What is pre-eclampsia?
Pre-eclampsia is a life-threatening condition that occurs after 20 weeks of pregnancy. It is characterized by high blood pressure (≤140/90mmHg), high levels of protein in the urine (proteinuria), vision problems, and even liver and kidney problems.
What causes pre-eclampsia?
The cause of pre- eclampsia is multifactorial. Research and medical experts suggest that the cause of pre-eclampsia is a defective placenta (the organ that nourishes the fetus throughout pregnancy). In early pregnancy new blood vessels develop and evolve to efficiently send blood between the mother and the growing baby. However, in women with pre-eclampsia, these blood vessels do not develop or function properly. The blood vessels are narrower than normal blood vessels and fail to react to hormonal signaling which limits the amount of blood that can flow through them.
This dysfunction causes an increase in the mother’s blood pressure as the body tries to supply the placenta with enough blood. If left untreated, this can lead to several life-threatening complications such as pulmonary edema (fluid buildup in the lungs), kidney failure, stroke, and even seizures (a condition known as eclampsia).
Who is at risk for developing pre-eclampsia in pregnancy?
History of preeclampsia: A personal or family history of pre-eclampsia significantly increases the risk of pre-eclampsia.
Chronic hypertension: If you already have chronic hypertension (high blood pressure), you have a higher risk of developing pre-eclampsia.
First pregnancy: The risk of developing pre-eclampsia is highest during your first pregnancy.
Age: The risk of pre-eclampsia is higher for very young pregnant women as well as pregnant women older than 35.
Race: Black women have a higher risk of developing pre-eclampsia than women of other races.
Obesity: The risk of pre-eclampsia is higher if you're obese.
Multiple pregnancy: Pre-eclampsia is more common in women who are carrying twins, triplets or other multiples.
Interval between pregnancies: Having babies that are less than two years or more than 10 years apart leads to an increased risk of pre-eclampsia.
History of certain conditions: Having certain conditions before you become pregnant (such as chronic high blood pressure, migraines, type 1 or type 2 diabetes, kidney disease, a tendency to develop blood clots, or lupus) increases your risk of pre-eclampsia.
How can I reduce my risk of getting pre-eclampsia?
For people with risk factors, there are some steps that can be taken prior to and during pregnancy to lower the chance of developing pre-eclampsia. These include:
losing weight if you are overweight/obese (prior to pregnancy-related weight gain)
controlling your blood pressure and blood sugar (if you had high blood pressure or diabetes prior to pregnancy)
maintaining a regular exercise routine
getting enough sleep
eating healthy foods that are low in salt and avoiding caffeine.
What are the signs and symptoms of pre-eclampsia?
Pre-eclampsia may occur suddenly without any symptoms and the increase in blood pressure may be sudden or develop gradually. However, the common signs and symptoms associated with pre-eclampsia are:
IMPORTANT:
It is important that you attend your pre-natal visits for a regular blood pressure monitoring because the first sign of pre-eclampsia is commonly a rise in blood pressure. If you develop any of the symptoms, please seek medical attention immediately.
How is pre-eclampsia treated?
Your doctor will advise you on the best way to treat pre-eclampsia. Treatment generally depends on how severe your pre-eclampsia is and how far along you are in your pregnancy. However, the best treatment for pre-eclampsia is delivery.
If you are close to full term (37 weeks pregnant or more), your baby will probably be delivered early. You can still have a vaginal delivery, but sometimes a Cesarean delivery (C-section) is recommended. Your doctor may give you medication to help your baby's lungs to develop and to manage your blood pressure until the baby can be delivered.
When pre-eclampsia develops earlier in pregnancy, you will be monitored closely to prolong the pregnancy and allow for the fetus to grow and develop.
This article is written by Dr Itumeleng Buti MBChB (Pret)
Take home message
Pre-eclampsia is a medical emergency! If you suddenly develop any of the above symptoms seek medical attention immediately. Always attend your prenatal check-up!
References
American College of Obstetricians and Gynecologists. Practice Bulletin No. 202: Gestational hypertension and preeclampsia. Obstetrics & Gynecology. 2019; doi: 10.1097/AOG.0000000000003018.
Bokslag A, et al. Preeclampsia; short and long-term consequences for mother and neonate. Early Human Development. 2016;102:47.
August P, et al. Preeclampsia: Clinical features and diagnosis. Available from: https://www.uptodate.com/contents/search. Accessed February 4, 2022
Karumanchi SA, et al. Preeclampsia: Pathogenesis. Available from: https://www.uptodate.com/contents/search. Accessed February 4, 2022. Norwitz ER, et al. Early pregnancy prediction of preeclampsia.
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