Introduction
Hypertension is a condition where the blood exerts more pressure (than normal) against the walls of the blood vessels. It is a common condition but can be severe if left untreated. People with hypertension may not always show symptoms, so the only way to know if a person is hypertensive is to keep a check on it. Increased levels of blood pressure seen only in pregnancy are called gestational hypertension. It generally gets resolved with the birth of the baby.
What Is Gestational Hypertension?
Elevated levels of blood pressure seen in pregnancy are termed gestational hypertension. It is usually seen in about six percent of all pregnancies. Even before her pregnancy, a woman with hypertension is called a chronic hypertensive person. A woman is said to have gestational hypertension if her blood pressure levels are above 140/90 mm of Hg, provided her blood pressure levels were normal before twenty weeks of pregnancy. In gestational hypertension, protein release will not be in the urine.
What Is Pre-eclampsia?
In some conditions, gestational hypertension can often develop into pre-eclampsia. This usually occurs in young women in their first pregnancy. It is more common in pregnancies with multiple fetuses, like twins or triplets. Women with chronic hypertension and who have had hypertension in their previous pregnancies are more likely to have pre-eclampsia. When a woman with gestational hypertension also has increased amounts of proteins excreted in her urine, it is called pre-eclampsia. It is a more severe condition and needs to be treated appropriately. Left unattended, it can lead to eclampsia, a severe form of preeclampsia. In eclampsia, women are seen to have seizures. It occurs in one in one thousand six hundred pregnancies, usually towards the end.
What Are the Causes of Gestational Hypertension?
Studies are still going on to find the exact cause behind gestational hypertension. Many factors can cause it, and deficient placental implantation during the initial periods of pregnancy can be a cause. Some conditions may increase the risk of gestational hypertension, which can include:
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Already existing hypertension.
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Diabetes.
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Kidney diseases.
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Hypertension in the previous pregnancy.
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The mother's age is less than twenty years or more than forty years.
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Multiple fetuses.
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African-American race.
What Are the Causes of Preeclampsia?
Pre-eclampsia is more common among women with a large placenta, like in multiple pregnancies, and in women with associated microvascular diseases like diabetes, hypertension, collagen vascular diseases, etc. Other factors that can increase the risk can include:
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Genetic susceptibility.
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Increased parity (increased age difference between the partners).
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Maternal age is more than forty.
Notably, cigarette smoking is associated with a lower risk of pre-eclampsia. However, the adverse outcomes like low birth weight, placental abruption (a severe complication during pregnancy where the placenta detaches from the uterus), and perinatal death (death of the baby before twenty-eight weeks of gestation and the first seven days of life) weigh more than the benefit caused.
What Is the Prognosis for Pre-eclampsia and Gestational Hypertension?
Studies show that the prognosis for pregnancy-induced hypertension is similar to normotensive (normal blood pressure) pregnancies. However, if it develops into pre-eclampsia, the risk of morbidity and mortality increases for both the mother and the baby. The perinatal mortality (or perinatal death) in a mother with severe pre-eclampsia is double that of a mother with normal blood pressure. Gestational hypertension also shows a poor perinatal outcome. There are chances of placental abruption in some cases of gestational hypertension.
What Are the Differences Between Pre-eclampsia and Gestational Hypertension?
Though increased blood pressure is seen in both conditions, there are many differences between the two conditions. Gestational hypertension does not show any symptoms usually. A pregnant woman is said to have gestational hypertension if she shows multiple readings that are abnormally high after twenty weeks of pregnancy. On the other hand, pre-eclampsia exhibits symptoms like headaches, swelling in the hands and legs, etc. The presence of protein in the urine is another factor that differentiates the two conditions - the protein in urine is seen in cases of pre-eclampsia. At the same time, gestational hypertension does not show it. Low birth weight and preterm birth are some complications seen in gestational hypertension, while pre-eclampsia shows more severe complications. Complications in pre-eclampsia can include organ damage to the mother. Gestational hypertension generally does not cause any harm to the mother or the baby, while pre-eclampsia is life-threatening both to the mother and the baby. Gestational hypertension usually starts after pregnancy and disappears within or after twelve weeks after the baby's birth. On the contrary, preeclampsia occurs during pregnancy, usually towards the end and rarely after birth.
What Are the Similarities Between Pre-eclampsia and Gestational Hypertension?
Gestational hypertension and pre-eclampsia have elevated blood pressure after twenty weeks of pregnancy. Both of them have almost similar risk factors like obesity and previous history of increased blood pressure.
What Are the Complications of Pre-eclampsia?
Severe cases of pre-eclampsia can become complicated if not managed appropriately. They can include:
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Preterm birth (birth before the gestational age is completed).
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Poor fetal growth due to the lack of oxygen and nutrients.
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Low birth weight.
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Placental abruption (the placenta separates from the uterus).
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Stillbirth (the baby is born dead).
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Internal organs and blood systems damage, including the kidneys, liver, and brain.
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Increased risk of heart disease in the mother.
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Eclampsia (severe pre-eclampsia affecting the brain's functioning, causing seizures or coma).
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Hemolysis (destruction of the red blood cells), elevated liver enzymes, and low platelet count (HELLP) syndrome(a rare and severe complication of pre-eclampsia due to damage to the liver and blood cells.
How Is Pre-eclampsia and Gestational Hypertension Diagnosed?
Gestational hypertension is diagnosed when at least two readings of elevated blood pressure are seen twice after twenty weeks of gestation. According to the American College of Obstetricians and Gynecologists (ACOG), high blood pressure in pregnancy is when the systolic blood pressure increases to more than 140 mm/Hg and diastolic reading over 90 mm/Hg. Blood pressure over 160/110 mm Hg is considered severe hypertension. If a pregnant woman has constantly elevated high blood pressure, it is recommended to take a urine test to check for protein.
Conclusion
Early diagnosis and appropriate management of gestational hypertension and pre-eclampsia help to prevent further complications. Gestational hypertension usually disappears after delivery. However, it increases the risk of hypertension later in life. Pre-eclampsia, if managed appropriately, usually resolves after six weeks post-delivery but can progress into a more severe form in the postpartum period if not managed appropriately.
