Pregnancy Induced Hypertension

Pregnancy-induced hypertension (PIH) means high blood pressure in pregnancy. It occurs in about 10% of pregnancies.

What needs to be understood at this point is that PIH is different from chronic hypertension which exists before pregnancy too.

High blood pressure in pregnancy can result in different signs and symptoms which need to be recognized timely to prevent any serious complications. Therefore, it is of paramount importance to diagnose and treat it timely.

What is pregnancy induced hypertension?

Pregnancy-induced hypertension is the significant increase in blood pressure during pregnancy which is usually higher than 140/90.

The term pregnancy-induced hypertension is used when this high blood pressure appears for the first time in pregnancy, or if there is a significant increase in blood pressure in chronic hypertensive patients.

If the condition worsens and proteins start to appear in the urine, and the pregnant woman also feels to have generalized swelling in the body, i.e edema, it means that PIH has now proceeded to a more severe form that is pre-eclampsia.

Difference between pregnancy induced hypertension, pre-eclampsia, and eclampsia?

Pregnancy-induced hypertension is the term generally used for raised blood pressure that occurs during the pregnancy for the first time, or sudden increase in blood pressure in previously known hypertensive patients.

It usually occurs within the first 20 weeks and is not associated with proteinuria (appearance of proteins in the urine).

However, high blood pressure that appears after 20 weeks which is also associated with proteinuria is called pre-eclampsia.

The severe form of PIH or pre-eclampsia is eclampsia. A pregnant woman who suffers from seizures in addition to high blood pressure and proteinuria is called eclampsia.

Risk factors for pregnancy induced hypertension:

Although there is no exact known cause for pregnancy-induced hypertension, the following risk factors have been thought to be implicated in inducing high blood pressure in pregnancy:

Young or old age of the pregnant woman (less than 20 years old or more than 40 years old)
African American women
Obesity
Chronic hypertension
Diabetes
First pregnancy in a woman
Twin pregnancies
In-vitro fertilization
10-year gap between first and second pregnancy
History of pregnancy-induced hypertension in previous pregnancies
Family history is positive for developing pregnancy-induced hypertension
Renal disease
Autoimmune disorders like SLE or rheumatoid arthritis – etc

Blood pressure monitoring is mandatory if you are having one or more of these risk factors as you will be more likely to get this illness.

A urine test may also help in the early diagnosis of pregnancy-induced hypertension. These tests and monitoring will help in identifying the PIH patients properly.

Symptoms of pregnancy induced hypertension:

A patient with PIH may experience no symptoms. In such patients, it will be difficult to diagnose this condition, and may only be recognized as hypertension by frequent blood pressure monitoring.

However, in other cases, one or more of the following symptoms may present in the patient.

High or sudden increase in blood pressure
Generalized swelling or edema that mostly starts from the feet
Severe headache
Changes in vision
Sudden weight gain
Nausea and vomiting
Upper abdominal pain – etc

Experiencing one or more of these symptoms during the pregnancy should be alarming and indicate the onset of PIH.

In this case, it is advised that you contact your physician or your doctor immediately for timely management of your high blood pressure.

How to diagnose pregnancy induced hypertension:

The following tests in the presence of clinical symptoms can be done for the detection of PIH.

Blood pressure measurements
Urine tests
Eye examination to check changes in the retina
Coagulation profile to see any coagulation defect
Evaluation for edema including blood albumin levels
Liver and kidney tests
Frequent weight measurements

Any disturbance seen on these tests associated with symptoms can lead to the diagnosis of PIH. The main emphasis now should be the primary management of the disease.

Complications associated with pregnancy-induced hypertension

Most cases of pregnancy-induced hypertension resolve without any serious damage. However, pregnancy-induced hypertension may cause various complications in both mother and child. It can even prove to be fatal if proper attention is not given to managing this high blood pressure.

1. HELPP syndrome

One of the complications of uncontrolled PIH is HELLP syndrome. It stands for Hemolysis, Elevated Liver enzymes, and Low Platelets.

It can be very concerning for the patient as hemolysis (breakdown of red blood cells) leads to anemia and hence low oxygenation problems.

Low platelets lead to increased bleeding time and elevated liver enzymes point to the fact that the liver has been damaged.

This condition may or may not be preceded by high blood pressure. It rarely occurs, so it is prevalent in about 0.1 to 1% of pregnancies.

But if and when it occurs, it can prove to be lethal and early delivery is usually advised to terminate this medical emergency.

2. End-organ damage

With blood pressure this high, it leads to increased resistance in blood vessels. This causes disturbance in blood flow to the organs and can cause end-organ damage.

Organs at risk for low blood flow include the brain causing stroke, the liver, kidneys causing acute renal failure, lungs causing fluid accumulation, and the uterus and placenta risking the life of the fetus.

Therefore, pregnancy-induced hypertension can endanger the life of both child and mother in multiple ways.

3. Placental abruption

PIH can also lead to placental abruption in its severe form. Placental abruption is the premature detachment of the placenta which compromises the blood flow to the fetus.

It can cause severe hemorrhage for the mother and can also risk the life of the fetus as the nutrient and oxygen supply to the fetus is blocked.

It is a medical emergency and must be treated immediately as it leads to premature delivery or death of the baby.

4. Fetal complications

Fetal complications associated with pregnancy-induced hypertension include restricted growth due to decreased blood flow and so low birth weight. Worst case scenario, it can also cause stillbirth.

How to treat pregnancy induced hypertension?

Once the diagnosis of PIH is made, efforts of the physician are directed towards the goal of treating it before it produces any complications.

The treatment preferred depends on the severity of the disease. The following options are available:

Simple bedrest at home or in hospital
Medication to bring the blood pressure low
Magnesium sulfate to prevent seizures
Fetal monitoring – to assess the health of the fetus which includes fetal movement count, fetal heart sounds, ultrasound imaging, and Doppler flow test.
Repeat tests to monitor the disease advancement
Early delivery of the baby may be planned if the disease is severe and the life of the baby or the mother is in danger. Generally, the rule is that if the pregnancy is more than 37 weeks, the baby is delivered either naturally or via C section but if the pregnancy is less than 37 weeks treatment options may vary from observation and monitoring to taking medications such as magnesium sulfate to avoid seizures or steroids for rapid maturity of fetal lungs and early delivery of the baby.

How to naturally help pregnancy induced hypertension?

A small increase in blood pressure can be managed or controlled at home with very little management;

Decreasing the intake of sodium and salts helps maintain blood pressure.
Drink enough water.
Do regular exercise
Avoid stress, anxiety, and depression
Abstain from alcohol, drugs, and cigarette smoking as they can worsen the situation
Avoid junk food – etc

How to prevent pregnancy-induced hypertension?

Preventing pregnancy-induced hypertension can be achieved by identifying risk factors and early onset of the disease. Pregnant women should be taught about the symptoms of PIH before it progresses to its complications.

Doctors usually recommend using low-dose aspirin as a prevention technique in high-risk patients. Regular measurements of blood pressure are generally advised for all patients who have any of the above-mentioned risk factors of PIH.

Does pregnancy-induced hypertension persist after pregnancy?

Generally, pregnancy-induced hypertension resolves after pregnancy within 6 weeks but it increases the risk of heart disease. In some rare cases, it persists as chronic hypertension.

Women with a history of chronic hypertension may continue to suffer from raised blood pressure even after the termination of pregnancy.

In all these instances, keeping in contact with your healthcare provider is important to maintain your blood pressure otherwise it may lead to serious complications.

Conclusion on pregnancy induced hypertension:

Pregnancy-induced hypertension is an abnormal rise in blood pressure due to unknown reasons for the first time in pregnancy.

If the risk factors are identified or symptoms appear in a pregnant woman, it is advisable to manage it from the start.

From simple home management techniques to hospital treatment, it should be treated before life-threatening complications occur. Immediate delivery may also need to be planned.

It usually resolves with childbirth but in rare cases, it may persist as chronic hypertension which requires further management.