What You Need to Know About Pregnancy-Induced Hypertension (PIH)

For many women, pregnancy is a blissful time, filled with daydreams of baby socks and grinning chubby faces. However, sometimes pregnancy can become a stressful and frightening experience. If you've recently been diagnosed with pregnancy-induced hypertension (PIH), you know exactly what I mean.

One of the most frustrating aspects of PIH is that women who develop it often don't feel sick. Equally troubling is that no one can say for certain what causes a woman to develop PIH. There is evidence that younger mothers (those under 20) and older mothers (those over 40) are at an increased risk. The same is true for those who already have high blood pressure going into pregnancy. There are some doctors who believe excessive weight gain can be a contributing factor, and it is clear that women who have had PIH in a previous pregnancy are at a greater risk of developing it in future pregnancies. Finally, women who are expecting multiples are more likely than those carrying one baby to develop PIH. One thing is for certain: while PIH is a serious complication, and requires careful monitoring by your doctor, it can be managed and you and your baby have an excellent long-term prognosis.

Pregnancy-induced hypertension is a type of high blood pressure that occurs during pregnancy. It is a relatively common complication, with between five and eight percent of women experiencing it. However, PIH can develop into much more serious complications, including eclamspia and HELLP syndrome, so if you begin to develop PIH, your doctor will want to monitor you closely.

Likely, your diagnosis has resulted from one of the following two events: either you had a higher than usual blood pressure reading at your last OB appointment (140/90 is often the threshold, but any significant increase over your usual blood pressure can be a signal), or, your urine showed an increased amount of protein (and you thought they made you pee in a cup at every visit just to humiliate you!). These symptoms are often accompanied by edema, or severe swelling, particularly of the hands and feet. Depending on the severity of change in your blood pressure or the amount protein "spilling", your doctor might take one of several steps.

If your blood pressure is only slightly elevated, or there is a low level of protein in your urine (+1, for example), you may be advised to rest as much as possible and be monitored with more frequent visits. When and if your blood pressure or protein levels increase further, your doctor may initially order you onto modified bedrest, and then later onto full bedrest. (Modified bedrest means you can be up an around for short periods of time each day, sitting, showering, etc. Full bedrest requires you remain in bed, often on your left side to increase circulation for you and your baby, for as much as 23 hours of every day.)

If your condition continues to worsen, you may be asked to come in for frequent blood tests to check on your liver and kidney function, as both of these organs can be compromised by high blood pressure. You will be asked to call your doctor immediately if you develop a severe headache or a burning sensation in your chest that will not go away (some describe this as the worst heartburn you can imagine) as these are both signs that your condition is rapidly worsening.

One of the most frustrating things about pregnancy-induced hypertension is that the only cure is to deliver your baby. Therefore, when you have reached 37 weeks of pregnancy, many doctors will induce labor in patients with PIH. In severe cases, labor must be induced (or a c-section performed) even prior to the 37 week mark, because severe high blood pressure can lead a woman to "stroke out", which can be fatal for both her and her unborn child. Your doctor will weigh the risks of a pre-term baby against the risks of allowing your PIH to worsen on a case-by-case basis, and will do what he or she thinks is best for both you and your baby.