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Testing & investigations for gestational hypertension

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Blood pressure monitoring is a standard practice for pregnant women in Canada and should be measured at clinical appointments to check for high blood pressure.

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Women with high blood pressure will also be checked for other symptoms of organ injury to determine if a women has gestational hypertension or preeclampsia. This could include testing urine for signs of kidney injury and testing blood for signs of liver or other injury. Pregnant women with gestational hypertension will not show signs of additional organ injury.

 

When women are diagnosed with gestational hypertension, doctors will investigate how well mom’s placenta is functioning. Dysfunction of the placenta is more common in women with preeclampsia than women with gestational hypertension.

 

Doctors will also monitor the baby to ensure that the growth and development are normal. This includes fetal heart rate, blood flow through the umbilical cord and blood flow in the brain. Studies have shown that pregnant women with hypertension tend to have smaller babies, compared to pregnant women with normal blood pressure. These investigations will let doctors know if the baby is being impacted by mom’s high blood pressure and if early delivery should be considered to ensure the health of the baby. It is recommended that the baby’s heart rate is monitored while mom is being given drugs that lower blood pressure, to make sure the baby's heart rate is stable.

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Doctors will be careful to watch that gestational hypertension doesn't progress into preeclampsia, which is considered a more severe type of hypertensive disorder. Studies have reported that over 40% of women with gestational hypertension developed additional signs of organ injury, and were subsequently diagnosed with preeclampsia.

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Treatment & management of gestational hypertension

 

Treatment for gestational hypertension is mostly centered around controlling mom's blood pressure and preventing any harm to mom and baby. 

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In pregnant women with non-severe gestational hypertension, doctors will typically try to keep mom’s blood pressure between 130 - 155 mmHg systolic and between 80 - 105 mmHg diastolic. If women with gestational hypertension have other health conditions (ie. diabetes, kidney disease), her doctors may try to lower her blood pressure even further to prevent complications. Doctors will try to maintain blood pressure of women with severe gestational hypertension below 160 mmHg systolic and below 110 mmHg diastolic.  

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Drugs used to lower mom’s blood pressure are called ‘anti-hypertensives’. The Society of Obstetricians and Gynaecologists of Canada advises that the choice of anti-hypertensive drug should be based on the patient, any contraindications to certain types of drugs and physician experience or familiarity with these drugs.

 

​There is evidence that some bed rest in hospital may help to prevent the development of severe hypertension and preterm birth. A combination of home and hospital care could be considered for women with gestational hypertension. If mom’s blood pressure does become severe, hospital admission is recommended.

 

There is not sufficient evidence to support other lifestyle changes, such as salt or calorie restriction, exercise and workload reduction for women with gestational hypertension.

 

Corticosteroid therapy should be considered for pregnant women with gestational hypertension who are less than 35 weeks pregnant, if delivery is possible within the next week. These drugs help to promote the maturity of the baby’s lungs and decrease the risk of adverse fetal effects.

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The Society of Obstetricians and Gynaecologists of Canada recommended that women with gestational hypertension who are over 37 weeks pregnant are delivered within days. Further, The American College of Obstetricians and Gynecologists recommends delivery for women with gestational hypertension over 34 weeks of pregnancy who have any abnormal mom or baby concerns.

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Prevention of gestational hypertension

 

Scientists hypothesize that if gestational hypertension is mainly caused by stress on the mom’s cardiovascular system, getting mom’s heart and blood vessels in good shape before pregnancy may be an effective way at preventing gestational hypertension. This would include steps to improve heart health, including regular exercise, maintaining a good blood pressure level, lowering cholesterol, eating healthy and quitting smoking. Studies have shown that exercise in pregnancy has also been shown to lower the risk of women developing hypertension.

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In pregnant women with low calcium intake, calcium supplementation also lowers the risk of all hypertensive disorders of pregnancy, including gestational hypertension. 

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Aspirin therapy does not reduce the risk of gestational hypertension from developing in pregnant women.

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Summary

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Gestational hypertension is a common hypertensive disorder of pregnancy that impacts approximately 8% of pregnancies. It is hypothesized that gestational hypertension is caused by dysfunctional of mom's heart and blood vessels. Treatment for gestational hypertension is mostly entered around controlling mom's blood pressure to protect mom and baby from hypertension. Further research is needed to identify the exact cause of gestational hypertension to understand which women are at the highest risk of this disease and how to press prevent it from developing.

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Disclaimer

 

Every woman and every pregnancy is unique. Pregnant women should speak to their healthcare provider to ensure maternal and fetal safety. This article is meant to provide readers with current information and opinions. All medical and treatment decisions should be discussed with your healthcare provider.

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This article was written by Dr. Kelsey McLaughlin and edited by Dr. Melanie Audette​.

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