【Definition】Hypertension occurring before pregnancy or within the first 12 weeks of pregnancy. Such pregnant women typically have essential hypertension, meaning hypertension not caused by pregnancy. Hypertension developing after 20 weeks of pregnancy—defined as systolic blood pressure exceeding 140 mmHg or diastolic blood pressure exceeding 90 mmHg, or a post-pregnancy blood pressure increase of 30 mmHg systolic or 15 mmHg diastolic compared to early pregnancy—is termed gestational hypertension.
【Impact】
(1) On the mother:
＊ Poorly controlled gestational hypertension may progress to preeclampsia.
＊ Premature placental abruption may necessitate early delivery, increasing risks of complications associated with preterm birth.
＊ Severe gestational hypertension carries a fetal mortality rate of approximately 6%.
(2) For the fetus:
＊ Hypertension causes abnormal fetal blood flow, leading to inadequate nutrient supply in utero. This results in relatively low birth weight and intrauterine growth restriction (IUGR).
＊ Insufficient oxygen supply may cause signs of fetal distress.
【Treatment】
＊The earlier gestational hypertension occurs, the greater its impact on the fetus.
＊Treatment prioritizes blood pressure control, emphasizing prevention over cure.
＊Dietary management is typically initiated first, avoiding excessively salty foods.
＊If blood pressure remains elevated, oral antihypertensive medications are prescribed.
＊Hospitalization is recommended for severely symptomatic patients, with magnesium sulfate administered to prevent convulsions.
2. Preeclampsia
【Definition】Preeclampsia is characterized by gestational hypertension accompanied by either edema or proteinuria, or both. When preeclampsia is complicated by convulsions, it is termed eclampsia, which carries a particularly high maternal and fetal mortality rate.
【Threat Level】Eclampsia is severe, with a fetal mortality rate of 10–28% and a 15% chance of preterm birth.
【Symptoms】The three major symptoms of preeclampsia are hypertension, proteinuria, and generalized edema. Their order of appearance is variable, and severity differs among individuals. Additional clinical symptoms include headache, weight gain, upper abdominal pain, blurred vision, oliguria, fetal growth restriction or acute distress, depletion of coagulation factors, and placental abruption.
【Causes】
＊The exact cause of preeclampsia remains poorly understood.
＊The primary pathological changes involve vascular spasm and retention of fluid and salt.
＊These alterations reduce renal filtration capacity and decrease placental blood supply, leading to elevated blood pressure, proteinuria, edema, and fetal growth restriction.
Lifestyle Guidelines for Pregnant Women with Preeclampsia
If signs of preeclampsia appear, expectant mothers should avoid excessive panic and observe the following precautions:
(1) Dietary control: Avoid excessively salty foods such as pickled items and canned goods.
(2) Maintain a high-protein diet: Consume 80–90 grams of protein daily to replenish protein lost through urine.
(3) Increase bed rest (preferably lying on the left side).
(4) Maintain emotional stability: Rest in bed frequently and keep a positive mindset to reduce physical strain.
(5) Self-monitor blood pressure: Measure blood pressure once in the morning and once in the evening daily to track changes. Seek immediate medical attention if abnormalities occur.
(6) Medication for severe cases: Hospitalization may be required for severe symptoms, involving blood pressure-lowering drugs and monitoring post-treatment status.
3. Gestational Diabetes
【Definition】Gestational diabetes refers to high blood sugar developing during pregnancy in women without pre-existing diabetes, occurring in approximately 1%–3% of pregnancies.
【Causes】Underlying diabetes or increased levels of pregnancy hormones—specifically progesterone and cortisol—may heighten insulin resistance, leading to elevated blood sugar.
Early screening is recommended for those with these risk factors: (1) History of gestational diabetes in a previous pregnancy. (2) Family history of diabetes. (3) Previous delivery of an infant weighing over 4,000 grams.(4) History of stillbirth or congenital malformations. (5) History of recurrent miscarriages. (6) Obesity. (7) Persistent vaginal candidiasis. (8) Glucose in urine. (9) Polyhydramnios. (10) Estimated fetal macrosomia.
【Screening Method】
＊ Between 24–28 weeks of pregnancy, consume 50 grams of glucose solution.
＊Blood glucose is tested one hour later. If the glucose level exceeds the standard of 140 mg/dL, a 100-gram glucose tolerance test must be performed.
＊The 100-gram glucose tolerance test requires fasting beforehand.
＊Blood is drawn once before consuming the 100-gram glucose solution, then again one, two, and three hours after consumption.
＊If two or more of the four glucose readings exceed the standard, gestational diabetes mellitus can be diagnosed.
＊If two or more of the four blood glucose readings exceed the standard, gestational diabetes can be diagnosed.
【Effects】
(1) Effects on the mother:＊May cause diabetic ketoacidosis.＊Hyperglycemic hyperosmolar non-ketotic diabetic coma.＊Pregnant women with gestational diabetes have approximately a 50% chance of developing diabetes within ten years.
(2) Effects on Infant and Newborn: ＊ Hypoglycemia ＊ Macrosomia (large baby) ＊ Respiratory Distress Syndrome ＊ Electrolyte Imbalances: e.g., hypocalcemia and hypomagnesemia, jaundice, birth injuries, increased rates of stillbirth and cerebral palsy.
What to do if diagnosed with gestational diabetes?
1. Nutrition counseling: If diagnosed with gestational diabetes, first consult a nutritionist for proper dietary guidance and engage in appropriate exercise.
2. Blood sugar control: A small number of patients may still struggle to manage blood sugar levels despite these measures. In such cases, insulin injections are necessary to strictly control blood sugar, ensuring maternal and fetal health and preventing complications.
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