Hypertensive disorders are common medical complications during pregnancy, affecting many expectant individuals globally. These conditions involve elevated blood pressure and can impact both the pregnant person and the developing baby. Understanding these disorders is important for recognizing signs and seeking timely medical attention. Early identification and careful management promote healthier outcomes for both mother and child.
Types of Hypertensive Disorders
Gestational hypertension is characterized by new-onset high blood pressure that develops after 20 weeks of pregnancy in those who previously had normal blood pressure. Protein in the urine or signs of organ damage are not present with this condition. Blood pressure typically returns to normal within six weeks following delivery.
Preeclampsia also develops after 20 weeks of gestation, involving high blood pressure and signs of damage to other organ systems, most commonly the kidneys, indicated by protein in the urine. Preeclampsia can also manifest without proteinuria, presenting with new-onset hypertension alongside symptoms like severe headaches, vision changes, or abnormal liver enzyme levels. Mild preeclampsia involves blood pressure readings of 140/90 mmHg or higher, while severe preeclampsia is diagnosed with readings of 160/110 mmHg or higher, or with more pronounced organ dysfunction or severe symptoms.
Eclampsia represents the most severe form of preeclampsia, occurring when seizures develop in a pregnant individual with preeclampsia. These seizures are not attributable to other brain conditions and represent a medical emergency, underscoring the importance of managing preeclampsia to prevent its progression.
Chronic hypertension refers to high blood pressure that was present before pregnancy, or diagnosed before 20 weeks of gestation. It can also be diagnosed if high blood pressure persists over six weeks postpartum. When a pregnant individual with chronic hypertension develops new or worsening high blood pressure and protein in the urine after 20 weeks, it is termed chronic hypertension with superimposed preeclampsia. This situation typically indicates a more complex and higher-risk pregnancy.
Recognizing the Signs and Risk Factors
Certain signs and symptoms during pregnancy can indicate a hypertensive disorder. These include:
- Swelling, particularly in the hands and face, though some swelling is common in normal pregnancies.
- Persistent headaches that do not improve with typical pain relievers.
- Visual disturbances, such as blurred vision, seeing spots, or temporary vision loss.
- Upper abdominal pain, often below the ribs on the right side.
- Severe nausea or vomiting developing late in pregnancy.
- Rapid weight gain over a short period, such as more than two pounds in a week, due to fluid retention.
Several factors increase the likelihood of developing hypertensive disorders during pregnancy:
- First-time pregnancy.
- Carrying multiple fetuses (e.g., twins or triplets).
- History of preeclampsia in a previous pregnancy.
- Pre-existing medical conditions like chronic hypertension, diabetes, kidney disease, or autoimmune diseases such as lupus.
- Age (under 20 or over 35 years old).
- Obesity (BMI of 30 or higher).
Diagnosis and Management During Pregnancy
Diagnosis of hypertensive disorders in pregnancy begins with regular blood pressure monitoring. A blood pressure reading of 140/90 mmHg or higher on two separate occasions, at least four hours apart, after 20 weeks of gestation, prompts further investigation. Healthcare providers also assess for protein in the urine, detected through a urine dipstick test or a 24-hour urine collection.
Blood tests are routinely performed to evaluate organ function. These tests may include checking liver enzymes and assessing kidney function through creatinine levels. A complete blood count also monitors platelet levels, as low platelets can indicate a more severe condition. These measures help distinguish between types of hypertensive disorders and determine their severity.
Management strategies during pregnancy are tailored to the specific type and severity of the hypertensive disorder. For gestational hypertension or mild preeclampsia, close monitoring is the primary approach, involving frequent blood pressure checks and urine tests. Fetal monitoring, including ultrasound to assess growth and amniotic fluid levels, and non-stress tests to evaluate fetal well-being, is also performed.
Activity restrictions, such as reduced physical exertion and increased rest, are recommended. In some cases, antihypertensive medications may be prescribed to lower blood pressure and prevent complications. If the condition is severe, hospitalization may be necessary for continuous and intensive management, including the administration of corticosteroids to accelerate fetal lung development if early delivery is anticipated. Delivery is often the definitive treatment, especially if the condition is severe or approaching term.
Potential Complications and Postpartum Considerations
Hypertensive disorders of pregnancy can lead to various complications for both the pregnant individual and the baby if not effectively managed. For the mother, these can include organ damage, particularly to kidneys, liver, and brain. HELLP syndrome is a complication characterized by hemolysis (breakdown of red blood cells), elevated liver enzymes, and low platelet count, which can be life-threatening. Stroke is another severe, though less common, maternal complication.
For the baby, potential complications include preterm birth, which can lead to respiratory distress syndrome and developmental issues. Intrauterine growth restriction (IUGR) occurs when the placenta does not adequately supply nutrients and oxygen, resulting in a smaller baby. Placental abruption, where the placenta separates from the inner wall of the uterus before birth, poses a significant risk to mother and baby.
Postpartum, most individuals with gestational hypertension or preeclampsia experience a resolution of their high blood pressure within days or weeks after delivery. However, continued monitoring of blood pressure is necessary for at least six weeks postpartum. Some individuals may require antihypertensive medication during this period.
Individuals who experienced preeclampsia or eclampsia have an increased long-term risk of developing chronic hypertension and cardiovascular disease later in life. Counseling about these long-term risks and recommendations for lifestyle modifications are provided. There is also an increased risk of recurrence in future pregnancies, which should be discussed with healthcare providers.