- Lissa Magloire, MD
Lissa Magloire, MD
- Texas Perinatal Group
- Edmund F Funai, MD
Edmund F Funai, MD
- Professor and Chief Operating Officer
- USF Health
Gestational hypertension and preeclampsia/eclampsia are hypertensive disorders induced by pregnancy; both disorders resolve postpartum. Gestational hypertension is the most common cause of hypertension in pregnant women.
Gestational hypertension is a clinical diagnosis defined by the new onset of hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) at ≥20 weeks of gestation in the absence of proteinuria or new signs of end-organ dysfunction . The blood pressure readings should be documented on at least two occasions at least four hours apart. Gestational hypertension is severe when systolic blood pressure is ≥160 mmHg and/or diastolic blood pressure is ≥110 mmHg on two consecutive blood pressure measurements at least four hours apart [1-4].
Gestational hypertension is a temporary diagnosis for hypertensive pregnant women who do not meet criteria for preeclampsia (table 1) or chronic hypertension (hypertension first detected before the 20th week of pregnancy). The diagnosis is changed to:
●Preeclampsia, if proteinuria or new signs of end-organ dysfunction develop
●Chronic (primary or secondary) hypertension, if blood pressure elevation persists ≥12 weeks postpartum
- American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122:1122.
- Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003; 102:181.
- Hauth JC, Ewell MG, Levine RJ, et al. Pregnancy outcomes in healthy nulliparas who developed hypertension. Calcium for Preeclampsia Prevention Study Group. Obstet Gynecol 2000; 95:24.
- Buchbinder A, Sibai BM, Caritis S, et al. Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia. Am J Obstet Gynecol 2002; 186:66.
- Yoder SR, Thornburg LL, Bisognano JD. Hypertension in pregnancy and women of childbearing age. Am J Med 2009; 122:890.
- Gaillard R, Steegers EA, Hofman A, Jaddoe VW. Associations of maternal obesity with blood pressure and the risks of gestational hypertensive disorders. The Generation R Study. J Hypertens 2011; 29:937.
- Sibai BM. Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases. Am J Obstet Gynecol 1990; 163:1049.
- Saudan P, Brown MA, Buddle ML, Jones M. Does gestational hypertension become pre-eclampsia? Br J Obstet Gynaecol 1998; 105:1177.
- Barton JR, O'brien JM, Bergauer NK, et al. Mild gestational hypertension remote from term: progression and outcome. Am J Obstet Gynecol 2001; 184:979.
- Melamed N, Ray JG, Hladunewich M, et al. Gestational hypertension and preeclampsia: are they the same disease? J Obstet Gynaecol Can 2014; 36:642.
- Bellomo G, Venanzi S, Saronio P, et al. Prognostic significance of serum uric acid in women with gestational hypertension. Hypertension 2011; 58:704.
- Wu Y, Xiong X, Fraser WD, Luo ZC. Association of uric acid with progression to preeclampsia and development of adverse conditions in gestational hypertensive pregnancies. Am J Hypertens 2012; 25:711.
- Noori M, Donald AE, Angelakopoulou A, et al. Prospective study of placental angiogenic factors and maternal vascular function before and after preeclampsia and gestational hypertension. Circulation 2010; 122:478.
- Verlohren S, Herraiz I, Lapaire O, et al. The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients. Am J Obstet Gynecol 2012; 206:58.e1.
- Rana S, Powe CE, Salahuddin S, et al. Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia. Circulation 2012; 125:911.
- Valensise H, Vasapollo B, Novelli GP, et al. Maternal total vascular resistance and concentric geometry: a key to identify uncomplicated gestational hypertension. BJOG 2006; 113:1044.
- Villar J, Carroli G, Wojdyla D, et al. Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions? Am J Obstet Gynecol 2006; 194:921.
- Ros HS, Cnattingius S, Lipworth L. Comparison of risk factors for preeclampsia and gestational hypertension in a population-based cohort study. Am J Epidemiol 1998; 147:1062.
- Hjartardottir S, Leifsson BG, Geirsson RT, Steinthorsdottir V. Recurrence of hypertensive disorder in second pregnancy. Am J Obstet Gynecol 2006; 194:916.
- Brown MA, Mackenzie C, Dunsmuir W, et al. Can we predict recurrence of pre-eclampsia or gestational hypertension? BJOG 2007; 114:984.
- Silver HM, Seebeck M, Carlson R. Comparison of total blood volume in normal, preeclamptic, and nonproteinuric gestational hypertensive pregnancy by simultaneous measurement of red blood cell and plasma volumes. Am J Obstet Gynecol 1998; 179:87.
- Gyselaers W, Staelens A, Mesens T, et al. Maternal venous Doppler characteristics are abnormal in pre-eclampsia but not in gestational hypertension. Ultrasound Obstet Gynecol 2015; 45:421.
- González-Quintero VH, Smarkusky LP, Jiménez JJ, et al. Elevated plasma endothelial microparticles: preeclampsia versus gestational hypertension. Am J Obstet Gynecol 2004; 191:1418.
- Maloney KF, Heller D, Baergen RN. Types of maternal hypertensive disease and their association with pathologic lesions and clinical factors. Fetal Pediatr Pathol 2012; 31:319.
- Broekhuijsen K, van Baaren GJ, van Pampus MG, et al. Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial. Lancet 2015; 385:2492.
- Crowther CA, Bouwmeester AM, Ashurst HM. Does admission to hospital for bed rest prevent disease progression or improve fetal outcome in pregnancy complicated by non-proteinuric hypertension? Br J Obstet Gynaecol 1992; 99:13.
- Abdul Sultan A, West J, Tata LJ, et al. Risk of first venous thromboembolism in pregnant women in hospital: population based cohort study from England. BMJ 2013; 347:f6099.
- Henderson JT, Whitlock EP, O'Conner E, et al. Low-Dose Aspirin for the Prevention of Morbidity and Mortality From Preeclampsia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US) 2014.
- Gillon TE, Pels A, von Dadelszen P, et al. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines. PLoS One 2014; 9:e113715.
- Corrêa RR, Gilio DB, Cavellani CL, et al. Placental morphometrical and histopathology changes in the different clinical presentations of hypertensive syndromes in pregnancy. Arch Gynecol Obstet 2008; 277:201.
- Magee LA, von Dadelszen P, Bohun CM, et al. Serious perinatal complications of non-proteinuric hypertension: an international, multicentre, retrospective cohort study. J Obstet Gynaecol Can 2003; 25:372.
- Barton JR, Barton LA, Istwan NB, et al. Elective delivery at 34⁰(/)⁷ to 36⁶(/)⁷ weeks' gestation and its impact on neonatal outcomes in women with stable mild gestational hypertension. Am J Obstet Gynecol 2011; 204:44.e1.
- Spong CY, Mercer BM, D'alton M, et al. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118:323.
- Cruz MO, Gao W, Hibbard JU. What is the optimal time for delivery in women with gestational hypertension? Am J Obstet Gynecol 2012; 207:214.e1.
- Foong SC, Pollard JK. Eclampsia in Southern Alberta: is there a role for seizure prophylaxis in all women with gestational hypertension? J Obstet Gynaecol Can 2003; 25:385.
- Ferrazzani S, De Carolis S, Pomini F, et al. The duration of hypertension in the puerperium of preeclamptic women: relationship with renal impairment and week of delivery. Am J Obstet Gynecol 1994; 171:506.
- Reiter L, Brown MA, Whitworth JA. Hypertension in pregnancy: the incidence of underlying renal disease and essential hypertension. Am J Kidney Dis 1994; 24:883.
- van Oostwaard MF, Langenveld J, Schuit E, et al. Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis. Am J Obstet Gynecol 2015; 212:624.e1.
- Wilson BJ, Watson MS, Prescott GJ, et al. Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study. BMJ 2003; 326:845.
- Magnussen EB, Vatten LJ, Smith GD, Romundstad PR. Hypertensive disorders in pregnancy and subsequently measured cardiovascular risk factors. Obstet Gynecol 2009; 114:961.
- Robbins CL, Dietz PM, Bombard J, Valderrama AL. Gestational hypertension: a neglected cardiovascular disease risk marker. Am J Obstet Gynecol 2011; 204:336.e1.
- Männistö T, Mendola P, Vääräsmäki M, et al. Elevated blood pressure in pregnancy and subsequent chronic disease risk. Circulation 2013; 127:681.
- Hnat MD, Sibai BM, Caritis S, et al. Perinatal outcome in women with recurrent preeclampsia compared with women who develop preeclampsia as nulliparas. Am J Obstet Gynecol 2002; 186:422.
- Knuist M, Bonsel GJ, Zondervan HA, Treffers PE. Intensification of fetal and maternal surveillance in pregnant women with hypertensive disorders. Int J Gynaecol Obstet 1998; 61:127.
- Cruz MO, Gao W, Hibbard JU. Obstetrical and perinatal outcomes among women with gestational hypertension, mild preeclampsia, and mild chronic hypertension. Am J Obstet Gynecol 2011; 205:260.e1.
- DIAGNOSTIC EVALUATION
- Measure protein excretion
- Evaluate for features of severe disease
- Perform laboratory evaluation
- Determine the severity of hypertension
- Assess fetal well-being
- RISK OF PROGRESSION TO PREECLAMPSIA
- Blood pressure less than 160/110 mmHg
- - Site of care
- - Patient education and counseling
- - Level of physical activity
- - Low dose aspirin
- - Maternal blood pressure and laboratory monitoring
- - Fetal assessment
- - Antihypertensive therapy
- - Antenatal corticosteroids
- - Timing of delivery
- - Intrapartum management
- Blood pressure greater than 160/110 mmHg
- MATERNAL PROGNOSIS
- Postpartum course
- Recurrence risk
- Long-term prognosis
- PERINATAL OUTCOME
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS