High blood pressure in pregnancy (Gestational hypertension)

Pregnancy is a time of excitement and anticipation. But for some women, it also becomes a period of vigilance, especially when it comes to high blood pressure. An estimated 8-10% of pregnant women experience elevated blood pressure, often termed Gestational Hypertension. Let’s delve deeper into this topic to understand its nuances and implications.

What is Gestational Hypertension?

Imagine the blood flowing in your vessels as water in a pipe. The pressure exerted by the blood on the walls of these vessels is termed blood pressure. When this pressure surpasses the reading of 140/90 mm Hg on two separate occasions, 24 hours apart, after the 20th week of pregnancy, it’s known as gestational hypertension. What’s reassuring is that for many women, this condition resolves within 12 weeks post-delivery. Unlike some other conditions, gestational hypertension doesn’t involve protein loss in the urine.

Different conditions in pregnancy associated with high blood pressure:

Pre-eclampsia: When the blood pressure exceeds 140/90mm of Hg on different occasions 24 hours apart and if this is associated with loss of protein in urine we categorise this condition as pre-eclampsia. This condition has the potential to affect every organ in the body.

Eclampsia: This is pre-eclampsia’s more menacing cousin. It involves seizures or convulsions, unrelated to any other known cause.

Chronic hypertension: This refers to high blood pressure observed before the 20th week of pregnancy, indicating a long-standing issue. When blood pressure exceeding 140/90mm of Hg is observed prior to 20 weeks of pregnancy, we categorise the women as having chronic hypertension.

For a visual breakdown of the subject, Dr. Ramya Sadaram explains gestational hypertension in this video (note: it’s in Telugu).

Are You At Risk?

Factors that can predispose you to high blood pressure during pregnancy include:

  • Being a young first-time mother or being over 40 years old.
  • Overweight diagnosis.
  • Carrying twins.
  • Pre-existing conditions like kidney disease, hyperhomocysteinaemia, or metabolic syndrome.
  • Insufficient intake of essential nutrients like calcium, antioxidants, or omega-3 fatty acids.

Symptoms to Watch Out For:

Symptoms can occur a bit differently in each pregnancy. The primary symptom is elevated blood pressure during the second half of pregnancy. Some women don’t show any symptoms and are merely diagnosed by blood pressure levels that are high when they undergo an annual antenatal exam.

High blood pressure during pregnancy can lead to other serious issues. These can include preeclampsia and eclampsia. While the primary symptom is elevated blood pressure in the latter half of pregnancy, other symptoms could include:

  • Persistent headaches
  • Oedema (swelling): Usually physiological oedema of pregnancy decreases on taking rest but if the swellings are increasing even after rest it is suggestive of pre-eclampsia. The swellings may also progress to the face abdominal wall vulva and whole body
  • Sudden weight gain
  • Vision disturbances, such as blurred or double vision
  • Nausea or vomiting
  • Pain in the upper right side of your belly, or pain around your stomach
  • Reduced urine output
  • Disturbed sleep
  • Shortness of breath

Diagnosing Gestational Hypertension:

At every pregnancy check-up, the blood pressure needs to be checked and urine albumin should be tested if blood pressure is more than 140/90 on two occasions 24 hours apart. 

The blood pressure should not be measured immediately after the patient walks into the clinic and also one reading is not enough as the patient can be apprehensive when visiting the doctor hence two readings 24 hours apart are required. 

The correct way of recording blood pressure: Sit in a comfortable chair with your back supported. Put both feet flat on the ground and keep your legs uncrossed. Rest your arm with the cuff on a table at chest height. Make sure the blood pressure cuff is snug but not too tight. The cuff should be against your bare skin, not over clothing.

Other tests  to be done are: 

  • Urine for Protein
  • Platelet count
  • Bleeding time, clotting time
  • Liver function tests 
  • Kidney function tests
  • Ophthalmic examination

Potential Complications with Gestational Hypertension

For the mother :

  • Seizures (Eclampsia).
  • Blindness/ dimness of vision
  • Kidney damage
  • Liver damage
  • Postpartum haemorrhage due to a disrupted coagulation system
  • Sepsis – infections
  • Shock

For the baby :

  • Intrauterine growth restriction- due to decreased blood flow to the baby
  • Intrauterine death
  • Abruptio placenta- separation of the placenta from the mother’s uterine wall before delivery leading to internal bleeding
  • Asphyxia
  • Preterm labor

How can you prevent Gestational Hypertension

Women who are at risk of developing hypertension can follow the below-mentioned regime:

  • Have regular antenatal check-ups- for early detection
  • Using anti-thrombotic agents like low-dose aspirin ( as advised by a gynaecologist)
  • Calcium supplementation: As calcium deficiency predisposes to pre-eclampsia
  • Taking anti-oxidant-rich foods and Vitamins C, D & E rich foods
  • Nutritional supplementation with Magnesium, zinc
  • Taking Fish oils which are rich in omega-3 fatty acids
  • Have a high protein and low salt diet
  • Avoid tea, coffee and caffeinated beverages

In conclusion, while gestational hypertension can be concerning, understanding the condition and being proactive in monitoring and management can ensure both mother and baby remain healthy. Always consult with your gynaecologist for the best advice tailored to your specific situation.

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