Preeclampsia and What You Need to Know

May 22nd is World Preeclampsia Awareness Day

What is preeclampsia?

Preeclampsia (previously referred to as toxemia) is a pregnancy complication often pinpointed by high blood pressure. When a pregnant person has high blood pressure and signs that some of their organs (the kidneys and liver) may not be working normally, more than likely, they have preeclampsia. High blood pressure, or hypertension, is when the force of blood against the walls of the blood vessels is too high. It can stress the heart and cause problems during pregnancy. Pre-eclampsia usually begins after 20 weeks of pregnancy in a person whose blood pressure had been normal. It can lead to serious, even fatal, complications for both parent and baby.

Other terms associated with preeclampsia:

• Eclampsia is a severe form of preeclampsia that leads to seizures in the birthing person.
• HELLP Syndrome (hemolysis, elevated liver enzymes, and low platelet count) is a condition usually occurring late in pregnancy that affects the breakdown of red blood cells, how the blood clots, and liver function for the pregnant person.
• Postpartum Preeclampsia occurs after birth (usually within the first couple of days postpartum, but up to 6 weeks pp). It is important to know that postpartum preeclampsia can occur even if preeclampsia did not occur during pregnancy. The symptoms are also slightly different: severe headache, stomach pain, nausea & vomiting, spots or blurred vision, swelling in hands or face, blood pressure over 140/90 and shortness of breath.

Symptoms:

• Mild preeclampsia: high blood pressure, water retention, and protein in the urine.
• Severe preeclampsia: persistent headache, confusion, blurred vision, sensitivity to bright light, fatigue, nausea/vomiting, urinating small amounts, pain in the upper right abdomen, shortness of breath, and tendency to bruise easily.

Facts:

• Preeclampsia is a serious health problem for pregnant people around the world. It affects 2 to 8 percent of pregnancies worldwide (2 to 8 in 100). In the United States, it’s the cause of 15 percent (about 3 in 20) of premature births.
• In the last two decades, the rate of preeclampsia in the U.S. has increased 25%.
• You can still have a vaginal birth with preeclampsia.
• Most pregnant people with preeclampsia have healthy babies. But if not treated, it can cause serious problems, like premature birth and even death.
• If you're at risk for preeclampsia, your provider may want you to take low-dose aspirin to help prevent it.
• If you have blurred vision, swelling in your hands and face or severe headaches or belly pain, call your provider immediately.
• You can have preeclampsia and be unaware if you have no symptoms. It is important to have good prenatal care and a provider you trust even if you’re feeling fine.
• Preeclampsia is diagnosed through blood pressure checks and urine samples (checking for protein). Once diagnosed, it is monitored with continued BP and urine checks. Doctors may also run blood tests. They will also keep an eye on your baby with ultrasounds, fetal monitoring and/or non-stress tests to ensure they are not in distress. Getting a biophysical profile will be helpful to know exactly what is happening and how to proceed in labor.
• Preeclampsia survivors have double the risk for heart disease and stroke.

Risk Factors:

• First-time parent
• Previous occurrence with gestational hypertension or preeclampsia
• Family history of preeclampsia
• Those who have had fertility treatments
• Those carrying multiple babies
• Those younger than 20 years and older than age 40
• Those who had high blood pressure or kidney disease prior to pregnancy
• Those who are considered obese or have a BMI of 30 or greater
• Black birthing people
• Those with low socioeconomic status

Treatment: Treatment depends on how close you are to your due date. If you are close to your due date, and the baby is developed enough, your health care provider will probably want to deliver your baby as soon as possible. If you have a mild case and your baby has not reached full development, your doctor will likely suggest the following: rest (lying on your left side to take the weight of the baby off your major blood vessels), increased prenatal visits, consuming less salt, drinking a minimum of at least 8 glasses of water a day and increasing the protein in your diet. During visits, your provider will check your urine and blood pressure and ask about baby's movement (kick count.)

If you have severe preeclampsia, your doctor may prescribe medication for you. Most likely, the birthing person will stay in the hospital so your provider can closely monitor you and your baby. Your provider may treat you with medicines called antenatal corticosteroids (also called ACS). These medicines help speed up your baby’s lung development. You also may get medicine to control your blood pressure and medicine to prevent seizures (called magnesium sulfate). If you are at least 34 weeks pregnant, your provider may recommend that you have your baby as soon as your condition is stable. Your provider may induce your labor and/or you may have a cesarean birth. If you’re not yet 34 weeks pregnant but you and your baby are stable, you may be able to wait to have your baby.

Prevention: Because the exact cause of preeclampsia is unknown, there is currently no cure. Even so, there are things you can do to control or limit the risk factors such as:

• Drinking at least 8 glasses of water a day
• Avoiding fried foods and junk food
• Use little or no added salt in your meals and adding fresh herbs
• Avoid beverages containing caffeine
• Prioritizing rest & sleep
• Exercising regularly
• Elevating your feet during the day
• Reduce your stress at all costs

I have had a few birth clients who have experienced preeclampsia as well as postpartum preeclampsia, so I am quite familiar with the care and support surrounding it. Early identification is key for the health & safety of both parent and baby. To learn more, please visit the Preeclampsia Foundation or the American College of Obstetricians and Gynecologists.