Preeclampsia

Preeclampsia, formerly known as toxemia or pregnancy induced hypertension, is classified by elevated blood pressure, protein in the urine (proteinuria) and swelling in the legs, feet and hands. This occurs in 3-4% of all pregnant women after 20 weeks of pregnancy but can also occur earlier.

The exact cause of pre-eclampsia is unknown but there are many thoughts to what the cause may be. Here we discuss some causes.

Causes of Preeclampsia

1. There is a problem with the placenta

Inflammatory substances from the placenta circulate in pregnant women and affect their vessel walls, causing elevated blood pressure and leakage of protein through the vessel walls of the kidney resulting in proteinuria.

2. Poor nutrition

This has been suggested to play a major role in pre-eclampsia because in the past, it was more common in poor women. Having deficiencies in key nutrients like iron, iodine, folate, calcium, and zinc are possible factors.

3. High body fat

Just like poor nutrition, high body fat can play a role in pre-eclampsia because poor nutrition can lead to having high body fat or being obese. High concentrations of carbohydrates and fats can lead to obesity, and this can affect pregnancy.

4. Genetics

Women can, however, develop pre-eclampsia with no known history. It was found that there is a genetic component to pre-eclampsia, and this dates to the 19th century.

5. Autoimmune conditions

Some scientists go as far as to identity pre-eclampsia as an autoimmune condition. Studies have shown that autoimmune conditions, like lupus play roles in pre-eclampsia.

Risk factors for Preeclampsia

  • Being pregnant with more than one baby. This can occur because of the increase in placental mass.
  • Maternal age of 35 years and older or under 20 years. Studies have been done on women that are over the age of 35 years who are at a greater risk of having poor outcomes as it relates to pre-eclampsia. Results of such studies have suggested that this could be due to blood vessels ageing or arterial stiffness. However, 8 studies have also shown mothers who are under the age of 20 years are at a greater risk of pre-eclampsia than mothers who are over 35 years.
 Preeclampsia
  • More than 10 years since previous pregnancy. Studies have shown that this relationship deals largely with older women
  • First pregnancy. Studies have shown that pre-eclampsia is more common in first pregnancies.
  • African or indigenous heritage
  • Family history. Why it has such factors is not clearly understood. But once persons in the family have suffered from pre-eclampsia, you have a high likelihood of having preeclampsia.
  • Being overweight. Women with a higher body mass index are at a greater risk as well.
  • Had previous pre-eclampsia. Women with a history of pre-eclampsia or eclampsia have a higher risk of having of developing pre-eclampsia during another pregnancy than other women

Symptoms

  • Weight gain; this is one of the first things pregnant women with pre-eclampsia may notice. Pregnant women gain more than 3-5 pounds in a week due to pre-eclampsia. This is due to increased body fluid.
  • Abdominal pain; abdominal pains tend to be felt in the upper part of the abdomen below the ribs where the liver is located but can also be felt below the breastbone (epigastrium).
  • Severe headache; because headaches can be a common symptom in pregnancy, it is hard to determine if this symptom is indicating a serious condition. If you are concerned, you can contact a doctor.
  • Changes in reflexes; increased blood pressure can lead to increasing hyperreflexia, which is overactive or overresponsive bodily reflexes. An example of such is twitching.
  • Decreased urination; decreased urination or sometimes pregnant women with pre-eclampsia will have trouble with being able to urinate. This happens when blood vessels constrict from a rising in blood pressure.
 Preeclampsia
  • Dizziness; dizziness is a common sign of pregnancy and usually can occur after 12 weeks. If dizziness becomes extreme, you can contact your doctor or any other health professional.
  • Trouble breathing; this is due to fluid accumulating in the lungs (pulmonary edema). In essence when you breathe your lungs should fill up with air but instead, with pulmonary edema, your lungs fill up with fluid and the oxygen from the air cannot get from your lungs into your blood.
  • Nausea and severe vomiting; this occurs very often in the first trimester for pregnant women. However, if it continues into the second and third trimester you can check with a doctor or health care professional. Stress on the liver due to leaky blood vessels can lead to nausea and vomiting.
  • Vision changes (seeing blurry, floaters); high blood pressure stresses the retina and pushes it forward. The worst-case scenario is it can lead to blindness.
  • Elevated blood pressure; pre-eclampsia is pregnancy induced hypertension, so if your blood pressure is normal, you would suddenly develop high blood pressure.

Complications

 Preeclampsia
  • Eclampsia; this is a severe complication of pre-eclampsia where blood pressure gets so high it causes potentially fatal seizures.
  • Brain hemorrhage or cerebral hemorrhages, due to burst blood vessels in the brain. This causes localized bleeding in surrounding tissue.
  • Retinal detachment, where a thin layer of tissue at the back of the eye (the retina) pulls away from its’ normal position. This tends to lead to blindness.
  • Ruptured liver; this a life-threatening complication.
  • Accumulation of fluid in the lung; the fluid collects in many air sacs in the lungs and makes it difficult for someone to breathe.
  • Abruptio placenta, when the placenta separates from the wall of the uterus before birth. Internal bleeding occurs. The bleeding can be life threatening to both mother and child.
  • Kidney failure; this means that one or both kidneys can no longer function on their own.
  • HELLP Syndrome; it is a rare pregnancy complication that causes elevated liver enzymes and low platelet counts.
  • Fetal growth restriction; pre-eclampsia affects the arteries carrying blood to the placenta and if the placenta does not get blood, the baby will receive insufficient blood and oxygen. This can lead to fetal growth restriction.
  • Premature birth; pre-eclampsia can lead to anxiety and unexpected premature birth.
  • Cardiovascular disease; having preeclampsia can increase the risk of having future cardiovascular diseases.

Diagnosis

 Preeclampsia

Preeclampsia is diagnosed by:

  1. Checking blood pressure; women that have a blood pressure 140 mmHg or higher systolic or 90 mmHg or higher diastolic after 20 weeks of gestation may have pre-eclampsia. It is severe if blood pressure is 160 mmHg or higher systolic or 110 mmHg or higher diastolic on two occasions at least 6 hours apart.
  2. Urine test; this is requested at every antenatal appointment. This can determine the proteinuria levels.
  3. Blood test; they can determine if you have pre-eclampsia when doing blood test.
  4. Ultrasound; when an ultrasound is performed, doctors can monitor the fetal size and monitor the amniotic fluid volume.
 Preeclampsia

Prevention

 Preeclampsia

You can reduce your risk of pre-eclampsia by: –

  • Losing weight if you are overweight or obese prior to pregnancy if you can.
  • Trying to control blood pressure if you already suffer from high blood pressure.
  • Exercise.
  • Make sure you get enough rest.
  • Eat healthy
 Preeclampsia

Treatment

Your doctor or health care provider will advise on the best way to treat pre-eclampsia. Pre-eclampsia treatment may depend on how severe it is.

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