What Are the Treatments for Gestational Hypertension?

Gestational hypertension is the development of high blood pressure (typically greater than 140/90) in a woman who is more than 20 weeks pregnant. In the United States, it occurs in 6 to 8 percent of all pregnancies, with 70 percent of these being first-time pregnancies. High blood pressure effects both the mother and the baby, and may lead to serious complications if left untreated. Close monitoring of the pregnancy and the prescribing of medications as needed are the most common forms of treatment.

Need for Treatment

• Gestational hypertension can decrease the flow of blood to the placenta, thereby decreasing the baby's supply of oxygen and nutrients. This results in slowed growth and smaller babies. Hypertension also increases the risk of placental abruption, where the placenta detaches from the uterus prematurely, and preeclampsia, a potentially life-threatening condition that may necessitate early delivery.
  Gestational hypertension poses the same health risks to mothers as chronic non-pregnancy-related hypertension, including an increased risk of heart attacks and strokes. High blood pressure during pregnancy increases the mother's odds of developing diabetes, heart disease, kidney disease and chronic hypertension later in life. With careful monitoring and treatment, however, these risks can be minimized.

Treatment of Mild Cases

• Initially, in mild cases, the doctor may recommend frequent naps or several days of bed rest and a low-sodium diet. If this proves to be enough to keep the mother's blood pressure in check, it may be the only treatment that is necessary. However, more frequent prenatal visits are usually advised so that the condition can be monitored more closely. Blood pressure is checked at each visit, and a urine sample is collected to test for protein in the urine, which is an indication of preeclampsia. Those who do not respond to this treatment may be hospitalized for a few days to see whether the condition can be improved in a more controlled environment.

Monitoring and Diagnostic Tests

• Some monitoring tests may be performed by the mother at home. The doctor may ask the mother to count the number of times she feels the baby move or kick for a specified period of time each day, which is helpful in assessing the baby's health. The mother may also be asked to collect urine for 24 hours so that a more sensitive test for protein can be done than that which is routinely done with at prenatal visits.
  In addition to blood pressure and urine checks, ultrasounds assess the baby's growth and development and the amniotic fluid level, and are typically done every three weeks when high blood pressure is present. Nonstress tests, which monitor the baby's heartbeat and movements, and biophysical profiles are other ways to assess the baby's health. These may be ordered weekly or biweekly.

Medications

• Because any medication that's taken during pregnancy may affect the baby, medications are usually prescribed only when other treatments are insufficient. However, some blood pressure medications are considered safe for use during pregnancy. Others should be avoided, including angiotensin receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, and rennin inhibitors. In cases of gestational hypertension, doctors prescribe the safest medications at the lowest effective doses. Those taking medication should take it exactly as prescribed. Stopping the medication or changing its dosage may do more harm than good, and these measures should not be undertaken by the patient without her doctor's advice.
  In some early drug trials, taking aspirin as a preventative treatment has been found to reduce the risk of preeclampsia. More studies are needed, however, to confirm these results.

Treatment of Severe Cases

• Severe gestational hypertension (typically 160/110 or higher) usually requires medication and hospitalization. Early delivery via C-section or labor inducement may be advised if the baby is sufficiently developed. If the pregnancy is less than 34 weeks along and the condition can be controlled in the hospital, corticosteroids may be given to speed the rate at which the baby's lungs and other organs mature, to facilitate an early delivery. If the mother's or baby's condition worsens and poses a health threat, delivery may be necessary, even if the baby is premature.

Symptoms Requiring Emergency Treatment

• If the mother develops symptoms of preeclampsia, medical attention should be sought immediately. These symptoms include persistent or severe headaches, disturbances in vision, excessive swelling, sudden weight gain, pain or tenderness in the upper abdomen, nausea and vomiting. Symptoms that may indicate a placental abruption include pain or tenderness in the uterus and vaginal spotting or bleeding. Because these conditions may put the life of the baby and the mother at risk, they require emergency treatment.