Preeclampsia

What is Pre-eclampsi?

Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby.

Pre-eclampsia affect 5-8% of all pregnancies. Pre-eclampsia is a rapidly progressive condition characterized by high blood pressure and protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with advancing disease report few symptoms.

Pre-eclampsia occurs after 20 weeks gestation. though it can occur earlier. Proper prenatal care is essential to diagnose and manage preeclampsia. Closely related conditions are: Pregnancy Induced Hypertension, Toxemia, HELLP Syndrome and Eclampsia. All are a leading global cause of maternal and infant illness and death.

Risk Factors

  • History of preeclampsia, particularly if onset is before the third trimester
  • First-time pregnancies
  • Increased maternal age
  • History of chronic high blood pressure, diabetes or kidney disorder
  • Family history of the disorder in (mother, sister, grandmother or aunt)
  • Women with greater than 30% Body Mass Index (BMI)
  • Multiple gestation Over 40 or under 18 years of age
  • Polycystic ovarian syndrome
  •  Autoimmune disorders: lupus, rheumatoid arthritis, sarcoidosis or MS

 

Pre-eclampsia Causes “Theories”

MEDICAL DESCRIPTION

LAY-PERSON DESCRIPTION

Uterine ischemia/ underperfusion

 

Insufficient blood flow to the uterus

Prostacyclin/thromboxane imbalance (ASA)

Disruption of the balance of the hormones that maintain the diameter of the blood vessels.

 

Endothelial activation and dysfunction

Damage to the lining of the blood vessels that regulates the diameter of the blood vessels keeping fluid and protein inside the blood vessels and keeps blood from clotting.

Calcium deficiency

Calcium helps maintain vasodilation, so a deficiency would impair the function of vasodilation

 

Hemodynamic vascular injury

Injury to the blood vessels due to too much blood flow,i.e. the garden hose hooked up to a fire hydrant

 

Pre-existing maternal conditions

Mother has undiagnosed high blood pressure or other preexisting problems such as diabetes, lupus, sickle cell disorder, hyperthyroidism, kidney disorder, etc.

 

Immunological Activation

The immune system believes that damage has occurred to the blood vessel and in trying to fix the "injury" actually makes the problem worse (like scar tissue) and augments the process.

 

Nutritional Problems/Poor Diet

Insufficient protein, excessive protein, not enough fresh fruit and vegetables (antioxidants), among others theories.

 

High Body Fat

High body fat may actually be the symptom of the tendency to develop this disorder linked to the genetic tendency towards high blood pressure, diabetes and insulin resistance.

 

Insufficient Magnesium Oxide and B6

Magnesium stabilizes vascular smooth muscles and helps regulate vascular tone. Too much magnesium acts as a laxative and is not absorbed into the body.

Genetic Tendency

 


What Does Pre-eclampsia do?

It causes blood pressure to rise and puts you at risk of stroke or impaired kidney function, impaired liver function, blood clotting problems, pulmonary edema (fluid on the lungs), seizures and, in severe forms, maternal and infant death.

Because preeclampsia affects the blood flow and placenta, babies can be smaller and are often born prematurely.  Preeclampsia is a leading cause of illness and death globally for mothers and infants.

How does preeclampsia affect pregnancy?

Preeclampsia is often silent, showing up unexpectedly during a routine blood pressure check and urine test. In cases like this, if the baby is near term (after 36 weeks) the baby is induced, delivered and the mother watched and sent home as usual.

If preeclampsia occurs earlier in the pregnancy, especially for a mother expecting multiple births, its impact is more profound. Time off work, bed rest, medication and even hospitalization may be prescribed to keep the blood pressure under control. It is in the best interest of the babies to be kept in-utero as long as possible. Unfortunately, the only "cure" for the disease is delivery of the baby. Sometimes it is in the best interest of the mother to delivery the baby before term. Medical personnel may prescribe anti-hypertensive medications, such as beta-blockers. If the blood pressure cannot be controlled with medication and rest and the mother's and/or infant's health is at risk, then the mother may be given steroids to aid the maturation of the infant's lungs and the baby will be delivered.


When does Pre-eclampsia occur?

Preeclampsia can appear at any time during the pregnancy, delivery and up to six weeks post-partum, though it most frequently occurs in the last trimester and resolves within 48 hours of delivery. Preeclampsia can develop gradually, or come on quite suddenly, even flaring up in a matter of hours, though the signs and symptoms may have been present for months undetected or unnoticed.Can preeclampsia affect the baby?

Can preeclampsia affect the baby?

Preeclampsia can cause:

Prematurity

Preeclampsia is responsible for 15% of premature births in the US each year. It is the leading known cause of preterm birth. According to the March of Dimes, in 2001, 476,250 infants were born prematurely…over half from unknown causes. Preeclampsia represents 30% of the known causes of prematurely--or approximately 70,000 premature births.

A baby is considered premature prior to 36 weeks gestation (one month early) but most severe prematurity issues occur to babies born before approximately 32 weeks in developed countries, and somewhat later in developing countries. (As developing countries often lack the standard of critical care that preemies require). The impact of prematurity is not fully known, even in infants who were only slightly premature.

Intrauterine Growth Restriction (IUGR)

Reduced blood flow to the placenta restricts the supply of food to the baby and can result in a shortage of food and subsequent starvation. As a result, they may be smaller for their gestational age. Ultrasounds can help identify IUGR. The good news is many babies who suffer from IUGR can catch up on their growth within a few months.
It is important to note that many women blame themselves or poor nutrition for IUGR. Such problems are caused by a failing placenta and not the mother’s diet. A woman could be eating all of the right things but if the placenta is not capable of passing such nutrients along--the baby will suffer.

Acidosis

The baby survives by receiving nutrients and oxygen through the placenta. In preeclampsia, the placenta becomes compromised and the baby’s body begins to restrict blood flow to the limbs, kidney and stomach in an effort to preserve the vital supply to the brain and heart. If the baby reaches the point where there is no further reserve of oxygen (as the placenta detaches or dies) the baby’s body can extract energy from its fuel supplies without oxygen. This process generates a poisonous waste product--lactic acid. If too much lactic acid builds up the baby will develop “acidosis” and become unconscious and stop moving. Delivery is essential at this point. (thanks to: Pre-Eclampsia: The Facts, by Redman, Walker, 92).

Death

Infant death is one of the most devastating consequences of preeclampsia. It is impossible to say how many infants die each year, however, we estimate that at least 1200 babies die due to preeclampsia in the US alone. Many countries do not have the means to keep a premature baby alive. In these countries--the death toll is significant.

At the Preeclampsia Foundation a full 20% of our members have lost at least one baby or suffered a miscarriage. Because this disease can manifest in a very short time--a woman can have a normal prenatal appointment in the morning and lose her baby by the afternoon. We encourage our women to err on the side of caution.

Ongoing life challenges

Preeclampsia has been linked to a host of lifelong challenges for infants born prematurely, among them learning disabilities, cerebral palsy, epilepsy, blindness and deafness. With prematurity also comes the risk of extended hospitalization, small gestational size and the interruption of valuable bonding time for families. Prematurity stresses a family unit, and this stress is compounded when the mother is also ill.

Some studies suggest that babies born to a preeclamptic mother have an increased risk of high blood pressure and diabetes later in life. Very few studies have followed the health of these babies.

Education, vigilance and being proactive patients can reduce some of these deaths but ultimately-we need more research. We need to find a cure.

What is the cure?

The only cure is delivery of the baby. When preeclampsia develops, the mother and her baby are monitored carefully. There are medications and treatments that may prolong the pregnancy, which can increase the baby's chances of health and survival. Unfortunately, once the course of preeclampsia has begun, the health of the mother must be constantly weighed against the health of the baby. In some cases, the baby must be delivered immediately, regardless of gestational age, to save the mother's and/or baby's lives.

What can we do?

Right now, early diagnosis through simple screening measures and good prenatal care can predict or delay many effects of the condition. Prompt treatment saves lives. Research may be able to provide insight into the causes of the condition, and even help to develop a cure. The Preeclampsia Foundation can help to fund the research needed to find a cure and work to bring the information we already have to those who need it most. In developing countries, as many as 30 percent of maternal deaths are caused by preeclampsia.

Will I get preeclampsia in a subsequent pregnancy?

If my first pregnancy was normal

If you had a normal first pregnancy, your risk of having preeclampsia in the next pregnancy is very low, however if you have other risk factors (such as advanced maternal age, excess weight, family history of hypertension) you should still be watchful and alert to early warning signs. A study in Aberdeen, Scotland showed that nearly 1 in 150 women whose blood pressures had been entirely normal in their first pregnancy had preeclampsia in a second pregnancy. (ref: Preeclampsia: The Facts by Redman, Walker 1992) 

If I had preeclampsia in my first or an earlier pregnancy

There has not been significant research looking at the rate of reoccurrence in subsequent pregnancies, however the consensus among experts is that preeclampsia in a previous pregnancy is the single largest risk factor for developing preeclampsia. It is entirely wrong to say that if you had it in your first--you will not get it again. The risk of having it again is approximately 20%, however experts cite a range from 5-80% depending on when you had it in a prior pregnancy and how severely you had it.

The risk increases if since your previous pregnancy you have developed chronic hypertension, diabetes, or if you are having IVF, twins or other multiples, as well as the risk factors mentioned above.

If I had it in a first but not a second

If you do not have preeclampsia in a second pregnancy, your risk for reoccurrence in a third is low, though it can happen.


If I have been advised against getting pregnant again

Some preeclampsia experiences are traumatic for those who cared for you as well. Sometimes a doctor feels out of their depth and will advise against a future pregnancy because they do not know what will happen and they fear for your safety and well-being. We advise all women in this position to seek out a pre-pregnancy consultation with a perinatologist who specializes in preeclampsia and related disorders. They can review your chart and give you a clearer idea of your risks. Even a well-meaning OB may not have the experience to make this call. No one will be able to decide for you, however, they can help you weigh your options.

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