You or somebody you know has just been diagnosed with pre-eclampsia, but what does this mean?
Well, firstly, “eclampsia” is a condition in which a pregnant person suffers from seizures and extremely high blood pressure that can damage various organs. Eclampsia is a very serious illness that can be lethal to both the mother and child. 1
So what about “pre-eclampsia”?
Pre-eclampsia is the stage before eclampsia has developed, at this point you will have abnormally high blood pressure (hypertensive disorder), but you still have time to get treatment before things turn dangerous. With careful management of your condition, you can avoid an adverse outcome.
Pre-eclampsia is responsible for over 70,000 maternal deaths and 500,000 fetal deaths annually worldwide, according to the CDC.2 It affects 5 to 7% of all pregnant women with higher rates reported in developing countries, up to 16%. In the United States, hypertensive disorders in pregnancy are present in 1 in 25 pregnancies. The prevalence is greater in black women.3
What Are the Symptoms?
Extremely high blood pressure is the calling card of pre-eclampsia. If you haven’t had your blood pressure taken lately but you have noticed any of the following symptoms get to your doctor ASAP, they are all signs that you may be suffering from severe hypertension.4,5
- A sudden headache
- Visual disturbances—this could be shimmering, flashing, double vision, dim vision
- Swelling of the legs and facial puffiness
- Difficulty breathing
- Abdominal pain, typically on the right upper side
- Nausea and vomiting
- Rapid weight gain
In some cases, you might not feel any changes in your body, despite having pre-eclampsia. This is why attending your antenatal appointments to have your blood pressure taken is very important.
Diagnosis of Pre-Eclampsia
While your doctor will check your blood pressure during your routine antenatal clinic visits, it is essential that you make an appointment if you experience any symptoms of hypertension between visits.
You will be diagnosed with pre-eclampsia if your blood pressure reading is above 140/90 and a urine test reveals proteinuria of ≥300 mg in a 24-hour collection.4,5
Your doctor might make the diagnosis based on a high blood pressure measurement and other symptoms (for example indications of liver damage, kidney dysfunction, edema) even when you have no proteins in your urine sample. 4,5
The doctor will then order a series of tests:
- Complete blood count
- Kidney function tests
- Urinalysis
- Liver function tests
- Coagulation profile
These will help your health care team to determine how far your condition has progressed and what they need to do to get you healthy.4,5
An obstetrician will also assess the well-being of the fetus.
Treatment of Pre-Eclampsia
The only definitive treatment for pre-eclampsia is delivery of the baby.4,5
Early Pregnancy
If your pregnancy is at 37 weeks or less your health care team will help you manage your blood pressure until it is safe for you to give birth.5
You will be prescribed anti-hypertensives (labetalol, nifedipine or methyldopa are commonly used) to keep your blood pressure under control.6
The team will then monitor your blood pressure. They will also check how your baby is doing. If your blood pressure rises above 160/110, you might be admitted to hospital so that the obstetrics team can keep an eye on you.4,5
If anti-hypertensive drugs do not help your blood pressure, or any other complications arise, you will need to deliver your baby early. The doctor will administer steroid medication to accelerate growth of the fetus’s lungs. This will lower the risk that the baby will develop breathing difficulties after birth. Your care team will make a plan with you to ensure that premature neonatal care is organized for your baby in advance.4,5
Late Pregnancy
If your pregnancy has progressed past 37 weeks, your birth team will discuss with you how soon you need to deliver. Your doctor will prescribe medication to induce labour, or, if necessary, they will perform a caesarean section. The safest option for mother and child is to deliver as soon as possible.4,5
If your condition is more severe, the doctor can prescribe medication to prevent seizures until you deliver.4,5
Who is at Risk of Getting Pre-Eclampsia?
Conditions that can predispose you to pre-eclampsia include:
- Obesity (BMI above 30 before pregnancy)
- History of hypertension or diabetes before pregnancy
- History of pre-eclampsia in previous pregnancy
- Multiple gestation (twins, triplets, etc.)
- Smoking
- First pregnancy
- Maternal age below 20 years or above 35 years
- family history of pre-eclampsia
- Autoimmune conditions such as Lupus and Anti-phospholipid syndromes.
- Period of more than 10 years since your last pregnancy
Obesity and pre-existing hypertension/diabetes are the strongest risk factors for developing pre-eclampsia, according to systematic reviews of the evidence.7
Prevention of Pre-eclampsia
If you are at risk of developing pre-eclampsia, you can take steps to prevent it. Start seeing your doctor before conception for an early risk assessment and to develop a care plan.
Lifestyle changes
Lifestyle changes are an effective and accessible way to prevent pre-eclampsia. Aim to lose some weight if you are obese or overweight. This will take some pressure off your heart as it will have less work to do. Try to incorporate exercise to help strengthen your heart. You might modify your diet to be more blood pressure-friendly. Check with a nutritionist or your doctor for advice on any dietary modifications that you need.9
Pre-existing Conditions
If you have pre-existing hypertension or diabetes mellitus, it’s critical that you continue to manage your condition carefully, if you need extra help, talk to your doctor. Check with a nutritionist or your doctor for advice on any dietary modifications that you need.
Medication
Early in pregnancy, your obstetrician can prescribe medication to help keep your blood pressure from rising. Low dose aspirin reduces the chances of developing pre-eclampsia by 30% in high-risk women.8
What Causes Pre-Eclampsia?
Pre-eclampsia is a placental syndrome. When the placenta forms, sometimes the blood vessels are not sturdy enough to handle the huge amount of blood flow needed by the fetus. Over time the blood vessels get more and more damaged and release inflammatory signals and proteins associated with damage to blood vessels. These inflammatory signals and proteins cross the placental barrier into the mother. The circulating placental proteins and inflammation do damage to the mother’s blood vessels over the course of the pregnancy.10 This, on top of existing risk factors can cause hypertension. Your heart works much harder to push blood through stiff or damaged vessels, and this in turn causes more damage to fragile vessels in organs such as the kidney, eye and brain.
What Are the Complications of Pre-eclampsia?
If you do not manage pre-eclampsia, it can develop into a serious condition. Complications include:
Placental Abruption
Pre-eclampsia increases the risk for placental abruption. Placental abruption is when the placenta separates from the uterus before the baby is born. This compromises blood supply to the fetus and needs immediate intervention.10
Organ Damage
Pre-eclampsia can cause liver damage and brain damage during pregnancy. Mothers who have experienced pre-eclampsia have a high risk of going on to develop kidney disease.11
Cardiovascular Damage
Pre-eclampsia can lead to cardiovascular disease in the long term. Women who developed pre-eclampsia during their pregnancy have a greater lifetime risk of stroke and heart attack.12,13
Eclampsia
Eclampsia is the onset of seizures or falling into a coma. Severe headache, altered mental state, blurry vision and epigastric pain are common signs of impending eclampsia. These seizures can be severe, causing brain damage or even death.1
Fetal Growth Restriction
Put simply, during pre-eclampsia, the placenta can’t deliver enough nutrients to the fetus. Sometimes this means your baby might be smaller than expected. In severe cases, it can lead to fetal brain injury and death. 1,10
To Conclude
If you experience any symptoms when you are expectant, talk to your doctor as soon as possible. Pre-eclampsia is well characterized and there are well-developed treatment plans in place to help you have a safe pregnancy and a happy outcome.
Make sure you keep up with your antenatal visits so that you can catch it early.
References
1.Magley M HMR. Eclampsia. In: StatsPearls. StatsPearls Publishing; 2023. www.ncbi.nlm.nih.gov/books/NBK554392/
2.Preeclampsia, Genomics and Public Health | Blogs | CDC. Published October 25, 2022. Accessed December 29, 2023. https://blogs.cdc.gov/genomics/2022/10/25/preeclampsia/
3.Shahul S, Tung A, Minhaj M, et al. Racial Disparities in Comorbidities, Complications, and Maternal and Fetal Outcomes in Women With Preeclampsia/eclampsia. Hypertens Pregnancy. 2015;34(4):506-515. doi:10.3109/10641955.2015.1090581
4. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122-1131. doi:10.1097/01.aog.0000437382.03963.88
5.Recommendations | Hypertension in pregnancy: diagnosis and management | Guidance | NICE. Published June 25, 2019. Accessed December 29, 2023. https://www.nice.org.uk/guidance/ng133/chapter/Recommendations#management-of-pre-eclampsia
6.S D, Novri DA, Hamidy Y, Savira M. Effectiveness of nifedipine, labetalol, and hydralazine as emergency antihypertension in severe preeclampsia: a randomized control trial. F1000Res. 2022;11:1287. doi:10.12688/f1000research.125944.2
7. Elawad T, Scott G, Bone JN, et al. Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence. BJOG: An International Journal of Obstetrics & Gynaecology. 2024;131(1):46-62. doi:10.1111/1471-0528.17320
8. Wang Y, Guo X, Obore N, Ding H, Wu C, Yu H. Aspirin for the prevention of preeclampsia: A systematic review and meta-analysis of randomized controlled studies. Frontiers in Cardiovascular Medicine. 2022;9. Accessed December 29, 2023. https://www.frontiersin.org/articles/10.3389/fcvm.2022.936560
9. Ogunwole SM, Mwinnyaa G, Wang X, Hong X, Henderson J, Bennett WL. Preeclampsia Across Pregnancies and Associated Risk Factors: Findings From a High‐Risk US Birth Cohort. Journal of the American Heart Association. 2021;10(17):e019612. doi:10.1161/JAHA.120.019612
10. Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol. 2019;15(5):275-289. doi:10.1038/s41581-019-0119-6
11. McDonald SD, Han Z, Walsh MW, Gerstein HC, Devereaux PJ. Kidney Disease After Preeclampsia: A Systematic Review and Meta-analysis. American Journal of Kidney Diseases. 2010;55(6):1026-1039. doi:10.1053/j.ajkd.2009.12.036
12. Ahmed R, Dunford J, Mehran R, Robson S, Kunadian V. Pre-Eclampsia and Future Cardiovascular Risk Among Women: A Review. Journal of the American College of Cardiology. 2014;63(18):1815-1822. doi:10.1016/j.jacc.2014.02.529
13. Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335(7627):974. doi:10.1136/bmj.39335.385301.BE
