The ONE organ responsible for high blood pressure.
All About Gestational Hypertension
The cause of gestational hypertension is unknown. Some conditions may increase the risk of developing the condition, including the following: Pre-existing hypertension (high blood pressure) Kidney disease.
After 20 weeks of pregnancy, blood pressure that's higher than 140/90 mm Hg without any other organ damage is considered to be gestational hypertension. Blood pressure needs to be taken and documented on two or more occasions, at least four hours apart.
What causes gestational hypertension?
The cause of gestational hypertension is unknown. Some conditions may increase the risk of developing the condition, 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 40
- Multiple fetuses (twins, triplets)
- African-American race
Why is gestational hypertension a concern?
With high blood pressure, there is an increase in the resistance of blood vessels. This may hinder blood flow in many different organ systems in the expectant mother including the liver, kidneys, brain, uterus, and placenta. There are other problems that may develop as a result of severe gestational hypertension (blood pressure readings that are higher than 160/110 mm Hg). Placental abruption (premature detachment of the placenta from the uterus) may occur in some pregnancies. Gestational hypertension can also lead to fetal problems including intrauterine growth restriction (poor fetal growth) and stillbirth. If untreated, severe gestational hypertension may cause dangerous seizures (eclampsia) and even death in the mother and fetus. Because of these risks, it may be necessary for the baby to be delivered early, before 37 weeks gestation.
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 be completely asymptomatic. Symptoms may include:
- Increased blood pressure
- Absence or presence of protein in the urine (to diagnose gestational hypertension or preeclampsia)
- Edema (swelling)
- Sudden weight gain
- Visual changes such as blurred or double vision
- Nausea, vomiting
- Right-sided upper abdominal pain or pain around the stomach
- Urinating small amounts
- Changes in liver or kidney function tests
How is gestational hypertension diagnosed?
Diagnosis is often based on the increase in blood pressure levels, but other symptoms may help establish gestational hypertension as the diagnosis. Tests for gestational hypertension may include the following:
- Blood pressure measurement
- Urine testing to rule out preeclampsia
- Assessment of edema
- Frequent weight measurements
- Liver and kidney function tests to rule out preeclampsia
- Blood clotting tests to rule out preeclampsia
Treatment for gestational hypertension
Specific treatment for gestational hypertension will be determined by your doctor based on:
- Your pregnancy, overall health, and medical history
- Extent of the disease
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
- Bedrest, either at home or in the hospital, may be recommended
- Hospitalization (as specialized personnel and equipment may be necessary)
- Magnesium sulfate (or other antihypertensive medications for gestational hypertension if blood pressure readings are in the severe range)
- Fetal monitoring (to check the health of the fetus) which may include:
- Fetal movement counting. Keeping track of fetal kicks and movements. A change in the number or frequency may mean the fetus is under stress.
- Nonstress testing. A test that measures the fetal heart rate in response to the fetus's movements.
- Biophysical profile. A test that combines nonstress test with ultrasound to observe the fetus.
- Doppler flow studies. A type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel.
- 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 (lung immaturity is a major problem of premature babies).
Prevention of gestational hypertension
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.