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- What is pre-eclampsia?
- Signs of pre-eclampsia
- Risk factors for pre-eclampsia
- Causes of pre-eclampsia
- How is pre-eclampsia diagnosed?
- How is pre-eclampsia treated?
- What are possible complications of pre-eclampsia?
- How is pre-eclampsia managed in pregnancy?
- Is pre-eclampsia preventable?
Pre-eclampsia is a serious blood pressure condition that only occurs in some women during pregnancy. It causes blood pressure to rise (which is often the most common and known symptom) in women who are pregnant.
Pre-eclampsia most commonly occurs after the 20th week of pregnancy, in those women who are affected by this condition. The high blood pressure of women with pre-eclampsia usually returns back to normal after they deliver their baby.
Around 5-10% of all women in Australia will develop pre-eclampsia during their pregnancy. Only about 1-2% of all pre-eclampsia cases are dangerous enough to threaten the lives of both the mother and the unborn foetus.
Pre-eclampsia is one of the most common reasons for early induction of pregnancy and for recommendation of a caesarian birth.
Pre-eclampsia generally presents with no obvious symptoms initially, so it is often hard to detect until symptoms are more pronounced. This is why it is very important for pregnant women to have regular ante-natal care to closely monitor their progress throughout the pregnancy and to prevent complications of pre-eclampsia before they occur.
Pre-eclampsia most commonly causes the following symptoms:
- High blood pressure (higher than normal)
- Proteins in the urine
- Fluid retention, especially of the feet, face or hands that suddenly occurs or gets worse (fluid retention is also a common symptom of a normal, healthy pregnancy too which is why it is so important to regularly check blood pressure during pregnancy)
More serious symptoms of pre-eclampsia are:
- Headaches
- Blurring of vision or any other type of visual problems
- Abdominal pain (usually in the upper abdomen, under the ribs)
- Basically "just not feeling right"
Risk factors for pre-eclampsia
While it is not possible to predict with a great deal of accuracy which women will develop pre-eclampsia, certain women are more at risk than others:
- Women having their first pregnancy
- Women who have diabetes
- Women who are obese
- Women pregnant with multiple foetuses
- Women who are either younger (under 18) or older (over 45) and this is their first pregnancy
- Women with any type of kidney disease
- Women with any type of cardiovascular disease
- Women with pre-existing high blood pressure (and this can be either a diagnosed or undiagnosed condition)
- Women with a family history of pre-eclampsia (mother, grandmother have experienced it)
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The cause of pre-eclampsia is not known, but since it does occur more in some families than others, there could be a genetic basis to this condition.
Scientists believe pre-eclampsia is most likely due to a problem with the placenta (the attachment between the unborn baby and the mother's uterus).
The most common theory for pre-eclampsia is that the blood vessels in the placenta do not develop properly which may affect the transfer of oxygen and nutrients to the unborn baby.
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How is pre-eclampsia diagnosed?
Pre-eclampsia is normally diagnosed through the following tests:
- Blood pressure test - to determine if blood pressure is normal or too high. Normal blood pressure is around 120/80 mmHg; Mildly high blood pressure is between 140/90 mmHg - 160/100 mmHg; moderate to severely high blood pressure is over 160/100 mmHg
- Urine test - if blood pressure is high and pre-eclampsia is suspected, a urine test can confirm if there are any proteins in the urine
The best way to ensure that pre-eclampsia does not get worse and does not cause serious complications is to have regular ante-natal checks to monitor blood pressure for any signs of this condition.
There are a few treatments that are available for pre-eclampsia:
Delivering the baby early
The only total cure for pre-eclampsia is to deliver the baby (babies), because the mother's blood pressure normally returns back to normal after delivery and the other symptoms usually abate too.
If the pre-eclampsia occurs late in pregnancy, it is normal practice for the obstetrician to recommend early delivery, either through induced labour or caesarian birth. The risk for the baby is quite small.
The decision to deliver early needs to be based on several factors, including:
- Risk of complications occurring
- The severity of the pre-eclampsia (how high is the blood pressure and how much protein is in the urine); if the pre-eclampsia is not too bad, delivery is usually postponed until closer to full term, otherwise if it is severe, then delivery is advised sooner
- If the baby is being adversely affected
- The chance of premature baby doing well or better in a hospital than in an unviable womb with possible complications occurring
Other treatments can be used until the baby is safely delivered:
Magnesium sulphate
Studies show that when pregnant women with pre-eclampsia are given a magnesium sulphate supplement, it reduces their risk of developing eclampsia by about 50%. This is because magnesium sulphate is an anticonvulsant (and eclampsia is a condition which causes convulsions). Magnesium sulphate prevents eclampsia better than any other anticonvulsant medications and it is safe to use while pregnant (it does not adversely affect the baby). Magnesium sulphate is usually given by drip, by the doctor at the hospital, directly into a vein and is usually given at the time of delivery. This should not be self-prescribed!
Blood pressure medication
Some women are advised to take blood pressure medication for a short time if their pre-eclampsia is too severe. The blood pressure medication reduces symptoms, risk of complications and helps the pregnancy to progress further before delivery is required. Women taking blood pressure medication to manage their pre-eclampsia need to be strictly monitored by their obstetrician or family doctor. Examples of blood pressure medications are: Adalat, Nifecard, Aldomet
Bed rest
Bed rest is often advised for women with pre-eclampsia, but there isn't much evidence that it makes much of a difference. It is though, common practice to admit women with severe pre-eclampsia to hospital, to monitor them and their unborn baby.
What are possible complications of pre-eclampsia?
Most women who have pre-eclampsia while pregnant do not develop serious complication, but some do. The risk of serious complications of pre-eclampsia depends mostly on the severity of the pre-eclampsia - the more severe it is, the more likely there will be serious complications.
Ante-natal care is mandatory for all pregnant women, but especially for those women in the higher risk groups, to reduce their risk of developing pre-eclampsia, treating it if it does occur, managing it properly to reduce risk of complications, thus ensure their pregnancy is as healthy as possible.
The risk of complications from pre-eclampsia is greatly reduced by early diagnosis, treatment and management.
Complications for the pregnant mother
There are a number of serious complications of pre-eclampsia that can occur for the pregnant mother, including:
- Abruptio placentae - this causes the placenta to separate from the uterine wall. This can cause vaginal bleeding and abdominal pain. This is a serious complication and requires emergency medical treatment to save the life of the mother and unborn baby
- Eclampsia - this is a type of seizure (convulsion) which is life-threatening. About 1% of women with pre-eclampsia develop this condition
- Blood clotting disorder - this is the inability of the blood to clot properly and can cause severe bleeding (leading to death if it is not stopped)
- Liver, kidney, lung problems - the proper function of any (or all) of these organs can be adversely affected
- HELLP syndrome - "haemolysis, elevated liver enzymes and low platelets". This occurs in about 20% of women who have severe pre-eclampsia and causes serious bleeding. This is a serious complication and requires emergency medical treatment to save the life of the mother and unborn baby
- Stroke - bleeding into the brain, which causes possible brain damage and even ultimately possible death
Complications for the pregnant mother
There are a number of serious complications of pre-eclampsia that can occur for the unborn baby, including:
- Abruptio placentae - this causes the placenta to separate from the uterine wall. This can cause vaginal bleeding and abdominal pain. This is a serious complication and requires emergency medical treatment to save the life of the mother and unborn baby
- Poor blood supply - if the baby does not get adequate blood supplying proper oxygen and nutrients, this can cause growth retardation to the baby. In general, babies born to women with pre-eclampsia tend to be smaller
- Stillbirth - another complication of pre-eclampsia is an increased risk of delivering a deceased baby
How is pre-eclampsia managed in pregnancy?
All pregnant women should be referred to an obstetrician (specialist who delivers babies) before they are 20 weeks pregnant if they are in any of the following high risk categories for pre-eclampsia:
- Women having their first pregnancy
- Women who have diabetes
- Women who are obese
- Women pregnant with multiple foetuses
- Women who are either younger (under 18) or older (over 40) and this is their first pregnancy
- Women with any type of kidney disease
- Women with any type of cardiovascular disease
- Women with pre-existing high blood pressure (and this can be either a diagnosed or undiagnosed condition)
- Women with a family history of pre-eclampsia (mother, grandmother have experienced it
The obstetrician will make an assessment of your risk of developing pre-eclampsia (or possible complications) and will recommend a treatment plan for you. Regular check-ups on a monthly (or fortnightly) basis will be advised to ensure you have the best care possible.
There is some evidence that pre-eclampsia may be somewhat prevented in some women through the use of the following:
- Adequate intake of fish or fish oil - there is some evidence to suggest that eating fish high in omega-3 fatty acids (oily fish such as mackerel, salmon, sardines, trout and tuna), or using a fish oil supplement may play a part in either preventing pre-eclampsia occurring in the first place or preventing worsening of symptoms. This is because these types of fish help to improve circulation, thin the blood (and so reduce risk of clotting) and may also reduce blood pressure. Larger studies need to be done to confirm this as a recommended course of action for women at the highest risk of developing pre-eclampsia
- Adequate protein - there is some evidence to suggest that a diet with adequate intake of protein (between about 80g-100g per day) may assist in
- Low dose aspirin - there is some evidence that low dose aspirin can help prevent worsening of pre-eclampsia symptoms in some women
- Calcium rich foods - some evidence suggest that a diet rich in calcium may help to reduce the possibility of the condition worsening
- Magnesium rich foods - there is evidence that people who eat foods high in the mineral magnesium tend to have lower blood pressure in general. There has been no research yet to suggest that taking magnesium supplements helps prevent pre-eclampsia
- Vitamin D - there is some evidence to suggest that women who have adequate levels of vitamin D in their body are less likely to develop pre-eclampsia, especially with more serious complications. The research is limited on this, so more studies are needed to determine exactly how the vitamin from sunshine affects the body in pregnant women to possibly prevent pre-eclampsia
- Water - this is vitally necessary to reduce likelihood of dehydration in both the mother and unborn baby
Pregnant women should never self-prescribe with any medication or supplement and only take the above if they are recommended by their obstetrician specialist.
Note: Women who are at a higher risk of developing pre-eclampsia should discuss their alternative options with their obstetrician specialist before trying them because this is a serious and potentially fatal condition and needs extra care.
references
- Brown MA. Preeclampisa: a lifelong disorder. MJA 2003; 179 (4): 182-184
- DeCherney, Pernoll. Current Obstetric and Gynecological Diagnosis and Treatment, 8th ed. eMedicine 2004
- Duley L, Gulmezoglu AM, Henderson-Smart DJ. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia (Review). 2007; 3: 6-14
- Impey L. Obstetrics and Gynecology. 2nd ed. USA: Blackwell; 2006
- Norwitz ER Repke JT. Acute complications of Preclampsia. Clinical Obstetrics and Gynecology 2002; 45 Suppl 2: 308-29
- Osieki H. The Physicians Handbook of Clinical Nutrition, 2nd edition. BiConcepts 2002
- Stoppard M. New Pregnancy and Birth: A Practical Guide for All Parents To Be. Dorling Kindersely, UK, 2007
