Hypertension In Pregnancy

Dr. Mbikayi Tshimanga, Gynaecologist & Obstetrician at Melomed Richards Bay
FCOG (SA), F.MAS (India)

Hypertension is a common medical complication that affects 12 to 22% of all pregnancies. It is possible that the condition may lead to complications such as abruption (separation of the placenta from the wall of the uterus), cerebral hemorrhage, DIC-Hepatic failure (liver condition), eclampsia or acute renal failure.

In pregnant women, hypertension is diagnosed by means of a systolic blood pressure of 140 or more or a diastolic blood pressure of 90 or more. In severe cases, systolic blood pressure from 160 or diastolic blood pressure from 110 may be diagnosed.

There are various classifications of hypertension in pregnancy: In pregnancies under 20 weeks of gestation, the patient may suffer from chronic hypertension, while gestation of 20 weeks and more may present preeclampsia or eclampsia; gestational hypertension or chronic hypertension with super imposed preeclampsia.

Treatment for chronic hypertension may involve Angiotensin-converting enzyme (ACE) inhibitors; Angiotensin II receptors blocker (ARBs) or Thiazide or thiazidic-like diuretic.

However, these treatments may lead to several concerning complications that can endanger the expecting mother and unborn child’s lives. As such, utmost care should be taken when prescribing any hypertension medication to a pregnant woman.

Prevention of pre-elampsia
Pregnant women with chronic hypertension should be given 75-150mg aspirin once daily from 12 weeks of gestation.

Healthcare professionals should also offer placental growth factor (PLGF) testing to help rule out pre-eclampsia between 20 and 35 weeks of gestation.

The PLGF based test measures the amount of PLGF in the blood plasma or serum. PLGF is a protein involved in placental angiogenesis (the development of new blood vessels). In normal pregnancy, PLGF levels rise and peak at 26 -30 weeks, so when PLGF levels do not rise during pregnancy, there may be placental dysfunction.

Chronic Hypertension
Treatments for chronic hypertension may include antihypertensive, Labetalol, Nifedipine, Methyldopa and aspirin.

Gestational hypertension
Gestational hypertension is a new onset of hypertension after 20 weeks’ gestation without a high level of protein present in the urine, but with a patient’s blood pressure measuring above 140/90. Treatment could include Labetalol, Nifedipine and Methyldopa. However, this depends on the patient’s gestation period.