High-Risk Pregnancy

Pregnancy-Induced Hypertension (PIH)

What is pregnancy-induced hypertension (PIH)?

Pregnancy-induced hypertension (PIH) is a form of high blood pressure in pregnancy. It occurs in about 5 percent to
8 percent of all pregnancies. Another type of high blood pressure is chronic hypertension - high blood pressure that is
present before pregnancy begins.

Pregnancy-induced hypertension is also called toxemia or preeclampsia. It occurs most often in young women with a
first pregnancy. It is more common in twin pregnancies, in women with chronic hypertension, preexisting diabetes,
and in women who had PIH in a previous pregnancy.

Usually, there are three primary characteristics of this condition, including the following:

• high blood pressure (a blood pressure reading higher than 140/90 mm Hg, or a significant increase in one or
both pressures)

• protein in the urine

• edema (swelling)

Eclampsia is a severe form of pregnancy-induced hypertension. Women with eclampsia have seizures resulting from
the condition. Eclampsia occurs in about one in 1,600 pregnancies and develops near the end of pregnancy, in most
cases.

HELLP syndrome is a complication of severe preeclampsia or eclampsia. HELLP syndrome is a group of physical
changes including the breakdown of red blood cells, changes in the liver, and low platelets (cells found in the blood
that are needed to help the blood to clot in order to control bleeding).

What causes pregnancy-induced hypertension (PIH)?

The cause of PIH is unknown. Some conditions may increase the risk of developing PIH, including the following:

• pre-existing hypertension (high blood pressure)

• kidney disease
• diabetes
• PIH with a previous pregnancy
• mother's age younger than 20 or older than 40
• multiple fetuses (twins, triplets)

Why is pregnancy-induced hypertension a concern?

With high blood pressure, there is an increase in the resistance of blood vessels. This may hinder blood flow in many
different organ systems in the expectant mother including the liver, kidneys, brain, uterus, and placenta.

There are other problems that may develop as a result of PIH. Placental abruption (premature detachment of the
placenta from the uterus) may occur in some pregnancies. PIH can also lead to fetal problems including intrauterine
growth restriction (poor fetal growth) and stillbirth.

If untreated, severe PIH may cause dangerous seizures and even death in the mother and fetus. Because of these
risks, it may be necessary for the baby to be delivered early, before 37 weeks gestation.

What are the symptoms of pregnancy-induced hypertension?

The following are the most common symptoms of high blood pressure in pregnancy. However, each woman may
experience symptoms differently. Symptoms may include:

• increased blood pressure

• protein in the urine
• edema (swelling)
• sudden weight gain
• visual changes such as blurred or double vision
• nausea, vomiting
• right-sided upper abdominal pain or pain around the stomach
• urinating small amounts
• changes in liver or kidney function tests

How is pregnancy-induced hypertension diagnosed?

Diagnosis is often based on the increase in blood pressure levels, but other symptoms may help establish PIH as the
diagnosis. Tests for pregnancy-induced hypertension may include the following:

• blood pressure measurement

• urine testing
• assessment of edema
• frequent weight measurements
• eye examination to check for retinal changes
• liver and kidney function tests
• blood clotting tests

Treatment for pregnancy-induced hypertension:

Specific treatment for pregnancy-induced hypertension will be determined by your physician based on:

• your pregnancy, overall health, and medical history

• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

The goal of treatment is to prevent the condition from becoming worse and to prevent it from causing other
complications. Treatment for pregnancy-induced hypertension (PIH) may include:

• bedrest (either at home or in the hospital may be recommended)

• hospitalization (as specialized personnel and equipment may be necessary)

• magnesium sulfate (or other antihypertensive medications for PIH)

• fetal monitoring (to check the health of the fetus when the mother has PIH) may include:

o fetal movement counting - keeping track of fetal kicks and movements. A change in the number or
frequency may mean the fetus is under stress.

o nonstress testing - a test that measures the fetal heart rate in response to the fetus' movements.

o biophysical profile - a test that combines nonstress test with ultrasound to observe the fetus.
 o Doppler flow studies - type of ultrasound that uses sound waves to measure the flow of blood
through a blood vessel.

• continued laboratory testing of urine and blood (for changes that may signal worsening of PIH)

• medications, called corticosteroids, that may help mature the lungs of the fetus (lung immaturity is a major
problem of premature babies)

• delivery of the baby (if treatments do not control PIH or if the fetus or mother is in danger). Cesarean
delivery may be recommended, in some cases.

Prevention of pregnancy-induced hypertension:

Early identification of women at risk for pregnancy-induced hypertension may help prevent some complications of the
disease. Education about the warning symptoms is also important because early recognition may help women
receive treatment and prevent worsening of the disease.

From: http://www.healthsystem.virginia.edu/uvahealth/peds_hrpregnant/pih.cfm
Introduction to Preeclampsia

Although many pregnant women with high blood pressure have healthy babies without serious problems, high blood
pressure can be dangerous for both the mother and the fetus. Women with pre-existing, or chronic, high blood
pressure are more likely to have certain complications during pregnancy than those with normal blood pressure.
However, some women develop high blood pressure while they are pregnant (often called gestational hypertension).

The effects of high blood pressure range from mild to severe. High blood pressure can harm the mother's kidneys
and other organs, and it can cause low birth weight and early delivery. In the most serious cases, the mother
develops preeclampsia-or "toxemia of pregnancy"-which can threaten the lives of both the mother and the fetus.

What is preeclampsia?

Preeclampsia is a condition that typically starts after the 20th week of pregnancy and is related to increased blood
pressure and protein in the mother's urine (as a result of kidney problems). Preeclampsia affects the placenta, and it
can affect the mother's kidney, liver, and brain. When preeclampsia causes seizures, the condition is known as
eclampsia-the second leading cause of maternal death in the U.S. Preeclampsia is also a leading cause of fetal
complications, which include low birth weight, premature birth, and stillbirth.

There is no proven way to prevent preeclampsia. Most women who develop signs of preeclampsia, however, are
closely monitored to lessen or avoid related problems. The way to "cure" preeclampsia is to deliver the baby.

How Common Are High Blood Pressure and Preeclampsia in Pregnancy?

High blood pressure problems occur in 6 percent to 8 percent of all pregnancies in the U.S., about 70 percent of
which are first-time pregnancies. In 1998, more than 146,320 cases of preeclampsia alone were diagnosed.

Although the proportion of pregnancies with gestational hypertension and eclampsia has remained about the same in
the U.S. over the past decade, the rate of preeclampsia has increased by nearly one-third. This increase is due in
part to a rise in the numbers of older mothers and of multiple births, where preeclampsia occurs more frequently. For
example, in 1998 birth rates among women ages 30 to 44 and the number of births to women ages 45 and older were
at the highest levels in 3 decades, according to the National Center for Health Statistics. Furthermore, between 1980
and 1998, rates of twin births increased about 50 percent overall and 1,000 percent among women ages 45 to 49;
rates of triplet and other higher-order multiple births jumped more than 400 percent overall, and 1,000 percent among
women in their 40s.
Who Is More Likely to Develop Preeclampsia?

• Women with chronic hypertension (high blood pressure before becoming pregnant).

• Women who developed high blood pressure or preeclampsia during a previous pregnancy, especially if
these conditions occurred early in the pregnancy.

• Women who are obese prior to pregnancy.

• Pregnant women under the age of 20 or over the age of 40.

• Women who are pregnant with more than one baby.

• Women with diabetes, kidney disease,rheumatoid arthritis, lupus, orscleroderma.

What Are the Symptoms of Preeclampsia and How Is It Detected?

Unfortunately, there is no single test to predict or diagnose preeclampsia. Key signs are increased blood pressure
and protein in the urine (proteinuria). Other symptoms that seem to occur with preeclampsia include
persistent headaches, blurred vision or sensitivity to light, and abdominal pain.

All of these sensations can be caused by other disorders; they can also occur in healthy pregnancies. Regular visits
with your doctor help him or her to track your blood pressure and level of protein in your urine, to order and analyze
blood tests that detect signs of preeclampsia, and to monitor fetal development more closely.

How Can Women with High Blood Pressure Prevent Problems During Pregnancy?

If you are thinking about having a baby and you have high blood pressure, talk first to your doctor or nurse. Taking
steps to control your blood pressure before and during pregnancy-and getting regular prenatal care-go a long way
toward ensuring your well-being and your baby's health.

Before becoming pregnant:

• Be sure your blood pressure is under control. Lifestyle changes such as limiting your salt intake,
participating in regular physical activity, and losing weight if you are overweight can be helpful.

• Discuss with your doctor how hypertension might affect you and your baby during pregnancy, and what you
can do to prevent or lessen problems.

• If you take medicines for your blood pressure, ask your doctor whether you should change the amount you
take or stop taking them during pregnancy. Experts currently recommend avoiding angiotensin-converting
enzyme (ACE) inhibitors andAngiotensin II (AII) receptor antagonists during pregnancy; other blood pressure
medications may be OK for you to use. Do not, however, stop or change your medicines unless your doctor tells
you to do so.
While you are pregnant:

• Obtain regular prenatal medical care.

• Avoid alcohol and tobacco.

Talk to your doctor about any over-the-counter medications you are taking or are thinking about taking.

Does Hypertension or Preeclampsia During Pregnancy Cause Long-Term Heart and Blood Vessel Problems?

The effects of high blood pressure during pregnancy vary depending on the disorder and other factors. According to
the National High Blood Pressure Education Program (NHBPEP), preeclampsia does not in general increase a
woman's risk for developing chronic hypertension or other heart-related problems. The NHBPEP also reports that in
women with normal blood pressure who develop preeclampsia after the 20th week of their first pregnancy, short-term
complications-including increased blood pressure-usually go away within about 6 weeks after delivery.

Some women, however, may be more likely to develop high blood pressure or other heart disease later in life. More
research is needed to determine the long-term health effects of hypertensive disorders in pregnancy and to develop
better methods for identifying, diagnosing, and treating women at risk for these conditions.

Even though high blood pressure and related disorders during pregnancy can be serious, most women with high
blood pressure and those who develop preeclampsia have successful pregnancies. Obtaining early and regular
prenatal care is the most important thing you can do for you and your baby.

SOURCE: National Institutes of Health