Life Blood: An Examination Pregnancy Induced Hypertension

Introduction

A healthy pregnancy involves careful consideration of the health of the mother and the needs of the fetus. While it is not always the case, a healthy mother often means a healthy fetus (and vice versa). Even with the advancement of modern medicine, there are many complications that can arise with pregnancy, and mothers must take their own health into consideration. While some of these complications are not necessarily or entirely preventable or treatable, conditions will be made better with the right health considerations. One clear example of this is pregnancy-induced hypertension (or, gestational hypertension).

Hypertension, more broadly, essentially means high blood pressure in layman’s terms. This is a chronic medical condition when blood pressure in the body’s arteries threatens the heart and key organs. Hypertension falls under one of two classifications: primary hypertension or secondary hypertension (Carretero & Oparil, 2000). Primary (or, “essential”) hypertension accounts for over 90% of hypertension cases and is characterized by the fact that there is no principal bodily or medical cause for the chronic condition. It is simply a condition standing on its own. In contrast, secondary hypertension is caused by other medical conditions – such as complications with the kidneys, arteries, endocrine system, heart, or other organs (Carretero & Oparil, 2000).

Treatment of both classifications includes both lifestyle and dietary changes, as well as the possibility of drug treatment for those who find that lifestyle changes are not effective (Carretero & Oparil, 2000). Suggested dietary and lifestyle changes include the maintenance of normal body weight, a reduction in sodium intake, engagement in regular aerobic exercise, limitation of alcohol intake, and a diet full of fruit and vegetables (Williams et al., 2004). As the authors go on to state, “Combinations of two or more lifestyle modifications can achieve even better results” (Williams et al., 2004, p. 185). These changes will be applied to gestational hypertension specifically.

Of course, this information and potential treatments are related to hypertension more broadly. A specific summary of gestational hypertension is given below. There are differences in both cause and treatment that must be addressed. As the paper will discuss below, gestational hypertension poses some minor health risks for the mother and baby, but it can lead to more serious complications. The paper examines the identification, complications, treatment, and management of this chronic complication in pregnancy. By the end, the reader ought to have a fundamental (albeit brief) understanding of gestational hypertension.

Specifics: Gestational Hypertension

A more specific sub-set of hypertension is pregnancy-induced hypertension (PIH), or gestational hypertension. This is defined specifically as a new development of hypertension in a woman who is more than twenty weeks pregnant (Barton, 2001). There are several states of hypertension within any given pregnancy: gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome. Each of these is essentially a progression of the last, with each stage being more dangerous for the pregnant mother and the fetus.

Barton (2001) gives succinct definitions of these. He defines gestational hypertension as “having a blood pressure higher than 140/90 measured on two separate occasions, more than 6 hours apart, without the presence of protein in the urine and diagnosed after twenty weeks of gestation” (Barton, 2001, p. 981). He then defines preeclampsia as the next stage, stating “preeclampsia is gestational hypertension plus proteinuria [more than 300 mg of protein in a 24-hour urine sample]. Severe preeclampsia involves a blood pressure greater than 160/110” (Barton, 2001, p. 982). In other words, gestational hypertension can quite quickly progress to worse symptoms.

After preeclampsia comes eclampsia, which Barton defines as being characterized by “tonic-clonic seizures appearing in a pregnant woman with high blood pressure and proteinuria” (Barton, 2001, p. 982). This is when hypertension begins to take on external symptoms, bringing the pregnant patient to a new level of danger. Finally, the HELLP syndrome is essentially a hazardous confluence of three chronic medical conditions: elevated liver enzymes, hemolytic anemia, and a low platelet count (Barton, 2001). Each of these stages of hypertension ought to be monitored closely and treated accordingly. The potential health risks and problems for patients are given below.

Almost any woman is at risk of gestational hypertension when pregnant. However, there are certain factors that contribute to the risk factor. Barton identifies these factors as follows: first-time pregnancy, having family members who had PIH, multiple gestations (i.e. twins or triplets), pregnancy younger than 20 or older than 40, and (most obviously) women who had hypertension (or, high blood pressure) before pregnancy (Barton, 2001). Each of these factors must be taken into consideration when diagnosing and advising pregnant women on the potential problems, possible treatments, and effective management associated with gestational hypertension.

Problems for Patients

While gestational hypertension may be one of the most common chronic disorders seen in human pregnancy, its potential for harm for mothers and infants should not be overlooked. In fact, while gestational hypertension may have little health effect in and of itself, it is recognized that half of the cases of gestational hypertension progress to preeclampsia, which is potentially life-threatening to pregnant women (Abrams & Rutherford, 2011). As Abrams and Rutherford (2011) go on to state, “hypertension during pregnancy affects about 6-8% of all pregnant women” (p. 417). Such a commonly occurring complication in pregnancy must be given careful consideration.

Even without progression to further, more dangerous complications, gestational hypertension can prove problematic for pregnant mothers and their babies. Williams, et al. (2004) give a clear picture of these potential problems by getting at the root of this health issue. The authors state, “Hypertension can prevent the placenta from getting enough blood. If the placenta doesn’t get enough blood, your baby gets less oxygen and food. This can result in low birth weight” (p. 180). However, the authors do not end there – they do give some hope. As they say, “Most women still can deliver a healthy baby if hypertension is detected early and treated with regular prenatal care” (Williams, et al., 2004, p. 181). The particulars of this effective prenatal care will be given later.

Besides the health concerns for the baby being born, gestational hypertension can prove to be difficult for the mother’s health. As the paper has already mentioned, unaddressed and untreated gestational hypertension can lead to preeclampsia, which is particularly dangerous for the mother-to-be. Carretero and Oparil (2000) identify the potential risks of letting gestational hypertension progress to preeclampsia, saying that it is a major risk factor for “stroke, aneurysms of the arteries, peripheral arterial disease, and causes of chronic kidney disease” (p. 335). Therefore, chronic gestational hypertension must be avoided as much as possible. This can be accomplished through prevention measures, treatment of existing symptoms, the correct management of the patient, and the education of the patient regarding their health concerns. Each of these is discussed in turn. Of course, the most important may be the personal education of each patient, as their actions may prevent gestational hypertension altogether.

Treatment of Gestational Hypertension

The prevention and treatment of gestational hypertension are quite like hypertension more broadly, which were discussed above. Siebenhofer et al. (2004) gives further insight:

The first line of treatment for hypertension is identical to the recommended preventive lifestyle changes and includes dietary changes, physical exercise, and weight loss. These have all been shown to significantly reduce blood pressure in people with hypertension. Their potential effectiveness is similar to using a single medication. If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication (p. 120).

From this summation, patients must take into consideration dietary and lifestyle considerations, as well as the possibility of medication if the hypertension is more serious. However, the use of medicine to treat gestational hypertension has limited options, because “many antihypertensives may negatively affect the fetus” (Abrams & Rutherford, 2011, p. 428). If the risks associated with a case of hypertension are severe, the possibility of risk associated with medication may be considered as acceptable, given the face of the alternative. Abrams & Rutherford (2011) identify the three most common medications for treating severe gestational hypertension as labetalol, hydralazine, and methyldopa (p. 429). Of course, each of these must be approached with care, according to the advice of the pregnant patient’s physician. The lifestyle and dietary treatments should be adapted to gestational hypertension from the treatments discussed above.

Management & Education of the Patient

The successful prevention and treatment of gestational hypertension depend equally on the correct management of a patient by the physician and the personal education of the patient. For correct management, a physician should take the right steps during a prenatal checkup. This includes checking blood pressure and urine levels, ordering blood tests, examining the functions of the patient’s kidney and blood-clotting ability, and conducting an ultrasound to check baby growth and a Doppler scan to the efficiency of blood flow (Barton, 2001, p. 982). As with any potential complication for pregnancies, the possibility of gestational hypertension and its associated symptoms should be taken seriously. In the same way, patients ought to educate themselves regarding the possibility of gestational hypertension. This includes taking the advice of physicians into consideration, but also taking further steps to make sure that the proper steps are taken.

Conclusion

The above paper provides a brief examination of gestational hypertension. Of course, the entirety of gestational hypertension cannot be addressed in such a short paper. However, the paper has outlined the main identifying factors, as well as the possibilities for prevention and treatment. Ultimately, the paper identifies gestational hypertension as a potentially serious issue that must be addressed head-on by patients and physicians.

References

Abrams, E., and Rutherford, J. (2011). Framing postpartum hemorrhage as a consequence of human placental biology: An evolutionary and comparative perspective. American Anthropology, (113)3: 417-30.

Barton, J. (2001). Mild gestational hypertension remote from term: Progression and outcome. American Journal of Obstetrics and Gynecology, (184)5: 979-83.

Siebenhofer, A., Jeitler, K., Berghold, A., Waltering, A., Hemkens, L.G., Semlitsch, T., Pachler, C., Strametz, R., & Horvath, K. (2011). Long-term effects of weight-reducing diets in hypertensive patients. Cochrane Database of Systematic Reviews, 9(9): 118-127.

Williams, B., Poulter, N.R., Brown, M.J., Davis, M., McInnes, G.T., Potter, J.F., Sever, P.S., & McG, T.S. (2004). Guidelines for management of hypertension: Report of the fourth working party of the British Hypertension Society. Journal of Human Hypertension, (18)3: 139-185.