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

Hypertension in Pregnancy in sub-Saharan Africa: Treatment and Prevention

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.

Having hypertension increases your risk of pregnancy. Therefore you will need to register for antenatal care at a facility that has specialists and the presence of adequate facilities.

Your doctor will manage your pregnancy by: 

• Use of medications
• Close monitoring of your health and that of your baby
• Properly timed delivery  

Treatment of Chronic Hypertension

Chronic hypertension reduces the blood flow to the baby through the placenta. It also increases the risk of having preeclampsia.

 Because of this, you will need to register for antenatal care early (before 12 weeks) to allow your doctor to take adequate care of you.

 To make sure your pregnancy ends well, your doctor would:

• Recommend that you take aspirin tablets to reduce the risk of developing preeclampsia. You will start the medication at 12 weeks
• Ensure that you are on safe blood pressure medications and that you take them regularly. The common medications used for hypertension in pregnancy include methyldopa, nifedipine and labetalol
• See you more frequently to allow the close monitoring of your health and that of your baby
• Do serial monitoring of the growth of your baby with ultrasound
• Serially check your baby’s heart rate pattern 
• Determine the safe time for your baby to be delivered. Your doctor will usually plan your delivery between 37 weeks and your due date. 

When preeclampsia is superimposed on chronic hypertension, your doctor will manage it like preeclampsia.

Treatment of Gestational Hypertension, Preeclampsia and Eclampsia

These usually develop during the second half of pregnancy (after 20 weeks)

Attending antenatal regularly would enable your doctor to detect this very early.

The specific management of the different types include:

Gestational Hypertension

• Close monitoring of your blood pressure 
• Monitoring the growth and the heart rate of your baby
• Medications to control your blood pressure
• Your doctor may or may not admit you, depending on the state of your health and that of the baby. 
• Even when not admitted, your doctor would give you a close clinic appointment as gestational hypertension may progress to preeclampsia, so it requires close monitoring.
• If your blood pressure is well controlled and the baby remains okay, your doctor will plan delivery at around 37 weeks
• Occasionally  gestational hypertension may progress to preeclampsia and your doctor will manage it accordingly

Preeclampsia/Eclampsia

In mild preeclampsia, your doctor may not admit you but may give a closer clinic appointment.

If the preeclampsia is severe you will need to be admitted. 

The admission will allow your doctor to monitor

• Your health
• The health of your baby
• The progression of the disease
• The effect of the disease on your organs
• Determine the best time for delivery

Delivery of the baby is the main treatment for preeclampsia. This is because the problem is linked to the placenta.

Your doctor will deliver you by the fastest possible route. This would be either vaginal delivery or caesarean section, depending on the circumstances. Sometimes the delivery may occur far ahead of time, especially in severe cases.

Your doctor will plan you for immediate delivery if:

• Your pregnancy is up to 34 weeks
• You convulse (eclampsia)
• There is a problem with the growth or the heart rate of the baby
• You have symptoms like headache, blurring of vision or upper abdominal pain
• Your history, examination and blood tests show evidence of damage to organs like the liver or the kidneys.

If you do not have any of these and your pregnancy is less than 34 weeks, your doctor will admit you for close monitoring until delivery.

What are the Risks of Hypertension in Pregnancy to You and Your Baby?

Hypertension can affect multiple organs in the mother and also the placenta, so it has consequences. [5] These include:

Risks to Mother

• Liver damage
• Kidney damage
• Brain damage
• Blindness
• Stroke
• Death
• Increased risk of developing hypertension or ischaemic heart disease later in life

In addition, you are more likely to develop preeclampsia or eclampsia if you have chronic hypertension.

Risks to the Baby

• Intrauterine growth restriction(limitation of growth in the womb): This is because hypertension reduces the flow of blood to the placenta
• Abruptio placenta (premature separation of the placenta): This is because hypertension affects the blood vessels in the placenta.
• Prematurity: This is because severe hypertension may lead to early delivery
• Stillbirth(death of the baby in the womb)

How to Reduce Hypertension in Pregnancy

 Before pregnancy

Because of the risks of hypertension in pregnancy, there is a need for prevention. This prevention starts even before pregnancy. 

The measure includes:

• Healthy diet
• Low salt consumption
• Avoiding sedentary life
• Exercise
• Weight reduction
• Avoiding smoking
• Avoiding excessive alcohol intake
• Regular check-ups and compliance with medications if you already have hypertension

If you have hypertension already, to ensure a safe pregnancy you should visit the clinic for review by your doctor before getting pregnant (preconception care) 

This visit will allow the doctor to 

• Check your condition and ensure you are fit for pregnancy. 
• Ensure that the drugs you are taking are safe in pregnancy. 
• Provide counselling on how to cope with pregnancy as a patient with hypertension.

During Pregnancy

Some measures may help to reduce the risk of preeclampsia and eclampsia in pregnancy.

If you are at risk of hypertension during pregnancy your doctor would prescribe these medications:

• 75mg of aspirin taken daily from 12 weeks of pregnancy
• 1.5 to 2g calcium tablets, if your doctor thinks you are deficient in calcium

The World Health Organization recommends these two interventions for the prevention of preeclampsia and its complications.

In addition, registering for antenatal care early would enable your doctor to detect hypertension in pregnancy early. This reduces the risk of complications.

Conclusion

Hypertension adversely affects the outcome of pregnancy because of its effect on the baby and mother. Understanding the nature of the disease will enable mothers to seek timely care. This is especially important in Africa where it largely contributes to the burden of maternal deaths. By attending regular antenatal check-ups and adhering to prescribed treatments, the complications can be greatly reduced.  

← Symptoms and Diagnosis

References

1. Medscape. Hypertension and pregnancy: overview, chronic hypertension, differential diagnosis. [Internet].Updated 2024 Aug 8 [Cited 2024 Aug 24]; Available from here. 

2. Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Med. 2019 Apr 10;7:2050312119843700. doi: 10.1177/2050312119843700. Available from here. 

3. World Health Organization. Hypertension [Internet]. 2023 March 16. [Cited 2024 Aug 23]. Available from here.

4. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Who is at risk of preeclampsia? | NICHD. [Internet]. Last reviewed 2022 June 14. [Cited 2024 Aug 23]. Available from here. 

5. Eunice Kennedy Shriver National Institute of Child Health and Human Development. What are the risks of preeclampsia & eclampsia to the mother? | NICHD. [Internet]. 2018 November 19. [Cited 2024 Aug 24]. Available from here. 

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Watch this video to learn more about Hypertension in Pregnancy

Published: October 25, 2024

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