Gestational hypertension is one that occurs after the 20th week of pregnancy in women who were not hypertensive before becoming pregnant.
Hypertension is the most common health problem in pregnant women and is present in 10 to 15% of pregnancies. A pregnant woman may have hypertension either because she was already hypertensive before becoming pregnant or because she developed hypertension during pregnancy.
When hypertension occurs only after the 20th week of pregnancy in a woman who was not previously hypertensive, we classified as gestational hypertension. Once it appears, gestational hypertension usually lasts for the rest of the pregnancy, but tends to disappear in the first 12 weeks after delivery.
In this article, we will discuss hypertension in pregnancy explaining the differences between chronic hypertension in pregnant women, gestational hypertension, and preeclampsia. We will also talk about the treatment of hypertension in pregnant women and the risks to the baby.
TYPES OF HYPERTENSION IN PREGNANCY
The pregnant woman can be affected by 4 different forms of hypertension, namely:
1- Pre-existing chronic hypertension – individuals with blood pressure values often above 140/90 mmHg are considered hypertensive. In pregnancy, pre-existing hypertension is considered to be all hypertension that already existed before the woman became pregnant. As expected, women who are hypertensive before pregnancy will remain hypertensive throughout it.
Pre-existing hypertension is also considered if it is identified before the 20th week of pregnancy. When the woman discovers that she is hypertensive before the 20th week is because she was already hypertensive before pregnancy and she just did not know.
2- Preeclampsia – is the appearance of hypertension after the 20th week of gestation associated with loss of protein in the urine, which is called proteinuria. Hypertension that appears after the 20th week of pregnancy and is associated with kidney, liver, central nervous system, or decreased platelet count may also be preeclampsia.
3- Preeclampsia superimposed on chronic hypertension – is preeclampsia that occurs in previously hypertensive women.
4- Gestational hypertension – hypertension is considered gestational hypertension that occurs only after the 20th week of gestation and does not show loss of protein in the urine or any other manifestation suggestive of preeclampsia.
In this article, we will look at gestational hypertension, which is a form of pregnancy-induced hypertension.
WHAT IS MANAGEMENT HYPERTENSION
As we explained above, gestational hypertension is a form of hypertension that occurs after the 20th week of pregnancy in previously healthy women who do not show any signs of preeclampsia.
Although this form of hypertension may appear from the 20th week of gestation, most cases only appear at the end of pregnancy, as early as the third trimester.
Gestational hypertension is an exclusive hypertension of pregnancy, disappearing in most cases spontaneously within 1 to 2 weeks after delivery. If up to 12 weeks postpartum hypertension does not disappear, the patient happens to be considered as having chronic hypertension. The unconstrained determination of hypertension happens in roughly 15% of cases.
Gestational hypertension is a risk factor for the future development of hypertension. Even women who present normalization of blood pressure after childbirth, in the long run, having 4 times greater risks of developing chronic hypertension.
As mentioned in the article’s introduction, about 10 to 15% of pregnant women end up developing gestational hypertension. Some clinical features increase the risk of developing high blood pressure during pregnancy. They are:
- First pregnancy.
- Pregnant women with overweight.
- Pregnant women of the black ethnic group.
- Pregnant women over 35 years of age.
- Family history or preeclampsia personal.
- Twin pregnancy.
Pregnancy during adolescence.
Gestational hypertension is a much less serious problem than preeclampsia but can cause harm to the pregnant woman and the baby. Pregnant hypertensive women are at increased risk of changes in placental blood flow, restriction of fetal growth, placental abruption and premature delivery.
Complications are more common in women with severe gestational hypertension, characterized by persistently higher blood pressure levels than 160/110 mmHg.
RISK OF PREECLAMPSIA
Among pregnant women who initially have gestational hypertension criteria, approximately 1/3 end up evolving to have preeclampsia criteria, which is a more severe form of hypertension. Therefore, all pregnant women with gestational hypertension should be carefully observed during pregnancy, with frequent urine cultures testing for proteinuria.
We do not yet know whether gestational hypertension and preeclampsia are two distinct diseases or simply different clinical spectra of the same disease.
Some clinical features at the time of presentation of gestational hypertension predict an increased risk of progression to preeclampsia. They are:
- The onset of hypertension before the 34th week of pregnancy.
- Severe arterial hypertension.
- Changes in uterine artery flow detectable through Doppler ultrasound.
- High levels of uric acid.
TREATMENT OF HYPERTENSION IN PREGNANCY
Many of the medications commonly used to treat hypertension are contraindicated in pregnancy, which makes controlling pregnancy blood pressure a more complicated task. In addition, the safety margin is lower, as a reduction in blood pressure beyond what is desired can cause severe reduction of blood flow to the placenta, bringing damage to the fetus. Therefore, except in severe cases, obstetricians often choose not to treat hypertension with medication during pregnancy.
The treatment of pregnant hypertension depends on the degree of arterial hypertension.
- A) Blood pressure lower than 160 / 110mmHg – non-severe gestational hypertension
The majority of women with gestational hypertension who have blood pressure levels below 160 / 110mmHg can be accompanied with weekly or bi-weekly consultations to measure blood pressure and protein excretion in the urine. The pregnant woman should also be instructed to measure her blood pressure daily at home.
The goal of such frequent consultations is to identify early any signs of progression to preeclampsia. Patients should be informed of signs and symptoms of severity, such as a headache, visual changes, abdominal pain, decreased fetal movements, or vaginal bleeding.
In non-severe gestational hypertension, the pregnant woman does not need to be resting in bed, but a reduction in daily activities is indicated. Physical exercise should be avoided and if the professional work is very stressful or exhausting, the idea is to get away.
Scientific studies demonstrate that treatment of blood pressure in non-severe gestational hypertension does not convey advantages to the mother or the embryo and can likewise bring about undesirable side effects. Therefore, if the woman does not have blood pressure values greater than 160 / 110mmHg, it is not necessary to start any antihypertensive medication.
Birth in gestational hypertension is usually performed between the 37th and 39th weeks of pregnancy, depending on the clinical situation of the pregnant woman and the fetus.
- B) Blood pressure greater than 160/110 mmHg – severe gestational hypertension
Women who develop severe gestational hypertension have similar complication rates to preeclampsia and should be treated in the same way.
Severe gestational hypertension needs to be treated with antihypertensive drugs and delivery is performed between 34 and 36 weeks of pregnancy.
If the pregnant woman is younger than 34 weeks, Hospitalization is usually indicated for the control and follow-up of the fetus and blood pressure. The goal in these cases is to try to carry the pregnancy safely for at least 34 weeks.
The drugs most used for the control of blood pressure are Methyldopa, Hydralazine, Nifedipine and Labetalol.
(Please visit your Gynecologist before taking any type of medicine during pregnancy, information in this article is just only for knowledge purpose. Site owner is not responsible for any type adverse effect of medicine mentioned in this site)
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