What is the leading theory for gestational hypertension?

• A. Increased blood volume
• B. Stress
• C. Related to hyperglycemia
• D. Vasospasm

Answer: (D)

The key idea is that gestational hypertension arises from placental ischemia triggering widespread maternal endothelial dysfunction and vascular smooth muscle constriction (vasospasm). When the placenta doesn’t develop properly, its perfusion drops, releasing factors that injure the maternal endothelium and tilt the balance toward vasoconstriction and a proinflammatory, prothrombotic state. This systemic vasoconstriction raises peripheral resistance and blood pressure, and the endothelial damage leads to organ features such as proteinuria and edema.

This explains why the condition isn’t driven by simply having more blood volume, and why stress or hyperglycemia aren’t the primary mechanisms. Vasospasm, as a result of placental pathology and endothelial injury, best accounts the hypertension and potential end-organ effects seen in gestational hypertension.