Gestational hypertension

Our approach

At Northwell Health, we place a very keen focus on the management and surveillance of gestational hypertension, or high blood pressure during pregnancy. We are recognized as a leading health system for the implementation of best practice procedures, and we work hard to reduce the risks associated with gestational hypertension by helping you control every facet of your condition. Our thorough testing and treatment process will keep you and your baby healthy and reduce the risk of complications associated with gestational hypertension. We are proactive in our collaboration, which means we go above and beyond to ensure every member of our interdisciplinary team is behind your care.   

Overview

Gestational hypertension is a condition associated with high blood pressure during pregnancy. It occurs in about 6 percent of all pregnancies. Another type of high blood pressure is chronic   hypertension - high blood pressure, which is present before pregnancy begins.

Gestational hypertension can develop into preeclampsia, a serious pregnancy complication characterized by high blood pressure. This condition occurs often in young women with their first pregnancy. It is more common in twin pregnancies, in women over the age of 35 with chronic hypertension or hypertension from a previous pregnancy, as well as African-American women, and women with diabetes.

Gestational hypertension is diagnosed when your blood pressure readings are higher than 140/90 mm Hg and you had normal blood pressure prior to 20 weeks with no proteinuria (excess protein in the urine). 

Preeclampsia is diagnosed if you have gestational hypertension and increased protein in your urine.

With high blood pressure, there is an increase in the resistance of blood vessels. This may hinder blood flow in many different organ systems, including the liver, kidneys, brain, uterus and placenta.

There are other problems that may develop as a result of severe gestational hypertension (blood pressure readings that are higher than 160/110 mm Hg). Placental abruption (premature detachment of the placenta from the uterus) may occur in some pregnancies. Gestational hypertension can also lead to fetal problems, including intrauterine growth restriction (poor fetal growth) and stillbirth.

If untreated, severe gestational hypertension may cause dangerous seizures (eclampsia) and sometimes death of the mother or baby. Because of these risks, it may be necessary for the baby to be delivered early, before 37 weeks of gestation.

Risk factors

The cause of gestational hypertension is unknown. Some conditions may increase the risk of developing the condition, including the following:

  • Pre-existing hypertension (high blood pressure)
  • Kidney disease
  • Diabetes
  • Hypertension with a previous pregnancy
  • Mother's age (younger than 20 or older than 40)
  • Multiple fetuses (twins, triplets)
  • African-American race

Symptoms

The following are the most common symptoms of high blood pressure in pregnancy. However, each woman may experience symptoms differently, and a patient with gestational hypertension may be completely asymptomatic. Symptoms may include:

  • Increased blood pressure
  • Absence or presence of protein in the urine (to diagnose gestational hypertension or preeclampsia) 
  • Edema (swelling)
  • Sudden weight gain
  • Visual changes (blurred or double vision)
  • Nausea, vomiting
  • Right-sided upper abdominal pain or pain around the stomach
  • Urinating small amounts
  • Changes in liver or kidney function tests

Diagnosis

Diagnosis is often based on the increase in blood pressure levels, but other symptoms may help establish gestational hypertension as the diagnosis. Tests for gestational hypertension may include the following:

  • Blood pressure measurement
  • Assessment of edema
  • Frequent weight measurements
  • Liver and kidney function tests to rule out preeclampsia 
  • Urine testing to rule out preeclampsia Blood clotting tests to rule out preeclampsia 

Treatment options

Treatment options for gestational hypertension include:

  • Biophysical profile — A biophysical profile combines a nonstress test with an ultrasound. A nonstress test evaluates the fetal heart rate in response to the fetus’ movement. An ultrasound uses high-frequency sound waves to show an image of the internal organs. This is typically performed in the last trimester of your pregnancy.
  • Fetal Doppler ultrasound — A Doppler ultrasound helps examine the movement of blood through your umbilical cord between the uterus and the placenta. This can reveal any problems within your veins and arteries.
  • Nonstress test — A nonstress test evaluates the fetal heart rate in response to the fetus’ movement. This test is typically performed in the last trimester of your pregnancy.
  • Fetal movement counting — Your doctor may recommend keeping track of fetal movements and kicks. A shift in the number or frequency of movement could indicate that your baby is under stress.
  • Medication — Medications such as corticosteroids could help mature the lungs of your fetus.
  • Urine and blood laboratory testing — Your doctor may recommend continued urine and blood testing to watch for the worsening of gestational hypertension, or any indication of preeclampsia.