Hypertension ın gestational diabetes mellitus: Diagnosıs and treatment

Abstract

Gestational diabetes mellitus and hypertensive disorders of pregnancy, the most common complications in pregnancy, cause short and long term maternal and fetal health problems. Gestational hypertension and preeclampsia is more common in pregnancies complicated with gestational diabetes. Increased insulin resistance may predispose pregnant women to hypertensive disorders of pregnancy. There are four major hypertensive disorders related to pregnancy as gestational hypertension, chronic hypertension, pre-eclampsia and chronic hypertension with superimposed with pre-eclampsia. Gestational hypertension is defined as systolic blood pressure (SBP) ≥140 mmHg and diastolic blood pressure (DBP) ≥90 mmHg at ≥20 weeks of gestation in the absence of proteinuria or new signs of end-organ dysfunction. Gestational hypertension should be distinguished from preeclampsia which has a different prognosis in pregnant women with new-onset hypertension. Chronic hypertension is defined as hypertension that is present in prepregnancy or before the 20th week of pregnancy or persists longer than 12 weeks postpartum. Preeclampsia is a multisystemic progressive disease which develops in the last half of pregnancy, characterized by hypertension and proteinuira, or hypertension and significant end-organ dysfunction. There is insufficient evidence of antihypertensive treatment in pregnant women with diabetes because of the lack of randomized controlled trials in pregnant women with diabetes. Metformin may have beneficial effect in preventing hypertensive disorders of pregnancy by limiting weight gain and improving cardiovascular function. In the presence of mild to moderate gestational hypertension (systolic blood pressure <160 mmHg or diastolic blood pressure <110 mmHg), there is insufficient evidence that beneficial effects of antihypertensive therapy outweighs the potential risks. Aggressive treatment of severe hypertension (systolic blood pressure ≥160 and diastolic blood pressure ≥110 mmHg) in pregnancy should be avoided to avoid the risk of underperfusion for the fetus. However, if severe hypertension is accompanied by organ damage such as pulmonary edema or acute kidney disease, faster decrease in blood pressure should be achieved.