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What Treatment Options are Available for Gestational Hypertension?

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Updated May 22, 2014

Pregnant woman laying on bed
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Question: What Treatment Options are Available for Gestational Hypertension?
Answer:

The treatment of gestational hypertension follows a different set of guidelines than the treatment of general high blood pressure outside of pregnancy. The main goal of treatment in pregnant women is to prevent the development of more serious conditions like fetal growth restriction or placental abruption. Pregnancy also introduces other concerns into traditional treatment plans, since the well-being of the baby must be considered along with that of the mother. The most commonly used treatment options for pregnant women with high blood pressure are:

  • Bed rest
  • Short-term (acute) drug therapy
  • Long-term (chronic) drug therapy
In choosing a specific treatment plan, details such as whether the high blood existed before the pregnancy, how far along the pregnancy is, and how well the baby is doing must all be considered.

Bed Rest

Bed rest, or restricted activity, has long been prescribed for cases of gestational hypertension, regardless of its underlying cause. Though this practice has been used for a long time and continues to be a popular treatment option, there is very little solid evidence backing up the effectiveness of this therapy. Several small clinical studies have been conducted, along with one comprehensive literature review, but no large studies have been done. In general, the results are mixed. Some studies have shown that bed rest offers no protective benefits, while other studies have shown a small, but measurable, decrease in the risk of developing worsening high blood pressure or delivering prematurely.

Because of the lack of solid evidence, bed rest should not be viewed as a definitive treatment strategy. Still, mildly restricted activity does not pose any serious health risks, and can be used if it isn’t disruptive to your normal schedule. In cases where there are known problems with blood flow through the placenta – “uteroplacental insufficiency” – bed rest may offer some additional benefits.

Short-Term and Long-Term Drug Therapy

Drug therapy is an effective, proven way to moderate blood pressure during pregnancy, though care must be used in selecting and administering drugs. Because drug therapy during pregnancy can carry risks for both the mother and the baby, it is usually reserved for use only in cases where the blood pressure is very high, typically >150/100 mmHg.

For short term therapy, the drugs most often chosen are:

In the short term, if these drugs are unable to control the blood pressure, a drug called diazoxide is sometimes used if immediate blood pressure control is needed.

For longer term treatment that must continue for weeks or months, the drug choices are similar. Labetalol is one of the most commonly used drugs in pregnant women. Though all drugs carry unique risks for the pregnant patients, labetalol has been shown to be generally safe for use during pregnancy. Along with labetalol, some other drugs that may be used include:

  • Methyldopa
  • Long-acting calcium channel blockers (Nifedipine)

Fetal Evaluation

Fetal evaluation – checking the health and status of the baby – is a somewhat controversial component of treating gestational hypertension. While an ultrasound should be done at 16-20 weeks to provide an accurate baseline reading by which to evaluate the baby’s growth rate, there is no clear agreement about the role of other tests. Most doctors will perform a “nonstress test” along with an “amniotic fluid index” or a “biophysical profile” on a weekly basis towards the end of the pregnancy, as a way to ensure that growth is progressing normally. In general, close monitoring is only needed when conditions suggest that the baby may be at some risk. These conditions are different for different women, but may include signs that blood flow to the baby has been affected.

Labor and Delivery

Almost all women with uncomplicated gestational hypertension will go on to have a normal delivery at full term. These women typically have successful vaginal deliveries and no other serious problems. In cases where the blood pressure is severely elevated, or in cases of preeclampsia, early delivery is often considered. In cases of serious problems, like eclampsia, early delivery is usually attempted to avoid the development of potentially life-threatening complications. In general, though, remember that the vast majority of women with pregnancy-induced hypertension go on to have a successful, full-term pregnancy and have healthy infants.

Sources:

  1. Meher, S, Abalos, E, Carroli, G, Meher, S. Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database Syst Rev 2005; :CD003514.
  2. Remuzzi, G, Ruggenenti, P. Prevention and treatment of pregnancy-associated hypertension: What have we learned in the last 10 years? Am J Kidney Dis 1991; 18:285.
  3. Duley, L, Henderson-Smart, DJ, Meher, S. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev 2006; 3:CD001449.
  4. Abalos, E, Duley, L, Steyn, DW, Henderson-Smart, DJ. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy (Cochrane Review). Cochrane Database Syst Rev 2007; :CD002252.
  5. Podymow, T, August, P. Postpartum course of gestational hypertension and preeclampsia. Hypertension in pregnancy 20006; 25:210.

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