Pregnancy Induced Hypertension (Gestational Hypertension)

Pregnancy-Induced Hypertension (PIH) or Gestational Hypertension is a situation where the blood pressure (BP) remains high leading to complications like Preeclampsia or Toxemia affecting about 6 to 8 % of pregnant women. The BP remains high for 20 weeks or more showing no traces of protein in the urine. One will need an examination for Preeclampsia before the PIH diagnosis.

Symptoms

The doctor will check the blood pressure and conduct a few urine tests during every prenatal checkup. The kidney and blood-clotting functions are also checked besides specific blood tests. Ultrasound to monitor the growth and doppler scan is also done to measure the flow of blood to the placenta.

Other Symptoms 

  • Blood in vomit
  • Recurrent headaches
  • Reduced urination
  • Excessive sweating on the soles and palms
  • Traces of blood in the urine
  • Dizziness
  • Drowsiness
  • Rapid heartbeat
  • Extreme nausea and vomiting
  • Fever
  • Double or blurred vision
  • Unusual pain in the abdomen area
  • Buzzing sound in the ears

Types

  • Gestational Hypertension: High BP develops after 20 weeks but lowers down after the delivery.
  • Chronic Hypertension: High BP above 140/90 in the early and later trimester.
  • Preeclampsia: Severe condition after 20 weeks that includes both types of hypertension. High blood pressure with high protein levels in the urine can cause complications.

Who is at Risk?

  • First-time mothers
  • One has a history of PIH
  • Carrying multiples
  • Younger than age 20
  • A history of high BP or kidney disease before conceiving
  • African American
  • Obese

Risks

High blood-pressure increases the support which leads to disturbances in the flow of the blood to the placenta, uterus, brain, kidneys and the liver.

To The Baby

  • Genital defects
  • Improper flow of blood to the placenta causes the restricted growth of the intrauterine
  • Small in size than the regular one
  • Lesser than the ordinary weight at the time of birth
  • Maturity of the lungs due to the insufficient supply of oxygen causing Neonatal Asphyxia

Maternal Risks

  • Stillbirth
  • Blood clots
  • Placental abruption
  • HELLP syndrome, preeclampsia, and seizures
  • Early labor
  • Momentary failure of the kidneys
  • Problems of the liver, stroke, diseases of the kidney, diabetes, and disorders of the heart

Risk Factors

Researches are still working to find them, but there are several factors which may pose severe complications in the future:

  • First conceiving
  • Twin pregnancies
  • Being overweight
  • Less than 20 years of age
  • Lupus or any other disorders of the blood vessels
  • Induced BP in the first pregnancy
  • Any disease of the kidney
  • Any genetic case of high BP
  • Abnormalities of the placenta like Hyperplacentosis and Placental Ischemia

Will Blood Pressure Return to Normal after Delivery?

After the delivery, the doctor keeps a regular check for the signs related to preeclampsia and associated risks. However, BP will return to normal after a few weeks of the delivery. In some women, it may remain high for three months, but if its constant, diagnosis is required for chronic hypertension. Post-delivery, the BP lowers down at the end of the first and second trimester but may temporarily hide chronic hypertension.

Diagnosis

Here are the primary criteria required for the determination of a high BP:

  • Lack of the levels of protein in the urine
  • 140/90 or high readings of BP in the week 20

Some procedures and tests differentiate it from other complications like:

  • Assessing edema
  • Blood tests
  • Test for examining preeclampsia
  • Urine test to check the protein levels in the urine
  • Tests for checking the functionality of the liver and the kidneys
  • Examination of the eyes to review any changes in the retina

Complications

  • Delay in development: Causes premature birth
  • Placental Abruption: Placenta suddenly pulls off the uterine wall causing fetal distress and bleeding
  • Seizures: Some cases may be life-threatening needing seizures
  • Liver Ailments: Develops liver problems
  • Kidney Failure: Many examples of kidney failures in mothers suffering from PIH
  • Premature Baby: If PIH turns severe, a c-section needs to be done before the due date requiring urgent medical care.
  • Preeclampsia: Sudden weight gain, abdominal pain, and swelling

C-Section for PIH

Cesarean is advisable if it affects the health where in most cases it is not suggested. The gynecologist will merely use oxytocin to induce labor so that the delivery goes smoothly.

Treatment

The treatment depends on the due date, if it’s near, the doctor will want an early delivery. On having mild hypertension, it is advisable to:

  • Drink 8-9 glasses of water daily
  • Consume less salt
  • Go regularly for prenatal checkups
  • Lie on the left side when resting on the bed

Note: On having severe hypertension one may need medications for vaginal delivery.

Does High BP Mean You Have PIH?

The high BP does not always indicate PIH, however, if the gynecologist finds an abnormal increase in it, he/she may examine the condition with specific tests to diagnose PIH. Apart from having high BP, those who experience PIH have swelling and show protein in the urine.

Is Swelling a Symptom of PIH?

Swelling can indicate PIH but needs a proper diagnosis before being confirmed. It is a more severe condition, and if it doesn’t go away after adequate resting, it will spread to face and hands indicating a serious medical condition needing immediate attention.

Dietary Tips

  • Sodium increases the level of fluids in the body which in turn develops high BP. Lower the intake of salt (sodium) to reduce the risk
  • Try to include many vegetables and fruits in the diet as they are rich in potassium and will thereby help in reducing high levels of sodium keeping an eye on the condition of the heart
  • Follow a DASH diet to balance the scales of potassium as well as the sodium
  • Adding 1200 to 1500 mg of calcium and 300 mg of magnesium in the menu is a beneficial option to prevent high BP
  • Several herbs like Parsley, Cilantro add taste to the food. Adding spices including chili and pepper by replacing salt will also help

Note: Contact the doctor before using these spices and herbs during the trimesters

Remedies

  • Celery: Use the powder of Cereal mixed in warm water twice a day to overcome the condition quickly
  • Lemon juice: Drink two tablespoons of lemon juice to control the disease. Add few drops of it in the tea
  • Beet: Either eat it as a salad or drink its juice
  • Garlic: Garlic cloves are best to treat this condition. Three ground cloves mixed with water works best for managing high BP

Medications

Avoid taking any medication as they may be harmful to the health instead of some purposeful medicines such as Labetalol, Nifedipine, Hydralazine, and Methyldopa. However, taking magnesium sulfate will save against future complications.

Monitoring At The Hospital

  • Measuring the weight and BP
  • Blood and urine tests
  • Examining the growth and health of the fetus through an ultrasound while checking the movements of the fetus and BPP (biophysical profile)
  • Monitoring the quantity of the urine produced
  • Assessing the volume of the amniotic fluid because those who have lower levels fall victim to PIH

When BP returns to normal, one should take extra care of the eating habits as well as the lifestyle to prevent any future risk. However, PIH may return even after the birth of the baby in rare instances that may develop due to the lack of proper diagnosis earlier. Taking proper bed rest, medicines for hypertension, regular BP checkup and making various changes in the lifestyle can avoid risks like preeclampsia after the delivery. Also, contact your doctor before taking any medications for high BP during the trimesters.

Prevention

There are no ways to prevent it as of now, but some ways that may help include:

  • Avoid eating salt
  • Drinking 8-10 glasses of water
  • Avoid eating fried, and junk foods instead increase the intake of proteins
  • Exercise daily
  • Sleep at least 8 hours a day
  • Avoid drinking alcohol
  • Elevate the feet
  • Avoid caffeine
  • Take medicines after the doctor’s consultation
  • Reduce stress levels
  • Monitor the BP levels daily

References

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