Hypertension in pregnancy: symptoms, causes, drugs, etc.

Definition

What is hypertension in pregnancy?

Hypertension in pregnancy is a condition when blood pressure increases during pregnancy. High blood pressure that is not treated promptly can lead to health complications for the mother and the fetus.

A person is diagnosed with hypertension when their blood pressure is high, reaching 140/90 mmHg or more. While normal blood pressure is below 120/80 mmHg.

Hypertension is the most common medical problem encountered during pregnancy. About 10 percent of pregnant women are said to have experienced high blood pressure during their pregnancy.

Fortunately, this condition can still be overcome by making lifestyle changes and consumption of certain drugs.

How common is hypertension during pregnancy?

Hypertension is a common condition in pregnancy. According to Medscape, it is estimated that about 10 percent of cases of high blood pressure are found during pregnancy.

Hypertension in pregnancy is a condition that can be overcome by controlling the existing risk factors. To find out more information about this condition, you can consult a doctor.

Type

What are the types of hypertension that occur during pregnancy?

Hypertension that occurs during pregnancy can be divided into four types. The following is an explanation of each type:

1. Gestational hypertension

Gestational hypertension usually appears after 20 weeks of gestation and this hypertension can disappear after childbirth.

In this condition, there is no excess protein in the urine or other signs of organ damage.

The University of Rochester Medical Center said, this condition has no known exact cause. The reason is, gestational hypertension can be experienced by mothers who have never suffered from high blood pressure before their pregnancy.

2. Preeclampsia

Preeclampsia or pregnancy poisoning is a serious blood pressure disorder that can interfere with the work of the organs. Usually this occurs at 20 weeks of gestation and will disappear after you have delivered your baby.

Preeclampsia is characterized by high blood pressure and proteinuria (presence of protein in the urine).

You are at high risk of developing preeclampsia if the birth mother and the mother of the husband experience the same thing during their pregnancy.

You are also at high risk of developing this type of hypertension if you have had preeclampsia in a previous pregnancy.

The cause of preeclampsia is not certain. However, preeclampsia appears to be caused by disruption in the growth of the placenta so that blood flow to the placenta does not work properly.

3. Chronic hypertension

Chronic high blood pressure is the type most common in pregnant women. As many as 90-95 percent of cases of hypertension in pregnancy belong to this type.

Chronic hypertension occurs before 20 weeks of pregnancy. Unlike gestational hypertension, blood pressure sometimes won't return to normal after delivery.

Pregnant women who experience chronic hypertension already have hypertension before pregnancy.

This type of hypertension occurs without proteinuria, but as many as 1 in 4 women with chronic hypertension can develop preeclampsia.

4. Chronic hypertension with preeclampsia

Chronic hypertension can also sometimes occur with preeclampsia. This condition is indicated by a severe increase in blood pressure and the presence of protein in the urine.

Generally, this condition affects pregnant women with chronic hypertension that has existed since before pregnancy.

Signs and symptoms

What are the signs and symptoms of hypertension in pregnancy?

Signs and symptoms of hypertension in pregnancy, depending on the type. Of course, the most visible is blood pressure above 140/90 mmHg.

But in general, the following are signs of hypertension in pregnant women, launching from Primaya Hospital:

Severe headaches
Pain in the upper abdomen under the ribs on the right side
Nausea and vomiting
Decreased levels of platelets in the blood
Hard to breathe
Excess protein in the urine (proteinuria) or additional signs of kidney problems
Swelling of the face, hands and feet.
Weight gain drastically in 1-2 days.
Blurry or ghosting of vision.

Therefore, checking and controlling blood pressure during pregnancy is mandatory. Every expectant mother should be aware that blood pressure is at risk of increasing before, during, even after pregnancy.

When should I see a doctor?

You need to be vigilant if the above signs and symptoms appear. If you experience it, there is a possibility that your hypertension may have entered a more severe stage, such as preeclampsia.

However, if there are signs and symptoms not mentioned above during pregnancy, you still have to be vigilant. Always check with your doctor whatever concerns you have.

Cause

What causes hypertension in pregnancy?

It is not yet known what is the exact cause of hypertension in pregnancy. However, several health conditions can trigger an increase in blood pressure during pregnancy.

Some of them are:

Being overweight or obese
Smoke
Drink alcohol

You need to be careful if you have the factors above.

Risk factors

What factors can increase the risk of hypertension in pregnancy?

Hypertension in pregnancy is a health condition that can occur in almost every woman. However, there are several factors that can increase a person's risk for developing this condition.

The following are risk factors that can lead to hypertension in pregnancy:

Pregnant over 35 years of age
Pregnant for the first time
Pregnant twins
Unhealthy lifestyle (consuming lots of salt and fatty foods, excess body weight)
Pregnant results of IVF program

Quoting the American Society for Reproductive Medicine, using pregnancy aids (such as in vitro fertilization or IVF) also increases the chances of expectant mothers to suffer from high blood pressure.

Complications

What are the complications caused by hypertension in pregnancy?

If high blood pressure in pregnancy is not treated immediately, there are several health problems that can threaten both the mother and the baby in the womb. The following are complications that can potentially occur:

1. Placental abruption

Increased blood pressure during pregnancy has the risk of causing a rupture of the placenta or the placenta from the uterine wall. This condition is known as placental abruption.

In severe cases, there can be heavy bleeding that can threaten the life of the mother and the baby in the womb. In fact, there is a possibility that the baby could die in the womb (stillbirth).

2. The baby was born prematurely

In some cases, increased blood pressure in the mother requires that the baby be born prematurely. A birth can be categorized as preterm if the fetus has not reached 37 weeks.

Babies born prematurely generally have a higher risk of experiencing various health problems

3. Growth and development and health of the baby is disturbed

High blood pressure results in the placenta not getting enough blood intake. This condition has the potential to cause babies to be born with low body weight (LBW).

In addition, several problems with the baby's growth and development will arise, such as decreased learning ability, epilepsy, cerebral palsy, as well as vision and hearing problems.

4. HELLP syndrome

HELLP stands for hemolysis, elevated liver enzyme (increased enzymes in the liver), and low platelet count (decreased platelet levels).

HELLP syndrome is a dangerous and potentially life-threatening health condition. If left untreated, this condition can lead to preeclampsia.

This syndrome can damage important organs in the body, sufferers need to get emergency medical treatment.

5. Eclampsia

Eclampsia is a more severe form of preeclampsia. This condition occurs in 1 in 200 people with preeclampsia. Although rare, this condition is extremely dangerous and potentially life threatening.

What distinguishes preeclampsia is eclampsia accompanied by seizures. In some cases, sufferers can experience a decrease in consciousness, even coma.

6.Posterior reversible encephalopathy syndrome (PRES)

This syndrome is characterized by symptoms of neurological disorders, such as headaches, decreased consciousness, visual disturbances, seizures, and even coma.

Apart from being caused by an increase in blood pressure, this syndrome can also be triggered by other health problems, such as problematic kidney function, autoimmune diseases, and certain drugs.

7. Heart and blood vessel disease

Like regular hypertension, hypertension in pregnancy can also increase the risk of pregnant women suffering from various types of heart and blood vessel diseases.

Increased blood pressure causes damaged blood vessels and decreased heart function in the long run. This condition has the potential to trigger heart failure and heart attack.

8. Damage to other important organs

Apart from damaging the heart and blood vessels, hypertension can also reduce blood supply to vital organs, such as the brain, lungs, and kidneys.

If left untreated, this condition can lead to diseases such as strokes and kidney failure.

Diagnosis and treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How do doctors diagnose hypertension in pregnancy?

Blood pressure can be said to be high if it is at certain systolic and diastolic numbers.

The systolic number is a number that shows the pressure when the heart pumps blood, while the diastolic number shows the pressure when the heart is resting and not pumping blood.

If you have hypertension during pregnancy, the systolic pressure figure reaches 140 millimeters of mercury (mmHg) or more. Meanwhile, the diastolic pressure number is in the range of 90 mmHg or more.

Blood pressure calculations are usually categorized as follows:

Increased blood pressure (prehypertension): The systolic number is in the range 120-129 mmHg, and the diastolic number is below 80 mmHg. This condition is not classified as hypertension.
Stage 1 hypertension: If the systolic number is in the 130-139 mmHg range or the diastolic value is in the 80-89 mmHg range, you may have stage 1 hypertension.
Stage 2 hypertension: If the systolic number reaches 140 mmHg or more, and the diastolic reaches 90 mmHg or more, you may have stage 2 hypertension.

If you are more than 20 weeks pregnant and your blood pressure increases after checking 2 times in a span of 4 hours, you may have gestational hypertension.

How is hypertension in pregnancy treated?

Generally, your doctor will advise you to make changes to your diet and lifestyle first before giving medication.

Adequate rest can help lower blood pressure, remove excess fluid from the kidneys (diuresis), and reduce the risk of preterm birth.

The administration of drugs usually focuses on hypertension that is already severe and is at risk of causing complications, both for mother and baby.

During the administration of antihypertensive drugs, the doctor will regularly monitor the health condition of your fetus.

The following are antihypertensive drugs that can be given to pregnant women:

1. Alpha-adrenergic agonist

Types of drugs alpha-adrenergic agonist which is often given to pregnant women is methyldopa. The use of this drug does not have the potential to cause health or development problems in the baby, even after the baby is born and grows.

This drug acts on your nerves, so you may experience some side effects, such as disrupting your sleep. In addition, there is also the possibility of elevated liver enzymes.

However, taking this drug alone is generally less effective. Usually, the drug methyldopa will be combined with other antihypertensive drugs, such as diuretics.

Apart from methyldopa, drugs alpha-adrenergic agonist another that can be prescribed is clonidine. This drug has stronger side effects than methyldopa, and there is the potential to interfere with fetal growth.

2. Beta-blockers

Drug beta-blockers generally safe for consumption by pregnant women. Type beta-blockers which is often used to treat hypertension in pregnancy is labetalol.

Side effects that may arise are the body tired easily, and respiratory problems.

3. Calcium channel blockers

Drug calcium channel blocker, especially the types of nifedipine and verapamil, are usually given to pregnant women to treat hypertension. However, there are some side effects that arise, especially if this drug is taken in the long term.

Some of them are respiratory problems, problems with the nerves of the muscles, and the impact on fetal growth and development.

Antihypertensive drugs that generally should not be consumed by pregnant women are angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blockers, as well renin inhibitors.