Hypertensive disorders of pregnancy, previously known as Pregnancy induced

hypertension (PIH), are high blood pressure disorders of pregnancy. It has long been
one of the major problems for mothers in pregnancy, along with infection
and postpartum hemorrhage. Preeclampsia affects 5-8% of all pregnancies but 10-
20% of mothers will have a hypertensive disorder during pregnancy.

There are four different levels of hypertensive disorders in pregnancy:

1. Chronic Hypertention (Discovered prior to 20 weeks gestation.)

2. Gestational Hypertension
3. Preeclampsia/Eclampsia
4. Preeclampsia/Eclampsia superimposed on chronic hypertension

PIH can be detected early during regular prenatal visits, which is one of the reasons
they are so very important. If you have PIH and it is untreated you may wind up with
a preterm baby, a stillborn baby or a baby who has growth retardation (IUGR), not
to mention the effects on your health.

There are still different opinions on the causes of PIH. There are speculations of
placental involvement, underlying disease, hormonal involvement etc.

If you experience any of the following warning signs, report them to your
practitioner:

• Rapid weight gain, 4 - 5 lbs in a single week

• A rise in your blood pressure
• Protein in your urine
• Severe headaches
• Blurry vision
• Seeing spots in your eyes
• Severe pain over your stomach, under your ribs
• Decrease in the amount of urine

Not all of these symptoms or signs may be detected by an individual. This is one of
the reasons that it is so important that you keep your regular prenatal
appointments is to screen all women for the above symptoms as well as other signs
of PIH. If you must miss an appointment be sure to reschedule it right away.

There are treatment options for those women suffering from chronic hypertension
or gestational hypertension, including hypertensive medications. Some practitioners
recommend strategies that are dietary, while others involve exercise and rest.
Recently it has been shown that aspirin doesn't help in the treatment for women in
a low risk group but can be helpful for a select high risk group. If you have
preeclampsia, the only cure is delivering the baby. Talk to your practitioner about
which options are best for you because this is critical.
The important thing to remember is that PIH is a very serious illness. You must be
followed closely by your medical professional to help prevent prematurity and death
of your baby and other severe complications in the most severe cases.

Now it is also known that even slight rises in the blood pressure during pregnancy
can have a lasting effect. Women who have PIH or more severe forms are at greater
risk for coronary artery disease later in life.

Preeclampsia is a characterized, by vasospasms, changes in the coagulation system, and

disturbances in systems related to volume and BP control. Vasospasms results from an
increased sensitivity to circulating pressors, such as angiotensin II, and possibly an imbalance
between the prostaglandins prostacyclin and thromboxane A1.
Endothelial cell dysfunction, believed to result from decreased placental perfusion, may account
for many changes in preeclampsia. Arteriolar vasospasm may cause endothelial damage and
contribute to an increased capillary permeability. This increase edema and further decreases
intravascular volume, predisposing the woman with preeclampsia to pulmonary edema.
Immunologic factors may play an important role in the development of preeclampsia. The
presence of a foreign protein, the placenta, or the fetus maybe perceived by the mother’s
immune system as an antigen. This may then trigger an abnormal immunologic response. This
theory is supported by the increased incidence of preeclampsia or eclampsia in first-time
mothers or to multiparous woman pregnant by a new partner. Preeclampsia maybe an immune
complex disease in which the maternal antibody system is overwhelmed from excessive fetal
antigens in the maternal circulation. This theory seems compatible with the high incidence of
preeclampsia among women exposed to a large mass of trophoblastic tissue as seen in twin
pregnancies or hydatidiform moles.
Genetic predisposition maybe another immunologic factor. Dekker reported a greater frequency
of preeclampsia and eclampsia among daughters and granddaughters of women with a history
of eclampsia, which suggests an autosomal recessive gene controlling the maternal immune
response. Paternal factors are also examined.
Diets in inadequate nutrients, especially protein, calcium, sodium, magnesium, and vitamin E
and C, maybe an etiologic factor in preeclampsia. Some practitioners prescribed high-protein
diets (90 mg supplemental protein) without caloric restriction and moderate sodium intake in the
prevention and treatment of this disorder. However, data are
limited regarding the associationbetween diet and preeclampsia.
Preeclampsia progress along a continuum from mild disease to severe preeclampsia, HELLP
syndrome, or eclampsia. The pathophysiology of preeclampsia reflects alteration in the normal
adaptations of pregnancy. Normal physiologic adaptations to pregnancy include increase
bloodplasma volume, vasodilation, and decreased systemic vascular
resistance, elevated cardiac output, and decreased colloid osmotic pressure. Pathologic
changes in the endothelial cells of the glomeruli are uniquely characteristic of preeclampsia,
particularly in nulliparous women. The main pathogenic factor is not an increase in BP but poor
perfusion as a result vasospasm. Arteriolar vasospasm diminishes the diameter of blood
vessels, which impedes blood flow to all organs and raises BP. Function in organs such as the
placenta, kidneys, liver and brain is deceased by as much as 40% to 60%.

Introduction to Preeclampsia

Although many pregnant women with high blood pressure have healthy babies without serious
problems, high blood pressure can be dangerous for both the mother and the fetus. Women
with pre-existing, or chronic, high blood pressure are more likely to have certain complications
during pregnancy than those with normal blood pressure. However, some women develop high
blood pressure while they are pregnant (often called gestational hypertension).

The effects of high blood pressure range from mild to severe. High blood pressure can harm the
mother's kidneys and other organs, and it can cause low birth weight and early delivery. In the
most serious cases, the mother develops preeclampsia-or "toxemia of pregnancy"-which can
threaten the lives of both the mother and the fetus.

What is preeclampsia?

Preeclampsia is a condition that typically starts after the 20th week of pregnancy and is related
to increased blood pressure and protein in the mother's urine (as a result of kidney problems).
Preeclampsia affects the placenta, and it can affect the mother's kidney, liver, and brain. When
preeclampsia causes seizures, the condition is known as eclampsia-the second leading cause
of maternal death in the U.S. Preeclampsia is also a leading cause of fetal complications, which
include low birth weight, premature birth, and stillbirth.

There is no proven way to prevent preeclampsia. Most women who develop signs of
preeclampsia, however, are closely monitored to lessen or avoid related problems. The way to
"cure" preeclampsia is to deliver the baby.

How Common Are High Blood Pressure and Preeclampsia in Pregnancy?

High blood pressure problems occur in 6 percent to 8 percent of all pregnancies in the U.S.,
about 70 percent of which are first-time pregnancies. In 1998, more than 146,320 cases of
preeclampsia alone were diagnosed.
Although the proportion of pregnancies with gestational hypertension and eclampsia has
remained about the same in the U.S. over the past decade, the rate of preeclampsia has
increased by nearly one-third. This increase is due in part to a rise in the numbers of older
mothers and of multiple births, where preeclampsia occurs more frequently. For example, in
1998 birth rates among women ages 30 to 44 and the number of births to women ages 45 and
older were at the highest levels in 3 decades, according to the National Center for Health
Statistics. Furthermore, between 1980 and 1998, rates of twin births increased about 50 percent
overall and 1,000 percent among women ages 45 to 49; rates of triplet and other higher-order
multiple births jumped more than 400 percent overall, and 1,000 percent among women in their
40s.