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Gestational Hypertension

What is gestational hypertension?


Gestational hypertension is a form of high blood pressure in pregnancy. It occurs in about 6% of all pregnancies.
Another type of high blood pressure is chronic hypertension--high blood pressure that is present before
pregnancy begins. Other types of hypertension in pregnancy include preeclampsia and eclampsia.
Gestational hypertension can develop into preeclampsia. This condition occurs often in young women with a first
pregnancy. It is more common in twin pregnancies, in women over the age of 35, in women with chronic
hypertension or who had hypertension in a previous pregnancy, in African-American women, and in women with
diabetes.
Gestational hypertension is diagnosed when blood pressure readings are higher than 140/90 mm Hg in a woman
who had normal blood pressure prior to 20 weeks and has no proteinuria (excess protein in the urine).
Preeclampsia is diagnosed when a woman with gestational hypertension also has increased protein in her urine
or other signs such as a low number of platelets, impaired liver or kidney function, fluid in the lungs, severe
headaches, or visual disturbances.
Eclampsia is a severe form of preeclampsia. Women with eclampsia have seizures resulting from the condition.
Eclampsia occurs in about one in 1,600 pregnancies and develops near the end of pregnancy, in most cases.
HELLP syndrome is a variant of severe preeclampsia or eclampsia. HELLP syndrome is a group of physical
changes including the breakdown of red blood cells, changes in the liver, and low platelets (cells found in the
blood that are needed to help the blood to clot in order to control bleeding).

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
Diabetes
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:
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
A woman with gestational hypertension may not have any symptoms.

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


The goal of treatment is to prevent the condition from becoming worse and to prevent it from causing other
complications. Treatment for gestational hypertension may include:
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 if early delivery is likely (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.

Medical Reviewers:
MMI board-certified, academically affiliated clinician
Trevino, Healther, M., BSN, RNC

SORUCE: https://www.urmc.rochester.edu/encyclopedia/content.aspx?
ContentTypeID=90&ContentID=P02484

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