Gestational Hypertension vs Preeclampsia

Introduction

Gestational hypertension and preeclampsia both are conditions occurring during pregnancy. Gestational hypertension is also called as pregnancy-induced hypertension (PIH). It is defined as high blood pressure measuring above 140/90mm Hg in pregnant females without the presence of proteinuria (protein casts present in urine) and which occurs beyond 20 weeks of gestation. This high blood pressure occurs as a fresh occurrence without any prior history of hypertension in individuals. Pre-eclampsia or preeclampsia is defined as presence of high blood pressure along with presence of proteinuria occurring beyond 20 weeks of gestation.

Difference in causes and risk factors

The causes of gestational hypertension are obesity, age beyond 35 years, past history of diabetes and kidney disorders, multiple pregnancies like twin, triplets and placental abnormalities. The risk factors of preeclampsia include nulliparity (women who has not given to child before), prior history of hypertension, placental abnormalities like abnormal formation and abnormal functioning, family history of preeclampsia and age above 35 years.

Difference in diagnosis

A women is labeled as having gestational hypertension when two consecutive reading taken at least 6 hours apart are more than 140/90mm Hg. The pathogenesis of preeclampsia is that due to the abnormal formation of placenta or abnormal attachment of placenta there is lesser oxygenation to the fetus and the gestational sac. This leads to development of oxidative stress and release of inflammatory enzymes in the body. These inflammatory enzymes will lead to endothelial (cells of the blood vessels) dysfunction and lead to end organ ischemic (state of decreased oxygenation) failure. Preeclampsia is a very serious stage where there is potential danger to the life of the patient as organ failure can occur or if untreated eclampsia may ensue. Swelling or edema of hands and face is commonly seen in preeclampsia. The edema will also be pitting (if you press the edematous part with your finger then a depression will be formed at that place) in nature.

Gestational hypertension is simple high blood pressure whereas preeclampsia sees involvement of kidney along with high blood pressure. Patients suffering from high pregnancy induced hypertension will have significant reduction in blood pressure on cutting down in the quantity of salt whereas patients with preeclampsia will have to take strict measures such as bed rest. The blood supply is grossly affected in preeclampsia and hence Doppler study of the uterine artery and vein is suggested after one has conformed protein casts in urine sample.

Difference in treatment

Treatment for gestational hypertension is by anti-hypertensive medication which does not harm the fetus but also simultaneously help in reducing the blood pressure. The fetus whose mothers take anti-hypertensives may be at risk of lung maldevelopment.

The prevention for preeclampsia is done by giving low dose aspirin in high risk patients and also hypertensive medications in patients diagnosed of preeclampsia. One must also monitor the blood supply and plan for a safe delivery in advance. The baby when reaches viability may be opted for delivery by planned caesarean section so as to avoid further risks to the fetus as well as mother. Magnesium sulfate is given in order to avoid eclampsia which the most common and dangerous complication of preeclampsia.

Summary:

Gestational hypertension is hypertension alone but preeclampsia is hypertension along with presence of protein in the urine beyond 20 weeks of pregnancy.

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