A Root Cause Medicine Approach to Gestational Hypertension

Gestational hypertension affects a sizable number of expectant mothers, showing up in between 5% and 10% of all pregnancies. We're seeing more cases lately due to changes in maternal profiles, like older mothers and higher pre-pregnancy weights. 

If you or someone you know is pregnant, getting a grip on what gestational hypertension means and its root causes can offer some peace of mind. In this article, we'll take a closer look at gestational hypertension from a root cause angle, giving you a clearer picture of its origins and how to approach it. We'll break down its causes, effects, and ways to navigate it effectively.

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What is Gestational Hypertension?

Gestational hypertension refers to elevated blood pressure that develops after the 20th week of pregnancy and typically dissipates following childbirth. This condition is distinct from general hypertension as it exclusively emerges during the latter stages of pregnancy. While many affected women may not experience overt symptoms, regular prenatal check-ups are vital for detecting its onset. High blood pressure during this period can introduce complications for both the mother and fetus. It is distinct from other hypertension conditions, such as preeclampsia, although some women with gestational hypertension may eventually develop preeclampsia. 

Gestational Hypertension Signs & Symptoms

Gestational hypertension might present itself through a variety of symptoms. While high blood pressure can be asymptomatic, making it a "silent killer," there are some common signs and symptoms associated with the condition (1,2): 

• Swelling (edema): This can manifest as puffiness in the hands, face, and feet.
• Changes in vision: This could include symptoms like blurred vision, temporary blindness, visual field defects, or photophobia (sensitivity to light).
• Sudden weight gain: A rapid increase in weight over a short period can be a sign.
• Headaches: Persistent or severe headaches might be an indicator.
• Nausea or vomiting: Experiencing these symptoms without an apparent cause can be concerning.
• Reduced Urination: Urinating in smaller amounts than usual might be observed.
• Pain in the abdomen: Particularly discomfort or pain in the upper right quadrant.
• Physical exam findings: Typically, blood pressure readings with systolic levels above 140mmHg and/or diastolic levels above 90mmHg. More severe cases might record pressures above 160mmHg systolic and/or 110mmHg diastolic.
• Pulmonary symptoms: Such as dyspnea (shortness of breath) or rales (crackling sounds in the lungs).
• Renal and hepatic impairment: Water retention leading to peripheral edema or pain in the upper right quadrant of the abdomen, respectively.

What Causes Gestational Hypertension?

Though the exact cause of hypertension during pregnancy remains unknown, certain conditions or factors are believed to amplify the risks associated with its development. Evidence suggests that gestational hypertension could emerge from irregularities in the placenta's development and its vascular structures. To put it simply, some processes within the placenta may not occur as they should, leading to issues with blood supply (1,2).

Specific risk factors for gestational hypertension encompass a diverse range of conditions and personal histories that can compromise the health of the uteroplacental circulation. Among these factors are existing conditions like hypertension, kidney issues, diabetes, obstructive sleep apnea, clotting abnormalities, and autoimmune disorders. Moreover, women who have previously encountered preeclampsia, HELLP syndrome or are expecting more than one child show an increased vulnerability. Other predispositions include being above the age of 35 or below 20, being a first-time mother, having a high BMI, and having close relatives who've experienced gestational hypertension (1,2).

What Are The Potential Risks of Gestational Hypertension to the Pregnant Mom and Baby?

For the expecting mother, gestational hypertension is not just a transient condition limited to the pregnancy period. It heightens the probability of evolving into pre-eclampsia—a severe hypertensive state. Pre-eclampsia can manifest with organ dysfunction, notably impacting the liver and kidneys. The condition can also progress to eclampsia, characterized by seizures, which can be life-threatening. Beyond these immediate threats, women who experience gestational hypertension also face elevated risks of cardiovascular ailments in the future, encompassing conditions like hypertension and other cardiovascular events (1,2,3). 

The pregnancy itself isn't immune to the implications of gestational hypertension. This condition can lead to intrauterine growth restriction, where the baby's growth in the womb is compromised. Furthermore, it can precipitate placental abruption—a critical scenario where the placenta detaches from the uterus prematurely. This detachment can disrupt the baby's supply of oxygen and nutrients, leading to potential harm (1,2).

As for the baby, gestational hypertension introduces several complications. A significant concern is the increased likelihood of premature birth, with such early arrivals prone to respiratory challenges, feeding issues, and developmental delays. Additionally, there's an enhanced risk of the baby having a low birth weight, which can further influence their overall health and developmental milestones. While many individuals with gestational hypertension will have healthy childbirths, especially when the condition is identified early on, the severity of hypertension can proportionally increase the risk of serious complications for the child (1,2).

Functional Medicine Labs to Help Get To The Root Cause of Gestational Hypertension

Functional medicine labs offer a variety of tests that can help tailor treatment to patients, allowing providers to optimize management strategies.

Diabetes Panel

Diabetes mellitus is a known risk factor for gestational hypertension due to its potential to impact blood vessels and hence, uteroplacental blood flow. This panel helps to screen for diabetes risks, insulin resistance, and potential autoimmune destruction of beta cells. Detecting and managing diabetes early on can not only improve overall health but can also decrease the associated risk of developing gestational hypertension. This panel is particularly recommended for those with a history of diabetes or gestational diabetes in previous pregnancies (1,2).

Renal Function Panel Testing

Kidney health plays a crucial role in vascular health, making it vital to assess renal function if at increased risk or screening for gestational hypertension. This test provides an overview of the kidney's health, ensuring that any signs of renal dysfunction are detected early. Those with pre-existing kidney conditions or with a family history of renal diseases would particularly benefit from this panel (1,2).

Cardiac Health Panel

This panel offers a comprehensive assessment of cardiovascular health markers, which can be important to evaluate as pre-existing hypertension is a risk factor for gestational hypertension. The test provides insights into factors like cholesterol, inflammation, and other indicators that can inform the health of the cardiovascular system, which may be less than optimal with pre-existing cardiac conditions such as hypertension (1,2).

Autoimmune Profile

This test assesses the presence of various autoimmune markers. Identifying these markers offers an in-depth view into potential autoimmune disturbances which might be influencing or increasing the risk for gestational hypertension. This test is beneficial for those at increased risk of an autoimmune condition or a family history of one, as they are at a heightened risk for gestational hypertension and associated complications (1,2).

Additional Labs to Check

While not specifically a lab, a sleep study to screen for obstructive sleep apnea may be indicated based on patient history, as this can elevate the risk of gestational hypertension (1).

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Conventional Treatment for Gestational Hypertension

Conventional treatment for gestational hypertension involves close monitoring by healthcare providers, which may result in more frequent prenatal visits. This includes checking blood pressure, testing for signs of preeclampsia, and employing fetal monitoring methods such as ultrasounds and nonstress tests. Treatment options can range from at-home blood pressure monitoring and medication to hospitalization. For some patients, early delivery might be advised, and if premature birth is anticipated, steroids may be administered to aid fetal lung maturity (1,2).

Functional Medicine Treatment for Gestational Hypertension

Functional medicine treatment for gestational hypertension focuses on diet interventions, the use of certain supplements, and complementary and alternative treatment methods such as Qigong and meditation. 

Nutrition Guidelines For Gestational Hypertension Patients

For patients with gestational hypertension, it’s recommended to incorporate 4 or 5 servings of both vegetables and fruits daily, ensuring a variety of essential vitamins and minerals. Dairy intake should focus on 2 or 3 servings of fat-free or low-fat options. Protein sources like fish, poultry, and meat should be limited to two 3-ounce servings daily, while legumes, seeds, or nuts are encouraged at 4 or 5 servings weekly. 

It's beneficial to consume 7 to 8 servings of whole grains every day to ensure steady energy and fiber intake. In terms of fat, 2-3 servings of healthy fats like olive oil or avocados are optimal, while animal fats should be minimized. Limiting sweets and added sugar to 5 servings weekly helps maintain balanced blood sugar levels. 

An important aspect to also consider is sodium regulation; it's essential to reduce its intake, with a particular emphasis on checking food labels for hidden sodium in prepared dishes. Adopting a nutrient-rich diet, such as the Mediterranean diet, can be beneficial as it aligns well with these guidelines and offers a delicious way to support healthy blood pressure during pregnancy.

Supplements & Herbs for Gestational Hypertension

In managing gestational hypertension, certain supplements and herbs have shown potential benefits:

Calcium: Supplementation can help prevent hypertensive disorders during pregnancy. Adequate calcium intake has been linked to a reduced risk of hypertension and a decreased likelihood of preeclampsia.

Vitamin D: This vitamin is essential for proper calcium balance, influencing blood pressure levels. Its intake can help prevent hypertensive disorders, partly due to its role in the regulation of the renin-angiotensin system, which is crucial for blood pressure control.

Folic Acid: Taking folic acid supplements can offer a protective effect against pre-eclampsia, especially in women with identified risk factors.

Sodium and Potassium: Proper intake of these minerals is linked to a reduced risk of hypertensive disorders. Balancing sodium and potassium levels can help manage blood pressure, particularly in pregnant women at risk for preeclampsia. For most people, this frequently means avoiding excess sodium. 

Complementary and Integrative Medicine

Complementary and integrative medicine offers potential benefits for managing gestational hypertension. Mind-body interventions are rooted in the understanding that emotional and psychological stress can therefore influence hypertension. For instance, Qigong, a traditional Chinese medicine technique blending movement, breathing, and meditation, has been associated with significant blood pressure reductions in some studies. Similarly, techniques that involve slow, controlled breathing can enhance parasympathetic activity and potentially help lower blood pressure. 

Transcendental meditation, where practitioners meditate with a specific mantra, has also shown modest blood pressure-lowering effects in several randomized controlled trials. Acupuncture has garnered mixed results from studies. While some showed significant blood pressure reductions with genuine acupuncture treatments, others found no difference (in case you are wondering, acupuncture during pregnancy is generally considered safe). However, before incorporating any complementary or integrative approaches during pregnancy, it's essential to consult with a healthcare professional to ensure their appropriateness and safety (15). 

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Summary

In summary, gestational hypertension is a condition that affects a notable fraction of pregnant women, especially with the changing dynamics of maternal profiles. Recognizing the symptoms early and understanding the potential risks to both the mother and baby is key. With the availability of both conventional and functional medicine treatments, managing this condition is achievable for pregnant mothers. Utilizing functional medicine tests can pinpoint root causes, and adjustments in diet, supplemented by integrative therapies, can further assist in addressing the condition effectively.