Disease Description (Causes and Symptoms)
- Definition: Gestational hypertension is a condition in which blood pressure rises to 140/90 mmHg or higher during pregnancy without accompanying proteinuria and returns to normal within 12 weeks after delivery (usually occurring after 20 weeks of pregnancy).
- Causes·Pathophysiology: The main mechanisms are vascular endothelial dysfunction and systemic vasoconstriction caused by abnormalities in placental blood flow/perfusion. This may lead to elevated blood pressure and dysfunction of organs such as the liver, kidneys, and blood coagulation system. Risk factors: first pregnancy, family history of gestational hypertension, multiple pregnancy (twins), diabetes, kidney disease, a history of hypertension, hydatidiform mole, etc.
- Main symptoms: headache, visual disturbances (light flashes·blurred vision), upper abdominal (epigastric/right upper quadrant) pain, edema, and rapid weight gain. Laboratory findings may include liver·kidney dysfunction, thrombocytopenia, and pulmonary edema; the fetus is at risk of growth restriction and reduced amniotic fluid. If it becomes severe, it may progress to preeclampsia (with proteinuria)·eclampsia (seizures).
Treatment Methods and Precautions
- General principles: The fundamental treatment for gestational hypertension itself is delivery. Treatment aims to relieve symptoms, prevent complications, and determine the timing of delivery according to the maternal·fetal condition and gestational age.
- Hospitalization·monitoring: Hospital observation is recommended when hypertension is persistent·worsening or when symptoms such as headache·visual disturbances·upper abdominal pain occur. During hospitalization, vital signs·BP (measured frequently), symptoms, blood·urine tests (liver·kidney·platelets), chest evaluation, and fetal monitoring (NST/BPP) are performed.
- Drug treatment:
- Antihypertensive agents: Used for moderate to severe hypertension. Medications with established safety, such as labetalol (oral/IV), long-acting nifedipine (extended-release tablets), and methyldopa (traditional), are mainly used. ACE inhibitors/ARBs are contraindicated during pregnancy because of the possibility of harm to the fetus.
- In severe cases (e.g., blood pressure ≥160/110 mmHg), intravenous medications for immediate stabilization and continuous monitoring are required.
- Seizure prevention/treatment: When there is a risk of or occurrence of preeclampsia·eclampsia, administration of magnesium sulfate (intravenous) is standard.
- Delivery (the final treatment measure): Induction of labor or cesarean section is determined according to the maternal·fetal condition and gestational age. In severe cases, early delivery may be necessary (taking fetal maturity into consideration).
- Lifestyle management: Reduce activity (avoid excessive complete bed rest), regularly monitor blood pressure·fetal movement, and manage fluid·nutrition intake. Learn how to use the device accurately when measuring blood pressure at home.
- Prevention: In high-risk individuals, low-dose aspirin (e.g., 81 mg/day, according to the physician’s judgment) during early to mid-pregnancy may reduce the risk of preeclampsia. Calcium supplementation may be considered when dietary intake is low.
- Contraindications/precautions:
- ACEi/ARB/direct renin inhibitors are contraindicated during pregnancy.
- Seek emergency care immediately if severe symptoms occur (persistent headache·visual disturbances·severe upper abdominal pain·shortness of breath·hematologic abnormalities).
- Excessive bed rest increases the risk of thrombosis; follow the medical team’s instructions.
- Risk of complications: Preeclampsia·eclampsia, fetal growth restriction·early cesarean section·preterm birth, placental abruption, pulmonary edema, acute kidney injury·liver dysfunction·thrombocytopenia, etc.
Checklist Before an Outpatient Visit (Items to Prepare and Example Questions)
- Items to prepare/bring:
- List of medications currently being taken (including doses·administration times)
- Past medical history and pregnancy history (including complications in previous pregnancies)
- Recent blood pressure measurement records (if home blood pressure records are available, include dates·times·values)
- Recent weight changes and urine test results (proteinuria test results)
- Records of changes in fetal movement
- Allergy information
- Symptom records: Headache (onset·severity), visual disturbances, upper abdominal pain, shortness of breath, sudden swelling of the legs/face, etc.
- Test records: Bring recent blood test results (liver·kidney·platelets), ultrasound results (fetal growth·amniotic fluid volume), and NST/BPP results, if available.
General Example Questions to Ask the Doctor
- When do you recommend delivery in this condition (by gestational age)?
- What are the side effects of the medication you plan to prescribe, and what effects could it have on the fetus?
- How likely is my condition to progress to preeclampsia·eclampsia?
- How should I measure and record my blood pressure at home?
- What are the criteria for hospitalization, and which symptoms require me to go to the hospital urgently?
Example Questions Tailored to the Disease
- I am currently at (for example) 32 weeks of pregnancy. Considering the maternal·fetal condition, do you recommend immediate delivery, or should we continue observation and prolong the pregnancy?
- Am I (or is my family member) a candidate for the recommended aspirin therapy? When should I start taking it, and what dosage should I take?