures. The magnesium sulfate treatment may continue 24-hours after delivery. This helps decrease blood pressure after you have delivered your baby. Effects During and After Pregnancy Gestational hypertension can cause problems both during and after pregnancy. Some of these may be avoided if you follow your doctor s treatment plan. Managing your blood pressure is very important for both yourself and your baby. 5

When your blood pressure is high you may experience headaches and visual disturbances. Swelling in your hands, feet or face and upper abdominal pain can also be caused by high blood pressure. Increased blood pressure may reduce the amount of blood supplied to the placenta. This affects the amount of oxygen supplied to your baby. If an adequate amount of blood does not reach the placenta, then the placenta may not be able to provide the appropriate amount of oxygen and nutrients to your baby. In some women, gestational hypertension can develop into preeclampsia, eclampsia or HELLP syndrome. HELLP syndrome is a severe form of preeclampsia. Preeclampsia, eclampsia, and HELLP syndrome are all dangerous to you and your baby. The letters HELLP stand for: H hemolysis, which is the breakdown of red blood cells EL -- elevated liver enzymes LP -- low platelet count Premature delivery or delivery of a low birth weight infant can happen in women with high blood pressure. This is more common if blood pressure remains high for a long period of time. Premature delivery is delivery of a baby before the 37th week of pregnancy. A normal pregnancy is 40 weeks long. Uncontrolled blood pressure increases the risk of the placenta separating from the wall of the uterus. This is known as placental abruption, which is an emergency requiring immediate delivery. After delivery, your blood pressure should be reevaluated. This is to make sure that your blood pressure has returned to pre-pregnancy levels. Some women with gestational hypertension will develop chronic hypertension. This means the hypertension becomes ongoing, requiring continuous treatment. 6

Summary Hypertension that starts after 20 weeks of pregnancy is known as gestational hypertension. Approximately 8 out of every 100 pregnant women will have some form of hypertension during their pregnancy. Gestational hypertension can be dangerous for both the mother and baby. If prolonged, it can lead to premature labor. Getting diagnosed and treated can help prevent complications. Regular visits with your health care provider can help diagnose gestational hypertension early. Treatment decreases the likelihood of pregnancy complications. Most pregnant women can manage gestational hypertension by cutting down on salt and resting. In some cases, the doctor may prescribe medications to lower hypertension. 7