Preeclampsia

What is preeclampsia?

Preeclampsia is a hypertensive disease of pregnancy. Specifically, it is high blood pressure during pregnancy with increased levels of protein in urine.

Preeclampsia is one possible cardiovascular disease during pregnancy and occurs in 6 to 8% of all pregnancies. Cardiovascular disease is the leading cause of death in pregnant women in North America.

Causes of Preeclampsia

What are the causes of preeclampsia?

A woman’s body changes dramatically during pregnancy. It really is a wonder of life how a child can be born, and it wouldn’t be possible without the dramatic changes a woman undergoes! Here is a short list to name a few:

• Blood volume increases = the liquid and cellular volume of your blood increases. There is a greater amount of total fluid in the blood vessels.

• The systemic vasculature undergoes vasodilation = blood vessels all over the body become wider. One result is that the increased blood volume is held in.

• The renal blood vessels undergo vasodilation = the blood vessels that go to your kidneys become wider. This allows more blood to be filtered by the kidneys.

• The cardiac output increases = the amount of blood pumped through the heart increases. This is due to greater blood volumes and a faster heart rate.

• Vasomotor sympathetic activity increases = the brain releases neurotransmitters that cause changes throughout the body

With all these changes, the body adapts. The adaptations should allow blood pressure to remain normal. However, if the body does not adapt correctly, preeclampsia can develop. One thought is that “sympathetic overactivity” is the cause of pre-eclampsia but researchers are still working to determine the cause or causes of preeclampsia.

Risk Factors of Preeclampsia

What factors make it more likely to develop preeclampsia?

Some people are more prone to develop preeclampsia. The following are risk factors that may increase the likelihood of developing preeclampsia:

• Being pregnant with twins or more

• First-time pregnancy

• Family history of preeclampsia

• Being over the age of 40

• Having diabetes or kidney disease before becoming pregnant

• Being overweight or obese

• Having high blood pressure or cardiovascular disease before becoming pregnant

• Having a history of clotting disorder

Preeclampsia Symptoms

What are some symptoms you might be developing or experiencing with preeclampsia?

First, let’s define “symptom”. A symptom is a subjective sensation only experienced by the individual, like fatigue or a stomach ache. Signs on the other hand are objective findings that can be observed or measured, like swelling or temperature.

Possible symptoms of preeclampsia include:

• Headaches that are not relieved by over-the-counter medication

• Change in vision, such as blurred vision or seeing spots

• Abdominal pain

If you are pregnant, or recently pregnant (within the past 6 weeks), and experiencing any of these symptoms, please contact your provider for further evaluation.

Preeclampsia Signs

What are some signs that medical providers look for in pregnant women to evaluate for preeclampsia?

The diagnosis of preeclampsia depends on two measurements:

1. Blood pressure

• Blood pressure is divided into systolic and diastolic

• Systolic (top number) is the contraction pressure. During the contraction period, the heart pumps blood out.

• Diastolic (bottom number) is the filling pressure. During the filling period, the heart fills with blood.

• Preeclampsia is characterized as blood pressure >140/ >90

• From two measurements at least 4 hours apart

• Blood pressure that is >160

2. Urine protein level

• Urine protein that is >0.3g is considered abnormal

Other measurements that may be used include the number of platelets in the blood, amount of creatinine in the blood, liver enzyme levels, evidence of pulmonary edema or “fluid on the lungs”, and mental/visual changes.

Blood pressure can be monitored at home, but urine protein is a test that needs to be ordered by a medical provider. The diagnosis of preeclampsia can only be made by a medical provider and should be taken seriously given the dangers described below.

Other possible signs of preeclampsia include:

• Swelling in the face, hands, or feet

• Sudden weight gain, likely due to fluid retention

• Decreased urine output (a sign of kidney damage)

Dangers of Preeclampsia

Why should we be concerned about preeclampsia?

Preeclampsia can range from mild to severe with dangers that may include:

• Poor fetal development = poor blood flow to the placenta means the baby can’t get enough nutrients to develop properly. This can lead to low birth weight.

• Preterm delivery = poor development of the placenta can lead to early delivery of the baby.

• Placental abruption = poor blood flow to the placenta may weaken the placental connections to the uterus. This may result in detachment of the placenta which is life-threatening to both the baby and mother.

• Stroke = the cause of stroke in preeclampsia is still debated, but pregnant women with preeclampsia are more likely to have a stroke than pregnant women without preeclampsia.

• Eclampsia = eclampsia is the rare but serious advancement of preeclampsia. Eclampsia is characterized by seizures and requires immediate medical attention.

• HELLP syndrome = HELLP is a life-threatening complication of preeclampsia with the destruction of red blood cells, increased bleeding risk, and liver damage. While rare, it requires medical intervention.

Preeclampsia Treatment

How is preeclampsia treated?

Preeclampsia is a diagnosis by a certified medical doctor. Treatment includes close monitoring and interventions depending on the severity of the condition. Monitoring includes at-home and in-person visits to your provider’s office. At-home monitoring includes blood pressure monitoring. You can use the Takeoff Health quiz to get a personalized blood pressure monitor recommendation.

Medications can also be prescribed by your doctor for the management of preeclampsia.

Pregnancy-safe anti-hypertensive medications, like Labetalol or Nifedipine, can be used to lower high blood pressure. Magnesium sulfate may be considered in order to lower the risk of seizures. Steroids, like betamethasone or dexamethasone, may be considered to help with fetal development in patients at risk of preterm delivery.

These medications have their own side effects and should be considered and discussed with your doctor.

Ultimately, the treatment of preeclampsia is the delivery of the baby. Depending on the situation, your provider may suggest inducing delivery.

Postpartum Preeclampsia

Can you still get preeclampsia after giving birth?

Yes.

Preeclampsia can still develop after the delivery of the baby even if you did not have high blood pressure during the pregnancy. It usually occurs within days of delivery but may develop up to 6 weeks after delivery.

It is important to continue monitoring blood pressure after the delivery of the baby, go to post-partum medical appointments, and contact your medical provider with questions and concerns.

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Sources like the American Heart Association (AHA), American College of Obstetricians & Gynecologists (ACOG), and The Journal of Physiology were used in the writing of this article.

AHA: https://www.ahajournals.org/doi/full/10.1161/circulationaha.114.009029#d1e144

ACOG: https://www.acog.org/womens-health/faqs/preeclampsia-and-high-blood-pressure-during-pregnancy

Physiology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547268/

This is for informational purposes only and should not be considered as medical advice. Go to the emergency room if you are experiencing a life-threatening medical emergency. Disclaimer: Takeoff Health may make a small commission from some of the links above.