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Preeclampsia is a pregnancy complication. You may have high blood pressure, high levels of protein in your urine, which indicates kidney damage (proteinuria), or other signs of organ damage if you have preeclampsia. Preeclampsia usually develops after 20 weeks of pregnancy in women whose blood pressure was previously normal.
Preeclampsia, if left untreated, can cause serious – even fatal – complications for both the mother and the baby.
It is usually advised to have the baby delivered. The timing of delivery is determined by the severity of the preeclampsia and the number of weeks pregnant you are. Preeclampsia treatment prior to delivery includes careful monitoring and medications to lower blood pressure and manage complications.
Preeclampsia can occur after a baby is born, a condition known as postpartum preeclampsia.
WHAT ARE THE SYMPTOMS OF PREECLAMPSIA?
Preeclampsia is distinguished by high blood pressure, proteinuria, or other signs of kidney or other organ damage. You may not have any visible symptoms. During routine prenatal visits with a health care provider, the first signs of preeclampsia are frequently detected.
Preeclampsia can cause the following signs and symptoms in addition to high blood pressure:
- Excess protein in the urine (proteinuria) or other symptoms of kidney disease
- Low platelet levels in the blood (thrombocytopenia)
- Increased levels of liver enzymes, which indicates a problem with the liver.
- Extensive headaches
- Vision changes, such as temporary blindness, blurred vision, or light sensitivity
- Shortness of breath caused by a buildup of fluid in the lungs
- Upper abdominal pain, usually under the ribs on the right side
- Vomiting or nausea
During a healthy pregnancy, weight gain and swelling (edema) are normal. However, sudden weight gain or the appearance of edema, particularly in your face and hands, may indicate preeclampsia.
WHAT ARE THE CAUSES OF PREECLAMPSIA?
Preeclampsia is most likely caused by a combination of factors. Experts believe it starts in the placenta, the organ that feeds the fetus during pregnancy. New blood vessels form and evolve early in a pregnancy to supply oxygen and nutrients to the placenta.
These blood vessels do not appear to develop or function properly in women with preeclampsia. Problems with how well blood circulates in the placenta may result in irregular blood pressure regulation in the mother.
WHAT ARE THE RISK FACTORS OF PREECLAMPIA?
The following conditions have been linked to an increased risk of preeclampsia:
- Previous pregnancy preeclampsia
- Pregnant with more than one child
- High blood pressure (hypertension)
- Diabetes type 1 or type 2 prior to pregnancy
- Diabetic kidney disease
- Autoimmune conditions
- Utilization of in vitro fertilization
The following conditions are linked to a moderate risk of developing preeclampsia:
- First pregnancy with current partner
- Obesity
- History of preeclampsia in the family
- Mothers who are 35 years of age or older
- Pregnancy complications from a previous pregnancy
- More than ten years have passed since the previous pregnancy.
Other potential risks: Several studies have found that Black women have a higher risk of preeclampsia than other women. There is also some evidence that indigenous women in North America are at a higher risk.
A growing body of evidence suggests that these risk differences may not be based solely on biology. Inequities in access to prenatal care and health care in general, as well as social inequities and chronic stressors that affect health and well-being, may be associated with a higher risk.
Lower income is also associated with a higher risk of preeclampsia, most likely due to access to health care and social factors influencing health.
In terms of prevention strategies, a Black woman or a woman with a low income has a moderately increased risk of developing preeclampsia.
WHAT ARE THE COMPLICATIONS OF PREECLAMPSIA?
Preeclampsia complications may include:
- Limitation of fetal growth: Preeclampsia causes problems with the arteries that carry blood to the placenta. If the placenta does not receive enough blood, the baby may receive insufficient blood, oxygen, and nutrients. This can result in fetal growth restriction, or slow growth.
- Abruption of the placenta: Preeclampsia increases your chances of having a placental abruption. The placenta separates from the uterine inner wall before delivery in this condition. Severe abruption can result in heavy bleeding, which can be fatal for both the mother and the baby.
- Premature birth: Preeclampsia can cause an unplanned premature birth (birth before 37 weeks). In addition, preeclampsia is primarily treated with planned premature birth. A premature baby is more likely to have breathing and feeding difficulties, vision or hearing problems, developmental delays, and cerebral palsy. Some risks may be reduced if treatments are administered prior to preterm delivery.
- HELLP syndrome: Hemolysis (the destruction of red blood cells), elevated liver enzymes, and a low platelet count are all abbreviated as HELLP. This severe form of preeclampsia has a wide-ranging impact on several organ systems. HELLP syndrome is life-threatening for both the mother and the baby, and it can lead to long-term health problems for the mother.
Nausea and vomiting, headache, upper right belly pain, and a general feeling of illness or being unwell are all signs and symptoms. It can appear suddenly, even before high blood pressure is detected. It can also appear without any symptoms.
- Eclampsia: Eclampsia is the onset of seizures or coma in conjunction with preeclampsia signs or symptoms. Predicting whether a patient with preeclampsia will develop eclampsia is extremely difficult. Eclampsia can occur in the absence of any previous signs or symptoms of preeclampsia.
Severe headaches, vision problems, mental confusion, or altered behavior are all signs and symptoms that may appear before seizures. However, there are frequently no symptoms or warning signs. Eclampsia can occur before, during, or after childbirth.
- Other organ damage: Preeclampsia can harm the kidneys, liver, lungs, heart, and eyes, as well as cause a stroke or other brain injury. The extent of damage to other organs is determined by the severity of the preeclampsia.
- Cardiovascular disease: Preeclampsia may increase your chances of developing heart and blood vessel (cardiovascular) disease in the future. If you've had preeclampsia more than once or had a preterm delivery, your risk is even higher.
HOW IS PREECLAMPSIA DIAGNOSED?
Preeclampsia is diagnosed when you have high blood pressure after 20 weeks of pregnancy and at least one of the following symptoms:
- Protein in your urine (proteinuria), which indicates a kidney problem.
- Other signs of kidney disease
- A low platelet count in the blood
- Elevated liver enzymes, which indicates that the liver is damaged.
- The presence of fluid in the lungs (pulmonary edema)
- New headaches that do not go away even after taking pain relievers
- New vision problems
Hypertension
A blood pressure reading consists of two numbers. The first number is the systolic pressure, which is a measurement of blood pressure when the heart contracts. The diastolic pressure, or blood pressure when the heart is relaxed, is the second number.
High blood pressure is diagnosed during pregnancy if the systolic pressure is 140 millimeters of mercury (mm Hg) or higher, or the diastolic pressure is 90 mm Hg or higher.
Your blood pressure can be affected by a variety of factors. If you have a high blood pressure reading during an appointment, your doctor will most likely take a second reading four hours later to confirm the diagnosis.
Additional examinations
If you have high blood pressure, your doctor will order additional tests to look for other signs of preeclampsia, such as:
- Blood tests: A blood sample tested in a lab can reveal how well the liver and kidneys are functioning. Blood tests can also detect the presence of platelets, which are cells that aid in blood clotting.
- Urine analysis: Your doctor will request a 24-hour urine sample or a single urine sample to assess how well your kidneys are working.
- Fetal ultrasound: Your primary care provider will most likely advise you to keep a close eye on your baby's growth, which is typically done via ultrasound. The ultrasound images of your baby created during the exam allow for estimates of the baby's weight and the amount of fluid in the uterus (amniotic fluid).
- Biophysical profile or nonstress test: A nonstress test is a simple procedure that determines how your baby's heart rate responds when he or she moves. An ultrasound is used to measure your baby's breathing, muscle tone, movement, and the volume of amniotic fluid in your uterus during a biophysical profile.
HOW CAN PREECLAMPSIA BE TREATED?
Preeclampsia is treated primarily by either delivering the baby or managing the condition until the best time to deliver the baby arrives. This decision with your health care provider will be based on the severity of your preeclampsia, your baby's gestational age, and your and your baby's overall health.
If your preeclampsia isn't severe, you may need to see your doctor on a regular basis to monitor your blood pressure, any changes in signs or symptoms, and the health of your baby. You'll most likely be asked to check your blood pressure at home on a daily basis.
Severe preeclampsia treatment
Severe preeclampsia necessitates hospitalization to monitor your blood pressure and potential complications. Your baby's growth and well-being will be closely monitored by your doctor.
The following medications are commonly used to treat severe preeclampsia:
- Antihypertensive medications are used to lower blood pressure.
- To prevent seizures, anticonvulsant medication such as magnesium sulfate is used.
- Corticosteroids are used to stimulate the development of your baby's lungs prior to delivery.
Delivery
If your preeclampsia is not severe, your doctor may advise you to have a preterm delivery after 37 weeks. If you have severe preeclampsia, your doctor will probably advise you to have the baby before 37 weeks, depending on the severity of the complications and the baby's health and readiness.
The method of delivery, vaginal or cesarean, is determined by the severity of the disease, the baby's gestational age, and other factors discussed with your health care provider.
After delivery
Following delivery, you should be closely monitored for high blood pressure and other signs of preeclampsia. Before you leave, you will be told when to seek medical attention if you experience symptoms of postpartum preeclampsia, such as severe headaches, vision changes, severe belly pain, nausea, and vomiting.
HOW CAN PREECLAMPSIA BE PREVENTED?
- Medication: The use of low-dose aspirin is the best clinical evidence for preventing preeclampsia. If you have one high-risk factor for preeclampsia or more than one moderate-risk factor, your primary care provider may advise you to take an 81-milligram aspirin tablet daily after 12 weeks of pregnancy.
It is critical that you consult with your provider before taking any medications, vitamins, or supplements to ensure that they are safe for you.
- Healthy living and lifestyle choices: It's a good idea to be as healthy as possible before getting pregnant, especially if you've had preeclampsia in the past. Discuss with your provider how to manage any conditions that increase your risk of preeclampsia.