Gestational hypertension refers to symptoms such as high blood pressure, edema, and proteinuria appearing after 20 weeks of pregnancy. It is transient, disappearing after delivery. As a condition unique to pregnancy, it remains one of the primary causes of illness and mortality among pregnant women and perinatal infants.
In late pregnancy, systolic blood pressure ≥140 mmHg (18.7 kPa) and diastolic blood pressure ≥90 mmHg (12.0 kPa) indicate hypertension must be considered.Multiple theories exist regarding the causes of gestational hypertension. It is generally believed that certain substances from the placenta enter the maternal bloodstream, altering immune factors in the mother and causing systemic arteriolar spasm, leading to hypertension. Research has also suggested a link to genetic factors.
Primary Clinical Manifestations
1. Hypertension: Diagnosis is made when blood pressure reaches 140/90 mmHg on two separate occasions.
2. Proteinuria: Midstream urine samples should be tested; a 24-hour urine protein level exceeding 0.5 grams is considered abnormal. The presence of both hypertension and proteinuria indicates preeclampsia.
3. Edema.
4. Subjective Symptoms: Presence of headaches, blurred vision, chest tightness, nausea, or vomiting. These symptoms indicate progression to preeclampsia, requiring prompt examination and intervention.
5. Seizures and Coma: These represent severe disease progression, necessitating immediate medical attention and timely termination of pregnancy.
High-Risk Groups
The following groups are particularly susceptible to hypertensive disorders of pregnancy. Prenatal care is especially critical for these individuals, who must attend regular check-ups as directed by their physician to ensure maternal and fetal well-being.
1. Young primiparous women under 20 years old and older primiparous women.
2. Short and overweight individuals, especially those with a body mass index (BMI) greater than 24.
3. Women with pre-existing conditions such as primary hypertension, chronic nephritis, or diabetes during pregnancy, as they face higher incidence rates and potentially more complex complications.
4. Pregnant women carrying twins, experiencing polyhydramnios, or with a molar pregnancy, who also have elevated risk.
5. Women with malnutrition, particularly those with severe anemia.
6. Individuals more susceptible to onset during cold winter and early spring seasons or under conditions of elevated atmospheric pressure.
7. Women with a family history, such as a mother who experienced preeclampsia during pregnancy, have a higher likelihood of developing the condition.
Self-Monitoring
During the second and third trimesters, in addition to monitoring fetal movements, pregnant women should pay attention to their weight gain, which should not exceed 0.5 kilograms per week.After the eighth month of pregnancy, mild edema may appear in both feet each afternoon, typically subsiding after rest. If edema occurs too early (e.g., in the sixth or seventh month), persists for an extended period, does not disappear after rest, or worsens and spreads to the calves, immediately visit the hospital for blood pressure and urinalysis tests to check for gestational hypertension.
When lower limb edema occurs with normal blood pressure and urine tests, pay attention to the following:
1. Increase prenatal check-up frequency to once weekly.
2. Rest: Appropriately reduce workload and ensure adequate sleep. Rest at home; hospital admission may be necessary.
3. Left-side lying position: Adopt this position during rest and sleep.This position reduces pressure on the abdominal aorta and inferior vena cava from the right-rotated uterus, increases venous return to the heart, improves renal blood flow to boost urine output, and helps maintain normal uteroplacental circulation.
4. Diet: Ensure adequate intake of protein and vitamins, supplemented with iron and calcium. Adherence to these measures often alleviates symptoms, though in rare cases, the condition may progress.Severe hypertension with proteinuria is termed preeclampsia, requiring hospitalization and timely termination of pregnancy. Prevention The etiology of gestational hypertension remains unclear, making complete prevention impossible. However, the following measures aid in detection and prevention: 1. Attend regular prenatal care appointments at the hospital. Monitor weight and blood pressure at each visit, perform routine urine tests, and check for proteinuria.
2. Manage weight gain during pregnancy. Aim for approximately 12.5 kg total weight gain throughout pregnancy. Underweight women may gain up to 15 kg, while overweight women should limit gain to 5–10 kg.
3. For high-risk individuals mentioned earlier, take 50 mg of enteric-coated aspirin daily under medical supervision. Studies indicate that the enteric-coated aspirin group experienced a lower incidence of hypertension compared to the non-aspirin group.
4. Ensure balanced nutrition for pregnant women, including routine calcium supplementation and adequate intake of protein-rich foods (milk, lean meat, eggs). Supplement micronutrients, particularly vitamin E, vitamin C, iron, and calcium.
5. Prioritize prenatal care. After 28 weeks, rest in a left-side lying position for about 30 minutes daily at noon to enhance venous return to the heart and reduce lower limb edema.