Pregnancy Induced Hypertension (Gestational Hypertension)

What is pregnancy induced hypertension?

High BP in pregnancy is classified into three main categories – chronic high BP, pregnancy induced high BP and preeclampsia ^[1]. Development of high blood pressure in a woman after the 20th week of pregnancy (mid second or third trimesters) without any sign of protein in the urine (proteinuria) is referred to as pregnancy induced hypertension (PIH) or gestational hypertension ^[2]. A systolic blood pressure reading of or above 140 mmHg and a diastolic blood pressure reading of or above 90 mmHg are considered high blood pressure (even if only one reading is elevated) ^[3].

What are the causes and risk factors of pregnancy induced hypertension?

Researchers are still trying to find the exact causes responsible for developing new high BP while pregnant. The common risk factors include:

Being pregnant for the first time
Obesity
Family history of pregnancy induced high blood pressure (genetic predisposition increases the risk by 3 times) ^[4]
Diabetes and other blood vessel disorders (e.g. lupus)
Being below 20 or over 35 years of age
High BP in a previous pregnancy
Kidney disease ^[5]
Twin pregnancy ^[2]
Placental abnormalities such as placental ischemia and hyperplacentosis (characterized by increased placental activity)

Gestational Hypertension Signs and Symptoms

It is quite common for women with mild hypertension to have no detectable symptoms ^[5]. However, some women may experience:

Blurred vision
Sudden weight gain
Passing smaller amounts urine ^[5]
Breathing problem
Abdominal pain and vomiting
Headache and dizziness
Sudden swelling or edema of your face, hands and feet

Edema of hands and feet is a normal symptom of pregnancy, but signs of sudden swelling may be a serious pregnancy concern. Contact your doctor immediately if you have any of the above symptoms.

What are the risks of gestational hypertension?

The increased resistance of the blood vessels due to high BP hinders blood flow to the uterus and placenta as well as various organs including the kidneys, liver and brain ^[5].

Risks to the baby

Intrauterine growth restriction (restricted fetal growth) due to the lack of blood flow to the placenta
Neonatal Asphyxia (due to incomplete lung maturity because of limited oxygen supply to the placenta) ^[6]
Lower than average birth weight
Smaller than average size
Birth defects ^[7]

Maternal Complications

Preeclampsia, eclampsia (seizures) and HELLP syndrome
Placental abruption
Preterm labor and delivery
Stillbirth ^[5]
Blood clotting problems
Temporary kidney failure ^[8]
Future heart disorders, stroke, kidney diseases, liver problems and diabetes

How to prevent pregnancy induced hypertension?

Doing regular exercise ^[9]
Practicing prenatal yoga and relaxation techniques to reduce stress
Making sure not to gain too much weight
Avoiding fried foods and other junk foods
Increasing the amount of daily protein intake
Losing excess body weight before conceiving ^[10]
Staying well-hydrated by drinking plenty of fluids (at least 8 glasses of water a day) ^[11]
Avoiding smoking as well as drinking alcohol and caffeine beverages

Diet for Pregnancy Induced Hypertension

Following a low sodium (salt) diet as soon as you plan to have a baby can reduce your chances of having high BP in pregnancy. Sodium causes fluids to build up in your body, requiring the heart to work harder to pump all the extra fluid, which increases the risk of high BP. Including plenty of fresh fruits and vegetables in your daily diet is beneficial as the potassium content in these foods helps to keep the bad effects of sodium on your cardiovascular health in check ^[12]. Following a high-potassium low-sodium DASH diet plan (Dietary Approaches to Stop Hypertension) is a good option as well ^[13]. Make sure to add lots of calcium (RDA 1200-1500 mg) and magnesium (RDA 300 mg) rich foods in your daily diet ^[14]. You can use herbs like cilantro, parsley and spices like pepper and chili instead of salt to enhance the flavor and taste of your dishes ^[12]. However, make sure to consult your doctor regarding the safe amounts of these herbs and spices to use while pregnant.

Gestational Hypertension Diagnosis

The principal diagnostic criteria for PIH are:

BP readings of or above 140/90 taken twice at least 2 hours apart (developing after the 20th week of pregnancy)
No protein in the urine ^[15]

Diagnostic and monitoring procedures used for assessing the condition as well as differentiating it from more serious complications include:

Urine test for ruling out protein in the urine and preeclampsia
Blood tests ^[10]
Kidney and liver function tests
Assessment of edema
Blood clotting tests for ruling out preeclampsia
Eye exams to detect any retinal changes ^[16]

Gestational Hypertension Treatment and Management

Mild cases often do not need any treatment apart from certain lifestyle changes as the high BP goes away on its own after delivery ^[17]. Following a proper healthy diet and restricting your activity levels helps to control your BP. More serious cases may require close monitoring and blood pressure medicines along with bed rest, with the main object of the treatment being preventing the condition from advancing to preeclampsia. Regular natural remedies used for lowering high BP are not recommended for pregnant women.

Drugs and Medications

Not all high blood pressure medications are considered safe to use while pregnant. Those commonly used for the purpose include:

Methyldopa
Nifedipine
Labetalol
Hydralazine ^[18]

Your doctor may prescribe magnesium sulfate to prevent further deterioration of your condition ^[5]

Hospitalization for Monitoring

Urine and blood tests
Frequent blood pressure and weight measurement ^[5]
Checking the amount of urine production ^[19]
Ultrasound, biophysical profile (BPP) and counting fetal movement to assess fetal health and growth ^[20]
Amniotic fluid volume assessment ^[21] as women diagnosed with PIH often have low amniotic fluid levels (oligohydramnios)

Follow –up care even after the BP returns to normal includes diet habit and lifestyle changes like avoiding eating too much salt and doing regular exercise to avoid any long term effects. In some relatively rare cases, the PIH becomes a chronic condition as it continues even after giving birth. Affected women are often believed to have chronic hypertension from before pregnancy which was not detected in the early weeks ^[22]. Management after pregnancy includes hypertension medicines, monitoring tests, bed rest along with certain healthy lifestyle changes for preventing postpartum preeclampsia or organ damage. Consult with your doctor regarding the safety of breastfeeding while on hypertension medication.

Gestational Hypertension Incidence

It is diagnosed in about 6% of all pregnancies ^[5]. The recurrence risk for hypertensive disorders rises by 20-50% in a second pregnancy ^[23].

Pregnancy Induced Hypertension ICD-9 and ICD-10 Codes

The ICD-9 code used for referring to PIH is 642 ^[24] while its ICD-10 codes are O13 ^[25].

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