Gestational Hypertension During Pregnancy

Your body goes through a lot of changes during pregnancy. It is coping with creating and nurturing a whole new human being inside. As a result. it is bound to lose its balance at times. One of the most common and often noticed problems is gestational hypertension during pregnancy.

What is Pregnancy Induced Hypertension(PIH)?

Pregnancy Induced Hypertension or Gestational Hypertension are the medical terms for high blood pressure during pregnancy. The force with which the blood pushes against your arteries is called blood pressure. Humans have a particular range for normal blood pressure. When this pressure is more than the permissible range, it is called high blood pressure or hypertension.

Pregnancy causes an increase in blood flow to support the growing baby and to carry more oxygen through the body. When pregnancy causes this blood pressure to go too high, it is known as pregnancy-induced hypertension.

Gestational hypertension is different from chronic hypertension. Chronic hypertension is when a woman has high blood pressure even before the pregnancy. Gestational hypertension on the other hand is high blood pressure that starts during pregnancy and mostly subsides after the pregnancy comes to term.

Different Types of Gestational Hypertension

While hypertension is a blanket term given to cases of high blood pressure, it can be classified into four different types in the case of pregnant women.

Hypertension in pregnancy can be classified into

Chronic Hypertension
Gestational Hypertension
Preeclampsia
Preeclampsia superimposed on chronic hypertension

[Read : Preeclampsia]

Causes of Gestational Hypertension During Pregnancy

The exact causes of gestational hypertension are still unknown. Some of the possible reasons for PIH could be

A pre-existing condition of hypertension
Kidney diseases
Diabetes
Age (younger than 20 or older than 40)
Pregnant with twins or more
African American decent

Symptoms of Pregnancy Induced Hypertension

Many women don’t show any symptoms at all. One of the main symptoms of pregnancy-induced hypertension is high blood pressure. Gestational hypertension usually starts in the second half of the pregnancy, sometimes even earlier, and mostly subsides after birth.

Some of the common symptoms of gestational hypertension are

Sudden weight gain
Edema (Swelling)
Persistent headaches
Changes in vision or blurry vision
Nausea or vomiting
Pain around or in the upper right side of the stomach
Low urine output

Many of these symptoms are common during pregnancy. So, don’t panic if you notice these symptoms. Keep your doctor informed about all the symptoms and changes you experience throughout your pregnancy. They will diagnose issues if any with proper medical tests.

Is Swelling a Sign of Pregnancy Induced Hypertension?

All types of swelling need not be a sign of pregnancy hypertension. Many pregnant women routinely experience swelling in the legs due to fluid build-up that happens due to the various physiological changes. Having said what edema or fluid retention along with blood pressure may not be a good sign. If you experience any of the symptoms of hypertension along with fluid build-up, you may need to get yourself checked immediately.

Diagnosis of Gestational Hypertension During Pregnancy

Generally, in pregnancy, the gynecologist or the prenatal care provider will monitor the pregnant woman’s vitals, regularly. The mom-to-be will be asked to come for a check-up at least once a month. Every time she comes in for a check-up, the doctor will check her weight, blood pressure, heart rate, and a few other parameters that are prone to change in the due course of pregnancy. If the blood pressure is higher than expected, the doctor might ask for more tests to confirm it is indeed pregnancy-induced hypertension.

Some of the tests they might ask for to confirm the diagnosis are:

Reading of blood pressure
Check the body, especially feet for swelling
Kidney and liver function tests
Blood clotting tests

Does Pregnancy Induced Hypertension Affect Your Baby?

If left unchecked, yes it can affect the baby. Though not serious or fatal at all times, it can have a fatal outcome if PIH leads to a severe case of preeclampsia.

Some of the serious impacts maternal PIH can have on the baby are:

Low birth weight
Health complications due to insufficient nutrients
Permanent change to the structure and metabolism
Cardiovascular disease in adult life (very rare)

Do You Have to Undergo a C-Section if You Suffer From PIH?

It depends on how serious the condition is. If the doctor is able to keep the PIH under control with medications and lifestyle changes, they will wait for a vaginal delivery. However, if the doctor notices the PIH is affecting the fetus or placenta, they will opt for a C-section, sometimes even before 37 weeks. If preeclampsia or hypertension is having a serious impact on the mother’s health, it is important to do the needful to protect her health and the baby’s health in due process.

Does PIH Persist After Pregnancy?

No, in most cases it will subside after the birth of the child. However, if the mother had a serious case of preeclampsia, there are high chances for hypertension in the future. If PIH does not subside on its own after pregnancy, the doctor will take more tests for better understanding. In very rare cases, hypertension can continue or develop “after” the birth. This is called postpartum preeclampsia.

Complications of Gestational Hypertension

High blood pressure leads to a number of health complications even in a non-pregnant individual.

In the case of pregnancy-induced hypertension, the following complications are possible:

Decrease blood flow to your kidneys, brain, liver, uterus, and the placenta
Lead to preeclampsia or eclampsia

Preeclampsia is a serious complication during pregnancy, which can be very dangerous to both mother and baby. If the doctor confirms a preeclampsia diagnosis, they might require you to deliver the baby as soon as it comes to term, which is around 37 – 38 weeks. If the condition is very severe, the doctor might deliver the baby even before the 37 weeks mark.

Preeclampsia can lead to the following complications:

1. Poor Fetal Growth

Preeclampsia can restrict the arteries from carrying sufficient blood to the placenta. As a result, essential nutrients and sufficient oxygen does not reach the baby. This can slow down fetal growth resulting in low birth weight, or even pre-term birth.

[Read : Slow Fetal Growth During Pregnancy]

2. Placenta Abruption

The placenta attaches itself to the inner wall of the uterus once the egg is fertilized and stays attached until it’s time for birth. Placental abruption is when the placenta detaches itself from the uterus before the delivery begins. An abruption will cause severe bleeding and can even be life-threatening to both mother and baby.

3. Organ Damage

Constant high blood pressure can cause severe damage to other organs in the body like – kidneys, liver, heart, lungs, or even the brain. The more severe the preeclampsia, the more severe the damage can be.

4. Preterm Birth

Severe preeclampsia may require preterm delivery to protect both mother and baby. Premature birth can cause several issues for the baby.

5. HELLP Syndrome

HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count – a severe form of preeclampsia. This syndrome causes the destruction of red blood cells and even becomes life-threatening for both mother and baby.

6. Death of Mother and Baby

In severe but rare cases, when the preeclampsia goes unchecked, it can be fatal for both mother and child.

How to Treat Pregnancy Induced Hypertension?

If you are diagnosed with PIH, the doctor might take the following steps to treat hypertension and keep it in check:

Advice bed rest
Hospitalization if blood pressure does not reduce
Prescribe magnesium sulphate or other PIH medicines
Constant monitoring

How to Manage PIH?

PIH has to be managed with mild medications and lifestyle changes. The doctors may not prescribe anything strong unless the blood pressure is too high and might cause harm to the fetus.

The doctor will manage PIH in the following ways:

Check blood pressure regularly.
Dipstick proteinuria testing once or twice a week.
Blood tests to measure full blood count, liver function and renal function.
Fetal assessment to ensure PIH is not affecting the baby.
Admission into hospital if blood pressure is too high.

Can You Prevent Gestational Hypertension?

Unfortunately, no. It cannot be prevented. The exact cause for pregnancy-induced hypertension is still not clear. When the cause of a health issue is unknown, it cannot be prevented.

If the expecting mother is prone to hypertension due to genetic factors or previous pregnancies (if she has already experienced PIH), then the doctors can anticipate hypertension. Medications can be prescribed accordingly. However, the doctor will not necessarily prescribe hypertension medicines until a confirmed diagnosis.

For women at a high risk of developing preeclampsia, the doctor might prescribe aspirin from week 12 of the pregnancy or calcium supplements. Women at high risk of developing preeclampsia will have

Kidney stones
Diabetes
Autoimmune disease
Had PIH in the previous pregnancy

Tips to Prevent Pregnancy Induced Hypertension

On a general note, an expecting mother can follow these tips to keep her blood pressure in check and have a healthy pregnancy.

Exercise regularly after consulting the doctor about limits.
Take regular tests of blood pressure and other vitals.
Eat food rich in essential nutrients to help in the baby’s development.
Keep blood sugar in check.
Monitor weight and adjust your diet accordingly.
Engage in activities to reduce stress and keep pregnancy hormones in balance.
Take all prescribed prenatal vitamins without fail.
Cut back on salt, which is known to increase blood pressure (there is no scientific evidence that avoiding salt can prevent PIH but salt is linked to hypertension).

Many women suffer from pregnancy-induced hypertension. So, you are not alone, and doctors are well equipped to handle the situation with care. Gestational hypertension is nothing to be worried about if you are able to keep the blood pressure under check. If you can keep the triggers in check, it makes controlling your blood pressure relatively easier. Work with your prenatal caregiver to decide on the best course of action, that is safe for both you and the baby.

[Read : Tips To Deal High Blood Pressure During Pregnancy]

FAQ’s

1. If I Had PIH in My First Pregnancy, Will I Have it in My Second Pregnancy Too?

In most cases, yes. However, since the exact cause for PIH is unknown, one cannot predict you will definitely develop hypertension in your next pregnancy. Since there is a history, the doctors will be more cautious and take more frequent tests to catch the issue at the earliest.

2. Can Reducing Salt Intake Prevent Gestational Hypertension?

No, there is no scientific evidence supporting this belief. Doctors advise a low salt diet for patients with hypertension as salt is known to increase blood pressure. So, the same will be advised for PIH. However, there is no proof to suggest cutting out salt can prevent PIH.

3. If I Have PIH, Will My Baby Have Hypertension When They Grow up?

PIH is restricted to your pregnancy phase and will subside once the pregnancy comes to term. However, if you already have an underlying hypertension issue, which surfaces during pregnancy, it might get passed on genetically. Still, it is only a possibility and not a certainty.