High blood pressure in pregnancy (Gestational hypertension)

What is Gestational hypertension: Around 8-10% of 100 women who are pregnant suffer from hypertension during pregnancy. When the blood pressure of a pregnant woman exceeds 140/90 mm of Hg on two occasions, 24 hours apart after the 20th week of gestation is gestational hypertension. This usually resolves,12 weeks after delivery. This condition is not associated with the loss of protein in the urine.

There are 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 can damage every single organ in the body.

Eclampsia: Eclampsia is Pre-eclampsia accompanied by fits/seizures. These convulsions cannot be attributed to any other cause.

Chronic hypertension: When blood pressure exceeding 140/90mm of Hg is observed prior to 20 weeks of pregnancy, we categorise the women as having chronic hypertension.

Dr Ramya Sadaram explains gestational hypertension in Telugu

Who is at risk of developing high blood pressure during pregnancy

1) Young first-time mothers have a high incidence of pre-eclampsia, and women who are older than 40 years have chronic hypertension.

2) Women who have been diagnosed as overweight.

3) Women who are pregnant with twins.

4) Women with underlying kidney disease or hyperhomocysteinaemia or Metabolic syndrome.

5) Women who dont have sufficient calcium, antioxidant, omega-3 fatty acid intake.

What are the symptoms of gestational hypertension

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. You should watch for signs of high blood pressure. These could include:

  • Headache that doesn’t go away
  • 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 changes, such as blurred or double vision
  • Nausea or vomiting
  • Pain in the upper right side of your belly, or pain around your stomach
  • Making small amounts of urine
  • Disturbed sleep
  • Shortness of breath

How will you identify if you have gestational hypertension in pregnancy

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

Complications with gestational hypertension

For the mother :

  • Eclampsia- fits
  • 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

Consult gynaecologist online