Globally, hypertensive disorders of pregnancy complicate 10% of pregnancies (World Health Organization), and preeclampsia/eclampsia is one of the three leading causes of maternal morbidity and mortality worldwide (National Center for Biotechnology Information). A woman is seven times more likely to suffer from preeclampsia if she lives in a developing country (Preeclampsia Foundation). But, maternal hypertensive disorders are increasing in developed countries as well. Over the past 20 years in the United States the rate of preeclampsia has risen by 25%, and it now effects roughly 5-8% of pregnant women (Preeclampsia Foundation and the American College of Obstetricians and Gynecologists).
Preeclampsia and eclampsia are hidden dangers for pregnant woman, but by knowing the risks, these conditions can be better prevented – or sooner detected and treated.
What is preeclampsia and eclampsia?
Preeclampsia: According to guidelines released by the American College of Obstetricians and Gynecologists preeclampsia is a condition characterized by persistent high blood pressure that develops during pregnancy or during the postpartum period. Preeclampsia can be characterized by excess protein in the urine, decreased blood platelets, fluid in the lungs, kidney or liver trouble, or vision problems.
Eclampsia: When preeclampsia becomes very severe, it may develop into eclampsia. Eclampsia is characterized by one or more seizures during pregnancy or in the postpartum period.
Symptoms of preeclampsia and eclampsia:
According to the Mayo Clinic, monitoring blood pressure is an important part of prenatal care because typically the first sign of preeclampsia is a rise in blood pressure. High blood pressure may develop slowly or suddenly, therefor consistent monitoring is recomended. Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) — documented on two occasions, at least four hours apart — is abnormal. While the condition can sometimes develop without any symptoms, there are some signs that may point to preeclampsia: (Mayo Clinic)
High blood pressure
Severe headaches
Nausea or vomiting
Decreased urine output
Shortness of breath caused by fluid in your lungs
Upper abdominal pain, usually under your ribs on the right side
Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
Sudden weight gain and swelling — particularly in your face and hands
Impaired liver function
Excess protein in your urine (proteinuria) or additional signs of kidney problems
Decreased levels of platelets in your blood (thrombocytopenia)
Risk factors for developing preeclampsia/eclampsia:
History of hypertension. Although many women who develop preeclampsia/eclampsia have no history of high blood pressure, women with pre-existing hypertension (high blood pressure before pregnancy or within the first 20 weeks of gestation) and gestational hypertension (onset of high blood pressure after 20 weeks of gestation) are at increased risk for preeclampsia/eclampsia.
Other risk factors for preeclampsia and eclampsia include:
Diabetes
Obesity
Renal disease
In vitro fertilization
Women giving birth for the first time
A personal or family history of eclampsia
Multiple fetuses (i.e. twins, triplets, quadruplets)
Race (African American women were shown to be at a higher risk.)
Age (falling in the youngest or oldest categories of maternal age puts women at a higher risk.)
Either too short or too long interval between pregnancies. (Having babies less than two years or more than 10 years apart can increase risk of developing preeclampsia.)
New paternity (Each pregnancy with a new partner increases the risk of preeclampsia more than does a second or third pregnancy with the same partner.)
Recommendations for prevention and treatment:
These recommendations are taken from studies and articles on preeclampsia (from WHO and NCBI); consult a doctor before beginning any treatment plan or medication.
Studies have found a few methods that show promise in reducing the risk of developing preeclampsia. According to an article by the National Center for Biotechnology Information (NCBI), for women who were classified as moderate to high risk for developing eclampsia, “low-dose aspirin [was] associated with a 10–19% reduction in preeclampsia risk and a 10–16% decrease in perinatal morbidity and mortality.” The same article cites other studies that have shown that calcium supplementation may also be an effective treatment.
There have been numerous other recommendations for prevention and/or treatment. Though none have been proven to be useful in treating the root cause of preeclampsia/eclampsia, they may help treat the symptoms of it. NCBI notes these recommendations:
Lifestyle: daily bed rest, smoking cessation, weight reduction, and regular exercise.
Nutritional: higher intake of fiber, protein, and garlic; as well as reducing sodium intake.
Pharmacological: antihypertensive drugs, diuretics, nitric oxide, progesterone, low-dose aspirin, low-dose aspirin/heparin, zinc supplementation, calcium supplementation, fish oil supplementation, antioxidant supplementation, vitamin D, magnesium, folic acid and other B-vitamins, and concomitant vitamin C and E supplementation. (Consult your doctor and/or pharmacist.)
According to an article written by World Health Organization (WHO), early delivery is recommended for women with severe preeclampsia at term. While many women will go on to deliver healthy babies and fully recover, some women will experience complications in delivery and post-birth. After giving birth, some women can develop severe hypertension and postpartum preeclampsia. According to the American Heart Association, preeclampsia and eclampsia doubles the risk of stroke and quadruples the risk of high blood pressure later in the life.
According to the Preeclampsia Foundation, the main cause for delayed treatment for preeclampsia is “a lack of awareness and understanding of the signs and symptoms of the disease.” In developing nations, other causes which prevent women from seeking/receiving medical help for preeclampsia is due to poverty, limited access to a doctor, lack of information, and inadequate medical services.
The cause of preeclampsia remains unclear, and more research needs to be done to better understand this condition. Find out how Health Gauge is working alongside researchers at the International Center for Disease Research in Bangladesh (ICDR,B) to better study this health condition.
It is important to monitor preeclampsia throughout pregnancy, follow the doctor’s health plan, maintain a healthy lifestyle, as well as monitoring blood pressure to ensure it stays in a safe range. The goal of Health Gauge is to continue to research important health conditions and support people in monitoring health better, and in partnership with their care providers – increased health awareness brings empowerment.