Much Ado About Hypertension During Pregnancy
When a pregnant woman develops elevated blood pressure during pregnancy, it is known as pregnancy-induced hypertension or gestational hypertension.
Hypertension is a very common medical disorder seen in pregnant women. According to the World Health Organisation and the Federal Ministry of Health, Nigeria, gestational hypertension affects up to 10% of all pregnancies and is directly responsible for up to 29% of all maternal deaths in Nigeria today.
A blood pressure reading of 140/90 millimetres of mercury measured at least on two occasions 6 hours apart is considered as hypertension in pregnancy. Hypertension can manifest during pregnancy in these ways:
• Chronic hypertension: This is hypertension previously established prior to pregnancy.
• Gestational hypertension: This develops after 20 weeks of pregnancy.
Hypertension in pregnancy can worsen and affect the kidneys, brain and liver which leads to the passage of proteins in the urine, amongst other symptoms. This is known as preeclampsia. It can be life-threatening for both the mother and the unborn baby.
Further deterioration may lead to the occurrence of seizures in a woman with preeclampsia known as eclampsia.
What causes hypertension in pregnancy?
A singular cause for hypertension in pregnancy hasn’t been identified but a number of risk factors have been identified. However, the presence of these factors does not mean that one will develop hypertension in pregnancy. The risk factors are as follows:
• Having had hypertension or any of its complications in previous pregnancies.
• Being pregnant with twins, triplets, quadruplets etc.
• Being obese.
• Women whose sisters and mothers had hypertension in pregnancy.
• Being pregnant at a young age (20 or less) or at an old age (40 or older).
• Diabetic women or women with diabetes in pregnancy.
• Women who drink alcohol.
• Women who smoke.
• Being pregnant after a long interval (greater than 10 years).
• Women who had high blood pressure or kidney disease prior to pregnancy.
• Black women.
What symptoms may be seen?
Hypertension is a “silent” disease and symptoms may not be apparent. It also depends on how far along you are in pregnancy and how high your blood pressure gets. The more severe your hypertension and the earlier in pregnancy it appears, the greater your risk for problems.
However, all pregnant women should receive an antenatal education so that they are aware of the symptoms associated with preeclampsia. Such symptoms include:
• Severe headaches.
• Visual problems: blurred vision or flashing before the eyes.
• Severe pain in the upper abdomen.
• Shortness of breath.
• Nausea and vomiting.
• Sudden swelling of the face, hands or feet.
What complications can arise?
A myriad of complications may occur depending on the severity of hypertension and level of control. Here are a few common complications seen:
• Heart failure in mother.
• Small-sized baby.
• Death of the foetus.
• Kidney failure in mother.
• Preterm delivery of the foetus.
• Bleeding disorders in mother.
• Liver failure in mother.
• Stroke in mother.
• Blindness in mother.
How is gestational hypertension managed?
Treatment is specified to monitor (by frequent blood pressure measurements) and control blood pressure (by taking antihypertensives), minimise complications and ensure a healthy mother and child until and after delivery. Your doctor may prescribe a few tests to monitor your health and that of your baby.