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
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:
- Labetalol – a beta blocker
- Sustained release nifedipine – a calcium channel blocker
- Immediate release nicardipine – a calcium channel blocker
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:
- Long-acting calcium channel blockers (Nifedipine)
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.