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A look Into Pregnancy-induced hypertension

Kathleen Rovira
NHM 340-001
September 24, 2014

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Introduction:
Pregnancy-induced hypertension, also known as preeclampsia or toxemia, has been
shown to be the second most life-threating health condition for pregnant women, complicating
between 5-10 percent of womens pregnancies.1 Preeclampsia is a form of hypertension that
develops during a womens pregnancy who had a normal blood pressure but has increased after
20 weeks of gestation period resulting in swelling and protein in urine. 6, 10 Untreated
preeclampsia could lead to a more severe condition such eclampsia and HELLP syndrome. 10 Its
important to educate the population about this disease because, during pregnancy, women will
dismiss the symptoms as a normal effect of pregnancy instead of a more severe health condition.
In addition, the public has not been properly informed about this disease.
Background:
The national objectives on education about hypertensive disorders that occur during
pregnancy such, as preeclampsia, are to reduce the rate of infant and mortality after the 20-week
gestation period. 9 Another objective is to reduce the rate of low-birth weight infants and preterm
births. 9 Lastly, another goal of the nation is to increase the amount of women receiving prenatal
care during their first trimester to detect any developing pregnancy complications and ensure the
development of the fetus. 9 According to Brown, 4 preeclampsia accounts for 12.3 percent of
maternal death in the United States. 4 Also, hypertensive disorders during pregnancy are the
second most common cause of maternal death.1 Brown4, also states preeclampsia is more
prevalent in African American women. 4 The incidence rate of preeclampsia is about 6 to 8
percent in pregnancy. 2,4 According to Ananth, 11 the rate of preeclampsia has increased from the
previous rate of 3.4 percent in 1980; however, it has decreased from its rate in 2003. The at- risk
population of preeclampsia is women with chronic high blood pressure, kidney disease, and a

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history of preeclampsia prior to pregnancy. 7,8,10 Women who are classified as obese, younger
than age 20 or older than 35 years old, women carrying twins, triplets, or multiple births, African
American ethnicity, or a family history of preeclampsia. 7,8,10 Women who are expecting for the
first time are also at risk.7
Screening and Treatment:
The screening methods for preeclampsia include blood tests, urine analysis, fetal
ultrasounds, nonstress tests or biophysical profiles, BMI measurements, and measuring blood
pressure.7 Blood tests are used to measure the amount of platelets and to check the function of the
liver and kidneys. 8 Urine analyses are used to detect proteins in the urine and the status of the
disease. 7 Fetal ultrasounds are used to monitor the babys growth and the amount of amniotic
fluid in the uterus because the amount of amniotic fluid determines the babys blood supply
status. 7 Nonstress tests check the heart rate and movement of the baby in the uterus while the
biophysical profile uses both the ultrasound and nonstress test to retrieve more information on
the babys breathing tone, movement and amniotic fluid present. 7 Blood pressure measures
systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90
mmHg. 1 Other screening methods include BMI, edema assessment, eye examination and blood
clotting tests. 8 There are many factors that make a woman at risk for developing preeclampsia. If
a woman has a family history of developing preeclampsia, then she is more likely to develop the
disease. 7, 6 Additional risk factors for developing preeclampsia include; if it is the womans first
pregnancy, each new paternal partner increases a womans risk of the disease7, if the woman is
under the age of 20 or over the age of 40, if a women is obese6, 7, 8, women carrying multiple
children are at a higher risk6,7, if pregnancies are less than two years apart or more than ten years
apart the risk of developing preeclampsia is increased7, and also if the woman has a history of

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high blood pressure, migraine headaches, type 1 or type 2 diabetes, kidney disease, blood clots or
lupus are factors that lead to a higher risk of preeclampsia6,7. The treatment options for a woman
diagnosed with preeclampsia range from prescription drugs to induced delivery7, 8. Bed rest used
to be a common treatment method; however, there was no researched benefit to bed rest and it
was shown to cause blood clots and could effect the patients economic and social lives;
therefore, it is no longer recommended 6,7. In severe cases of preeclampsia the doctor will
hospitalize a patient and take continual readings using nonstress tests or biophysical regularity in
order to make sure the baby is healthy inside the uterus 7. In cases when preeclampsia develops
or persists late into the pregnancy, induced delivery of the baby or caesarian sections can be
performed7. Different medications can be used to help with the symptoms of preeclampsia such
as Antihypertensives, to lower the blood pressure for those women with severe high blood
pressure, corticosteroids to temporarily improve liver and platelet functions and mature a babys
lungs for babies who will be premature at birth7. Anticonvulsant medications, such as magnesium
sulfate, are prescribed for severe preeclampsia, to prevent seizures. 7
Nutrition and Lifestyle:
Risk factors that can be modified are; obesity, the number of paternal partners, age of the
woman when she gets pregnant, and the time between pregnancies are all modifiable risk factors.
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The family history of the patient, the number of children the patient is carrying, and the

personal history of high blood pressure, migraine headaches, type 1 or type 2 diabetes, kidney
disease, blood clots or lupus of the patient are all non-modifiable risks of preeclampsia. 7 Some
foods have been shown to possibly lower the rate of preeclampsia such as fish oil and garlic to
prevent preeclampsia but are considered inadequate of actually preventing preeclampsia based
on evidence. 6 Low-dose aspirin can lower the risk of preeclampsia and is seen as suitable for

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women who had preeclampsia in previous pregnancy and experience more than one case of this
disease in other pregnancies6 In these cases, a low daily dose of aspirin will be recommended and
should be taken at the end of a womens first trimester. 7 Calcium supplements are only beneficial
in the treatment of preeclampsia for women with calcium deficiency in developing countries 7
Obesity is a factor because it increases an individuals chances of developing
preeclampsia and is linked to high fat intake and poor nutrition, causing high blood pressure. 7
Moderate exercise is recommended during pregnancy because it improves vascular function and
maternal endothelial dysfunction; additionally it stimulates placental angiogenesis6. Women who
previously experienced preeclampsia and women planning to get pregnant should aim for
premium health status before getting pregnant to minimize the risk of developing preeclampsia7
Women who are overweight or obese are advised to lose weight prior to pregnancy and those
with diabetes or other health conditions contributing to the risk factors should be manage. 7
Educational Programs and Recommendations:
In order for information regarding this disease to be the most effective, educational
information should be direct and easy to read for patients to understand the contents and it should
limit medical term usage when describing the diseases. 6 Additionally, research shows that
providing women with signs and symptoms of preeclampsia in pictures will allow them to be
detected early for preeclampsia and may lower the rates of it developing into a more severe form
of preeclampsia and morbidity. 6 Additional resources such as mobile applications; Text4Baby,
sends out information about prenatal and postpartum to patients phones. 6 T.V monitors and
brochures, printed articles in the reception areas can also be used to convey information to
patients waiting. 6In addition, a prenatal care group programs are available for patients at no cost
to receive more information and improve perinatal outcomes. 6. There are some barriers toward

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the education of patients; for example, there is a limited time for each prenatal visit to cover most
of the prenatal information. 6 A negative impact of the health care providers is that some
providers fail to provide preeclampsia information to their patients in order to prevent
unnecessary anxiety. 6 This might be because they are not well informed about the disease
resulting in knowledge disparities in clinical management. 6 There is still much to learn about
this disease that could help early detection or even prevention. 6
Conclusion:
The nation has many goals for the future of this disorder, and they all move towards
having a more healthy population of pregnant women and newborns and according to Ananth 11
the rates of this disease have been dropping since 200311. There are many methods for testing for
this disease and many factors that put a woman at risk for developing this disease, and as such,
all pregnant women should seek regular prenatal care. There is a wide range of treatment options
for anyone diagnosed with this disease and all treatment regimes should be prepared for each
unique case depending on the severity of the symptoms. Proper daily nutrition and exercise are
frontline preventative measures that pregnant women can take in order to prevent this disease or
help cope with the symptoms of this disease, and attaining a healthier lifestyle prior to pregnancy
should be the goal of all women trying to become pregnant because it will help to prevent
development of this disease7. Finally, clearer explanation about this disease should become
commonplace between pregnant women and their doctors or nutritionists in order to help women
become more aware of the prevalence of this disease and the possible outcomes and treatment
methods; once there is better education on this disease, more women will be able to be properly
treated for preeclampsia and it can become a less fatal disease.
References

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1. Vest A, Cho L. Hypertension in pregnancy. Current Atherosclerosis Reports
[serial online].
March 2014;16(3):395. Available from: MEDLINE, Ipswich, MA.
Accessed September 21, 2014.
2. Podymow T, August P. Postpartum Course of Gestational Hypertension and
Preeclampsia. Hypertension In Pregnancy [serial online]. August
2010;29(3):294300. Available from: Academic Search Premier, Ipswich, MA. Accessed
September
22, 2014.
3. Zhiwen L, Rongwei Y, Le Z, Hongtian L, Jianmeng L, Aiguo R. Folic Acid
Supplementation
During Early Pregnancy and the Risk of Gestational Hypertension and
Preeclampsia.
Hypertension (0194911X) [serial online]. April 2013;61(4):873-879.
Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed September 22,
2014.
4. Brown C, Garovic V. Drug Treatment of Hypertension in Pregnancy. Drugs
[serial online].
March 2014;74(3):283-296. Available from: CINAHL Plus with Full Text,
Ipswich,
MA. Accessed September 22, 2014.

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5. Gabbay A, Tzur T, Weintraub A, Shoham-Vardi I, Sergienko R, Sheiner E.
Calcium level
during the first trimester of pregnancy as a predictor of preeclampsia.
Hypertension
In Pregnancy [serial online]. August 2014;33(3):311-321. Available
from: Academic
Search Premier, Ipswich, MA. Accessed September 22, 2014.
6. Roberts J, August P, Bakris G, et al. Hypertension in Pregnancy.
Washington D.C: The
American College of Obstetricians and Gynecologists; 2013.
http://www.acog.org/
~/media/Task%20Force%20and%20Work%20Group
%20Reports/Hypertensionin
Pregnancy.pdf. Accessed September 22, 2014
7. Mayo Clinic Staff. Diseases and Conditions.
http://www.mayoclinic.org/diseasesconditions/preeclampsia/basics/definition/con-20031644. Updated July
03, 2014. Accessed September 22, 2014.
8. Pregnancy induced hypertension. http://www.chw.org/medical-care/fetalconcernscenter/programs/conditions/pregnancy-complications/pregnancyinduced-hypertension/. Updated 2014. Accessed September 22, 2014.

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9. Maternal, Infant, and Child Health.
http://www.healthypeople.gov/2020/topicsobjecti
ives2020/overview.aspx?topicd=26. Updated September 22, 2014.
Accessed September 22, 2014.
10. Preeclampsia and Eclampsia: Condition Information.
http://www.nichd.nih.gov/health
/ topics/preeclampsia/conditioninfo/Pages/default.aspx. Updated June
18, 2013.
Accessed September 22, 2014.
11. Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United
States, 1980-2010:
age-period-cohort analysis. BMJ 2013;347:f6564. Accessed September
22, 2014.