Gestational hypertension or PIH ( pregnancy induced hypertension) is the presence of high blood pressure after 5 months of pregnancy with large amounts of protein in urine. Like the name suggests, It is high blood pressure due to effects of pregnancy. High blood pressure is blood pressure that is ≥140/90mmHg.
Gestational hypertension is the cause of death to both mother and baby. Its estimated that 5 percent of pregnant women develop the disease. Without proper counselling and treatment, It could complicate with eclampsia and HELLP syndrome.
What are the risk factors of gestational hypertension (PIH)?
Many pregnant women are at risk of gestational hypertension. These are some of the risk factors:
The age of the woman. Pregnant women more than 40 years or less than 18 years are at risk of PIH. If you are at this extreme of age and pregnant, visit your doctor early in pregnancy.
First time moms. Gestational hypertension is common in women pregnant for the first time. This chance is higher when other risk factors are present. It is vital for first time moms to visit prenatal clinic. During clinic visits, you will be counselled by your doctor.
Weight of pregnant women. The weight of pregnant women is assessed with body mass index. This is commonly referred to as BMI. Its the function of weight and height. The normal BMI is 18.5 to 25. More than 30 is obesity. Obese women with pregnancy are at risk of gestational hypertension.
Multiparous women. PIH mostly occurs in first time moms. However, pregnant women that has delivered before can still have PIH. This happens if:
- There is change of partner
- Previous delivery is more than 10 years
Family history of PIH. The presence of PIH in either the mother or sister is a risk factor. Inform your doctor during your clinic visits.
Preexisting diseases before pregnancy can predispose to PIH. These diseases are diabetes, high blood pressure, autoimmune diseases.
Although these risk factors will increase chances of PIH in pregnancy, It is about 5 percent of women that develop the disease.
What are the types of high blood pressure in pregnancy?
High blood pressure in pregnancy is classified into 3 groups
Gestational hypertension or pregnancy induced hypertension (PIH) without protein in urine
This is common in pregnant women. These women have normal blood pressure before pregnancy. Symptoms and signs of high blood pressure develop after 5 months of pregnancy. Urine test done will reveal no protein. In addition, blood pressure returns to normal after delivery.
Pregnancy induced hypertension (PIH) with protein in urine
This is similar to PIH without protein in urine. It is sometime called preeclampsia. However, there is abnormal amounts of protein in urine. Protein in urine is abnormal when there is more than 300mg of protein in 24 hours urine sample. PIH, with protein in urine, occurs after 5 months of pregnancy. Blood pressure returns to normal after delivery of the baby.
These are women with high blood pressure before pregnancy. Their blood pressure is high in the first 5 months of pregnancy. Without proper care, it can lead to death of the mother and baby.
What are the symptoms and signs of Gestational hypertension?
If you are still confused about the symptoms, then lets make it clear. The symptoms and signs of gestational hypertension is dependent on the severity of the disease.
Women with mild disease will most times not show symptoms. However, rise in blood pressure will give rise to some of these symptoms:
- Blurring of vision
- Pain in the abdomen
- Leg swelling
- Face and hands swelling
- Weight gain
- Increase reflex
What is the cause of PIH or Gestational hypertension in pregnancy?
Many factors contribute to PIH. These are some factors:
- Genetic factors. Pregnant women that either sister or mother had PIH in the past are likely to show symptoms of disease
- Autoimmune factors
- Placenta problems
Failure of trophoblast to invade placenta blood vessels is attributed to the disease. This would reduce blood supply to the baby. Lack of oxygen and nutrient will result to hypoxia and widespread endothelial dysfunction.
How will Gestational hypertension Affect the baby?
- Due to reduction in blood supply to your baby, oxygen supply to the baby is reduced. This will cause slow growth and lead to delivery of small babies
- PIH is a common cause of premature baby delivery. This can result to neonatal respiratory distress syndrome (Neonatal RDS). This leads to difficult breathing for your baby. Neonatal RDS is common in babies delivered before 32 weeks of pregnancy.
Other PIH effect on the baby includes
- Cerebral palsy
What is PIH or Gestational hypertension treatment?
The treatment of PIH in pregnancy is dependent on
- The age of the pregnancy
- The severity of the disease
- The medical state of the baby and mother
The treatment of PIH requires use of blood pressure lowering drugs and anti seizure drugs.
However, the cure of gestational hypertension in pregnancy is delivery of the baby and placenta.
Pregnant women with mild disease (Blood pressure ≥140/90 mmHg to 159/109mmHg) are routinely counselled. Some of your doctor’s advice include:
- Regular prenatal check up
- Regular use of routine drugs
- Bed rest
- Mild exercise
- Drink a lot of water daily
- Reduce salt intake
- Stop smoking
- Stop alcohol
Pregnant women with severe disease ( Blood pressure ≥160/110mmHg) are treated with:
Blood pressure lowering drugs. The common drugs used include methydopa, nifedipine, hydralazine, prazocin.
Anti seizure drugs. This will prevent onset of seizure in women with severe disease. The drug of choice is magnesium sulphate. However, use of Magnesium sulphate should be monitored in pregnancy.
What is the delivery plan for women with Pregnancy Induced Hypertension?
Women with mild disease are treated conservatively. This provides more time for your baby to mature. At 37 weeks, induction of labor is done and baby delivered. cesarean section will be require if indicated.
Women with severe disease require close monitoring. More care would be needed for pregnancy below 32 weeks. Steroids are given to help the baby lungs to mature. This will help breathing problems after delivery. Delivery of premature baby is by Cesarean section. This is to prevent further stress to the baby.
Prevention of pregnancy induced hypertension
Oral calcium supplements is associated with reduced incidence of PIH in pregnancy. This has shown to reduced incidence of PIH in pregnancy. In addition, Low dose aspirin is helpful for patients with chronic high blood pressure or kidney disease.
What are the complications of PIH?
- Eclampsia. This is the onset of seizure in a patient with High blood pressure.
- Death to mother and baby
- Premature babies
- Small babies
- HELLP syndrome
- Bleeding. This results from low blood platelets.
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