Types of hypertension in pregnancy | Causes and Risk factors | Symptoms and Diagnosis | Treatment and Prevention

Hypertension in Pregnancy in Sub-Saharan Africa – Essential Information for Africans

By: Dr. Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), MSc (Public Health), Freelance Medical Writer.  Medically reviewed By: Dr. ‘Kunle Soyemi. MBBS, FWACS; FRCOG. Consultant Obstetrician & Gynaecologist.

A black pregnant woman having blood pressure check.

Highlights

• Hypertension in pregnancy is one of the leading causes of maternal deaths in Africa, affecting 1 in 10 pregnancies.

• Chronic hypertension, gestational hypertension, preeclampsia, and eclampsia are the main types of hypertension in pregnancy.

• Early detection through regular antenatal visits can significantly reduce the risk of complications.

• Preeclampsia and eclampsia are severe forms that can lead to organ damage, seizures, and even death if not managed properly.

• Risk factors include advanced age, obesity, family history, and pre-existing conditions like diabetes.

• Proper management includes medication, close monitoring, and timely delivery to ensure the safety of both mother and baby.

Introduction

Hypertension is when blood runs through the vessels in the body at high pressure. It is defined as elevated blood pressure of up to or more than 140/90mmHg measured on at least two occasions. Hypertension in pregnancy is one of the major causes of maternal death in Africa. It is a condition that threatens safe motherhood and causes a significant threat to the life of the mother and baby. 

Consider the case below:

On the day Mrs M got married there was joy in the family. Barely two months after her wedding, she shared the news of her pregnancy and there was even more joy. In the course of her pregnancy, she developed hypertension in pregnancy. She was referred to a bigger hospital where she had an emergency Caesarean section. Even though her baby survived the ordeal, she lost the battle.

This is one of many tales of woe associated with hypertension in pregnancy in Sub-Saharan Africa (SSA).

This article aims to enlighten the African populace about the different variants of hypertension in pregnancy and how the condition affects the outcome of pregnancy.

What are the Types of Hypertension in Pregnancy?

Hypertension in pregnancy presents in many variants (types). While the different types can exist separately until the end of pregnancy, at times they may change into another type in the course of pregnancy.

Severity also varies as some types like preeclampsia and eclampsia have more harmful effects on pregnancy. 

The majority of the cases of hypertension in pregnancy occur in the second half of pregnancy.

There are four major types of hypertension in pregnancy. [1, 2]

These include:

• Chronic hypertension
• Gestational hypertension
• Preeclampsia
• Eclampsia

A unique and severe type of hypertension in pregnancy that may arise as a complication of preeclampsia and eclampsia is what is called HELLP syndrome. The condition is named from the significant components of its features as detailed below:

H: For haemolysis, which means the breakdown of red blood cells. 

EL: For elevated liver enzymes (i.e., increased levels in the blood of certain products of the liver, called enzymes)

LP: For low platelets count (platelets are cell components of blood that function to regulate blood clotting/bleeding)

As HELLP syndrome is an extremely serious condition, it must be diagnosed and treated without any delay, failing which harm or even death could result in the mother and unborn baby.

More basic information about the symptoms, risk factors and treatment of HELLP syndrome is available here.

Chronic Hypertension

This is elevated blood pressure before pregnancy or before the second half (20th eek) of pregnancy. This is divided into:

• Essential Hypertension: Hypertension without any known cause. This occurs in about 90% of cases.
• Secondary Hypertension: Hypertension due to a known cause i.e., kidney disease

Chronic hypertension increases the risk of preeclampsia.

If you have stable chronic hypertension and develop a sudden increase in blood pressure and protein in your urine with associated symptoms, it is regarded as chronic hypertension with superimposed preeclampsia. 

Gestational Hypertension

This is elevated blood pressure in the second half of pregnancy that is not associated with the presence of protein in the urine or any symptom. It was previously known as Pregnancy Induced Hypertension. Up to one-third of the pregnant women with gestational hypertension may end up having preeclampsia. So, there is a need for close monitoring of these women.

Preeclampsia

This is elevated blood pressure in the second half of pregnancy which is associated with the presence of protein in the urine and body swelling (oedema) on some occasions. This is a very severe form of hypertension in pregnancy. 

The disease is due to a problem with the blood vessels supplying the placenta. The release of some chemicals from the placenta results in widespread damage to the endothelium (the inner lining of blood vessels). It can rapidly deteriorate to cause damage to multiple organs and this is associated with a wide variety of symptoms.

Preeclampsia is of two types: mild and severe

• Mild Preeclampsia: This is when the systolic BP is between 140-159mmHg and the diastolic is between 90-109mmHg, It is not associated with symptoms
• Severe Preeclampsia: This is when the systolic BP is up to or above 160mmHg and the diastolic is up to or above 110mmHg. It is usually associated with symptoms and organ damage

Eclampsia

This type of hypertension in pregnancy is associated with convulsions (seizures). It occurs in the second half of pregnancy. This occurs in the background of elevated blood pressure and protein in the urine. On occasions, the convulsion may occur even before the signs and symptoms of preeclampsia manifest.

 Causes and Risk factors →

References

Related

Watch this video to learn more about Hypertension in Pregnancy

Published: October 24, 2024

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