Definition

Gestational hypertension is a type of high blood pressure that occurs during pregnancy and usually goes away after delivery. It is classified as one of the hypertensive disorders of pregnancy.

Gestational hypertension can affect about 3 out of 50 pregnancies. It is important to note that gestational hypertension is not the same as chronic hypertension, which is high blood pressure that occurs before pregnancy. Additionally, gestational hypertension is a distinct condition from preeclampsia and eclampsia. However, it is worth noting that gestational hypertension can progress into preeclampsia.

This condition often occurs in young mothers with their first pregnancy. Gestational hypertension can occur in twin pregnancies, mothers older than 35 years, those with a history of chronic hypertension or hypertension in previous pregnancies, African-Americans, and mothers with diabetes. Gestational hypertension is diagnosed when blood pressure is higher than 140/90 mmHg in pregnant women who had normal blood pressure before 20 weeks of age and there is no protein in the urine.

Causes

The exact cause is unknown at this time. It is suspected that fetal attachment abnormalities while in the womb contribute to the appearance of gestational hypertension. This is based on abnormalities such as reduced blood flow from the uterus to the placenta and decreased blood vessel function.

Risk factor

Several risk factors can increase the occurrence of gestational hypertension. Some of these risk factors include:

• having experienced high blood pressure before pregnancy or during a previous pregnancy
• having kidney disease
• having diabetes
• being younger than 20 years old or older than 40 years old
• being pregnant with twins at the time of this pregnancy
• African American race

Symptoms

Several clinical symptoms can appear in gestational hypertension, including:

• High blood pressure
• Presence of protein in the urine
• Edema 'swelling', especially in the legs
• Sudden weight gain
• Visual disturbances such as blurred or double vision
• Nausea, vomiting
• Abdominal pain, on the right side or around the stomach
• Small amount of urine
• changes or abnormalities in kidney and/or liver function tests

Diagnosis

The diagnosis of gestational hypertension can be made through a medical interview, physical examination, and supporting examinations if necessary.

The doctor will inquire about the patient's current symptoms during the medical interview. Because symptoms can indicate a specific disease, you must express them fully, including when they began. This information is necessary for the doctor to make an accurate medical diagnosis. If your symptoms point to gestational hypertension, the doctor will conduct a physical examination and supporting tests.

Physical Examination

During the physical examination, the doctor will examine the patient based on the symptoms to identify several clinical signs, which are objective signs obtained by the doctor during the examination.  

In the case of gestational hypertension, the doctor can detect a blood pressure of more than 140/90 mmHg during pregnancy and a gestational age of more than 20 weeks when two examinations are performed at least four hours apart.

Patients with a systolic blood pressure of more than 160 mmHg or a diastolic blood pressure of more than 110 mmHg can be diagnosed with gestational hypertension if their pressures remain the same after multiple examinations.

In addition, there is edema or swelling and visual disturbances like double vision or blurred vision.

Supporting Examination

Supportive examinations can also help establish or confirm the diagnosis of gestational hypertension. Examples include:

• Urine examination to determine the presence of protein in the urine
• Liver and kidney function tests
• Hemostasis 'blood clotting' examination can be done to rule out the diagnosis of preeclampsia

Management

The doctor will assess the pregnancy's condition, general health, and previous medical history to determine the appropriate treatment and therapy for gestational hypertension. Additionally, the duration of the disease, tolerance to medications, procedures, or therapies, and desired treatment outcomes will all be taken into account.

The goal of therapy is to prevent the condition from deteriorating and avoid any complications from arising. The management of the condition involves taking enough rest at home, and hospitalization may be necessary in some cases. For pregnant women with pre-eclampsia, magnesium sulfate treatment is recommended. If gestational hypertension leads to severely high blood pressure levels, then hypertensive drugs would be prescribed. Additionally, fetal monitoring will be conducted to ensure the safety of the baby.

Administration of antihypertensive drugs in gestational hypertension will be given when blood pressure is at abnormal values above 160/110 mmHg. Some first-line therapies include labetalol, hydralazine, and nifedipine.

When a patient is diagnosed with gestational hypertension, fetal monitoring for uterine growth retardation, placental abnormalities, and low umbilical placental blood flow is recommended.

The only way to treat gestational hypertension is through labor or delivery. According to the American Society of Obstetricians and Gynecologists' guidelines, patients with gestational hypertension who do not have severe clinical symptoms can postpone delivery until 37 weeks gestation.

Complications

Several complications can arise when gestational hypertension occurs, including:

• Eclampsia seizures
• Bleeding in the brain
• Swelling of the lung organs (pulmonary edema)
• Kidney failure
• Blood clotting abnormalities
• Hemolysis
• Liver damage
• Thrombocytopenia
• Growth disorders in the fetus
• Oligohydramnios
• Impaired placement of the placenta in the uterus

Prevention

Early recognition of mothers who have risk factors for gestational hypertension is one method of prevention. This can protect the mother from several potential disease complications.

Education about the symptoms that may appear is also important because early detection of gestational hypertension can help mothers receive treatment and prevent disease progression.

In addition, there are several other precautions to avoid gestational hypertension disease during pregnancy later, such as:

• Drinking enough water at least 8 glasses or 2 liters per day
• Consume salt in moderation
• Reduce fried foods and fast foods
• Get enough rest
• Avoid drinking alcohol
• Regular exercise, such as pregnancy exercises at least 3-5 times per week for 15-30 minutes per time
• Avoid drinks that contain caffeine

When to see a doctor?

If your existing symptoms worsen, such as abdominal pain that worsens with breathing, you should consult an obstetrician and gynecologist. The doctor will conduct a medical interview, physical examination, and other tests to determine the precise diagnosis of the underlying disease and, if necessary, appropriate treatment.

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