Gestational hypertension is a form of high blood pressure in pregnancy. It occurs in about six per cent of all pregnancies. When it comes to diagnosis, experts say gestational hypertension is confirmed when blood pressure readings are higher than 140/90 mm Hg in a woman who had normal blood pressure 20 weeks before, and has no proteinuria (excess protein in the urine). Understanding high blood pressure Celestine Karangwa, a medic at TCM Technology Clinic in Remera, Kigali, says blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps. He notes that high blood pressure or hypertension is when this force against the artery walls is too high. Karangwa says there are different types of high blood pressure in pregnancy. He mentions that gestational hypertension is one of them, and that this is high blood pressure that a woman develops while pregnant. “It starts after 20 weeks of pregnancy. Normally, the woman doesn’t have any other symptoms, and in many cases, it does not harm the mother or the baby, and it goes away about 12 weeks after childbirth,” he says. However, Karangwa is quick to note that this kind of hypertension usually does raise ones risk of high blood pressure in the future. The condition, he says, sometimes can be severe, which may lead to low birth weight or preterm birth. Therefore, he advises that regular check-up is always the way to go as it can help prevent further complications. Causes Iba Mayale, a gynaecologist/obstetrician in Kigali, says hypertension during pregnancy requires close monitoring. He says that the cause of gestational hypertension is unknown, and that understanding the conditions that may increase the risk of developing the condition is important. He says this is so because it controls exposure to gestational hypertension. These risk factors include pre-existing hypertension (high blood pressure), kidney disease, diabetes, and also hypertension during a previous pregnancy. Mayale says age is also a factor—younger than 20 or older than 40—are a high risk group of gestational hypertension. The medic notes that although there are many symptoms of high blood pressure in pregnancy, each woman may experience symptoms differently, and a patient with gestational hypertension may be completely asymptomatic. Some of the symptoms include increased blood pressure and, there is the absence or presence of protein in the urine (to diagnose gestational hypertension or preeclampsia). Edema (swelling), sudden weight gain are also some of the signs that are linked to gestational hypertension. Complications With high blood pressure, Mayale explains that there is an increase in the resistance of blood vessels. This, he says, may hinder blood flow in many different organ systems in the expectant mother, including the liver, kidneys, brain, uterus, and placenta. He goes on to add that 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). Also, gestational hypertension can lead to placental abruption (premature detachment of the placenta from the uterus), according to experts. Karangwa says gestational hypertension can also lead to foetal problems including intrauterine growth restriction (poor foetal growth) and stillbirth. If untreated, he says, severe gestational hypertension may cause dangerous seizures (eclampsia) and even death of the mother and foetus. “Because of these risks, it may be necessary for the baby to be delivered early, before 37 weeks gestation,” he says. Handling the condition Dean Damascene Bikorimana, a Kigali-based gynaecologist, says there are specific treatments for gestational hypertension, which can only be determined by the right physician. The treatment, he says, is normally based on the pregnancy, overall health, and medical history. Also, he says, the extent of the disease and one’s expectations for the course of the disease, are some aspects to be considered before treatment. Bikorimana says the goal of treatment is to prevent the condition from becoming worse, and to prevent it from causing other complications. The treatment, he says, may include bed rest, at home or in the hospital. Also, he says, magnesium sulphate (or other antihypertensive medications for gestational hypertension if blood pressure readings are in the severe range), can as well be administered to the patient. Bikorimana adds that there is a need for foetal monitoring to check the health of the baby. This, he says, includes checking foetal movement and keeping track of foetal kicks as a change in the frequency may mean the foetus is under stress.
