Pre-eclampsia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 31, 2016
StartDiseasesPre-eclampsia

Pre-eclampsia is a pregnancy-related complication associated with high blood pressure that can be dangerous for both mother and baby if not diagnosed and treated promptly. Good prenatal care and monitoring can help identify women at risk for pre-eclampsia so the condition can be prevented. While pre-eclampsia is a serious health problem, most women who develop these symptoms go on to have healthy babies. Pre-eclampsia is also referred to as toxemia.

Contents

Definition & Facts

Pre-eclampsia is an issue for pregnant women around the globe, occurring in 2 to 8 percent of pregnancies worldwide. In the United States, about 15 percent of births before 37 weeks are caused by this condition. Pre-eclampsia usually develops between the 20th week of pregnancy and six weeks postpartum, although in rare cases it may occur earlier.

HELLP syndrome is a more severe form of pre-eclampsia characterized by hemolysis, elevated liver enzymes, and low platelet count. The global mortality rate for this condition is estimated to be about 25 percent. Left untreated, pre-eclampsia can escalate into eclampsia, a related condition that can cause seizures and eventually brain damage and coma.

Symptoms & Complaints

Pre-eclampsia is characterized primarily by high blood pressure and may also cause protein in the urine, severe headaches, nausea, and vomiting, vision changes including blurriness, double vision, or light sensitivity, sudden weight gain, dizziness, and edema.

Unexplained shoulder pain, shortness of breath, anxiety, feelings of dread or doom, and weight gain of more than two pounds in a week (caused by water weight) are also causes for concern. However, some women experience no symptoms, while others mistake the symptoms of pre-eclampsia for normal aches and pains of pregnancy. That's why it's important for pregnant women to see a doctor immediately if they experience vision changes or severe abdominal pain.

Causes

While doctors don't know exactly what causes pre-eclampsia, some groups of women are at higher risk. These groups include

  • Women who are pregnant for the first time or pregnant with multiples
  • Women who have developed pre-eclampsia in a previous pregnancy or who have a family history of the condition;
  • Women who have high blood pressure, kidney disease, diabetes, a thrombophilia, or lupus
  • Women who got pregnant using in vitro fertilization
  • Women who are obese. In addition, each pregnancy with a new partner carries the same pre-eclampsia risk as a first pregnancy, and women who have a subsequent pregnancy sooner than two or greater than ten years after the first also have an elevated risk.

When a woman becomes pregnant, new blood vessels develop to help nourish the fetus, an organ known as the placenta. Experts theorize that in women with pre-eclampsia, these blood vessels fail to develop correctly and are only able to carry a limited amount of blood. This can be caused by reduced blood flow to the uterus, existing blood vessel damage, immune system conditions, or the presence of certain genes.

Diagnosis & Tests

At each prenatal visit, the health care provider will check blood pressure and test urine for protein to screen for pre-eclampsia. These screenings are critical since the condition can manifest with no symptoms. Even a small increase in blood pressure can indicate the presence of pre-eclampsia.

The reason for the urine screening is a condition known as proteinuria, in which proteins that are usually filtered out of the urine by the kidneys are allowed to pass through because of kidney damage caused by pre-eclampsia.

Treatment & Therapy

Because there is no cure for pre-eclampsia, therapy focuses on limiting the condition's impact on the health of the mother and the baby. Treatment for pre-eclampsia depends on the severity of the condition and how far along the mother is in the pregnancy when the condition is diagnosed. Mild pre-eclampsia after 37 weeks usually doesn't cause health issues for mother or baby.

When a mild form of the condition develops before 37 weeks, the heath care provider will monitor the health of the mother and the child to make sure the condition doesn't get worse, either on an outpatient basis or in the hospital if bed rest is necessary. In addition to blood pressure and urine screening, he or she may use ultrasound imaging, nonstress tests, or a combination of the two to make sure the condition is not affecting the baby adversely.

The doctor will also recommend lifestyle changes, such as resting on the left side, coming in for more frequent prenatal checkups, drinking at least eight glasses of water a day, limiting salt, and increasing dietary protein, all of which can slow the progression of the disease.

Severe pre-eclampsia may require induction of labor after 34 weeks of pregnancy. Before 34 weeks, women with a severe form of this condition usually must stay in the hospital and are administered antenatal corticosteroids to encourage the baby's lung development in case early delivery is necessary.

Prevention & Prophylaxis

While most risk factors for pre-eclampsia cannot be controlled, taking steps to lower blood pressure if it's too high or lose weight if one is obese before getting pregnant can help lower the risk. If one is at high risk for pre-eclampsia, the doctor might recommend a low-dose aspirin regimen for the duration of the pregnancy.

Left untreated, pre-eclampsia can cause kidney damage, liver disease, and brain damage as well as bleeding problems and clots. In addition to premature birth, pre-eclampsia can cause the baby to weigh less than five pounds at birth because high blood pressure prevents nutrients from reaching the fetus.

Placental abruption, in which the placenta separates from the uterine walls, is more common with pre-eclampsia and can also slow the baby's growth and development in utero. If a person develops pre-eclampsia, careful monitoring can help ensure the health of the mother and the baby

In addition, developing pre-eclampsia increases the risk for future cardiovascular disease including heart attack and stroke. After recovering from delivery, the person can reduce the risk by eating a nutritious die with limited fat, salt, and sugar; exercising regularly; and maintaining a healthy weight.