I recently worked with a client who was diagnosed with gestational hypertension at 35 weeks. She hadn't experienced high blood pressure in her 2 previous pregnancies or struggled with it in her current pregnancy. When we hear that a late-term pregnant mom has high blood pressure we often assume that means they have preeclampsia. However, gestational hypertension is a different diagnosis and does not necessarily mean it will develop into preeclampsia, although it can. So what are the differences and how are they diagnosed?
Gestational hypertension (or pregnancy induced hypertension, aka PIH) is diagnosed after 20 weeks of pregnancy if a woman's blood pressure is elevated to 140/90 or higher. Elevated blood pressure hinders blood flow to the liver, kidney, brain, uterus, and placenta which is why it needs to be identified and watched closely. Gestational hypertension has many of the same signs and symptoms of preeclampsia including:
-elevated blood pressure
-headaches
-edema (swelling)
-sudden weight gain
-vision changes
-nausea and vomiting
-right-sided upper abdominal pain
-urinating small amounts
If your blood pressure is elevated and you have some of these symptoms, your care provider will begin tests to look into further signs of preeclampsia. In addition to high blood pressure, preeclampsia also includes proteinuria (or protein in the urine), abnormal kidney or liver functions, and a low platelet count. In the absence of these symptoms, the diagnosis remains as gestational hypertension. Continual nonstress testing and fetal monitoring are also part of treatment to ensure that the baby is functioning well, growing, and that there are no signs of placental abruption.
Treatment for gestational hypertension or early preeclampsia include bedrest, hospitalization (if necessary for continued monitoring), magnesium sulfate, fetal monitoring, consuming less salt, and drinking at least 8 glasses of water a day. Treatment also depends on how close you are to the due date. If symptoms persist and preeclampsia develops your provider will most likely want to deliver the baby as soon as possible. If conditions are not severe, most providers will wait until 37 weeks and suggestion induction if the blood pressure remains consistently elevated.
Although there is no sure way to prevent hypertension, some factors can be controlled and others can't. The biggest indicator of developing hypertension is a family history or prior history of hypertension. Chances also increase if this is your first pregnancy, you are over 35, are African American, or have a body mass index (BMI) over 30. Some ways you can help prevent hypertension include:
-Drinking 8 glasses of water a day
-Using salt to taste
-Exercising regularly
-Getting enough rest
-Increasing the amount of protein you eat, while decreasing the amount of junk foods and fried
foods you eat
-Avoiding caffeine
My client monitored her blood pressure at home, had nonstress tests multiple times a week, went to regular midwife appointments, and went into the hospital several times for extra testing if symptoms worsened. She was able to manage the blood pressure without being hospitalized, it never developed into preeclampsia, and she was induced at 37 weeks. She was still able to maintain her birth preferences and delivered a healthy, normal weight baby.
Although unexpected conditions can be frightening, once you have ensured that you and your baby are safe, you can still maintain many of the desires you have for your pregnancy and delivery with the right information and support. Many babies are still born without complications and the mother's blood pressure often returns to normal after delivery.