What Is Preeclampsia and How Is It Treated?

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What is Preeclampsia and How Is It Treated?

Preeclampsia is a condition that occurs during pregnancies and occasionally continues postpartum. It is a rapidly progressive condition, seen in 5%-8% of all pregnancies, and it is characterized by high blood pressure. It is usually diagnosed after 20 weeks of pregnancy in women whose blood pressure levels have previously been normal. Advanced symptoms of preeclampsia can include headaches, abdominal pain, nausea and vomiting, confusion, blurred vision, and signs of damage to the kidneys or liver.

Preeclampsia can also affect the blood flow to the placenta, which can affect how your baby receives oxygen and food. This can cause your baby to have a lower birth weight. Most women who are diagnosed with preeclampsia will deliver healthy babies and not have any issues after their pregnancy. However, if it goes undiagnosed, the condition can increase to severe very quickly. The Preeclampsia Foundation reported that preeclampsia in the United States has increased by 25% in the past two decades and is the leading cause of maternal and infant illness and death.

What are some signs and symptoms of preeclampsia?

• High blood pressure: This is one of the biggest red flags that preeclampsia may be developing. High blood pressure is traditionally defined as blood pressure of 140/90 or greater, measured on two separate occasions six hours apart. During pregnancy, a rise in the lower number (diastolic) of 15 degrees or more, or a rise in the upper number (systolic) of 30 degrees or more can also be a cause for concern.
• Proteinuria, another sign of preeclampsia, is the result of proteins (normally confined to the blood by the filtering role of your kidney) spilling into your urine. This is because preeclampsia temporarily damages this “filter.” Albumin, a protein made by your liver, as well as many other proteins, are lost this way. A certain amount of swelling is normal during pregnancy, but an accumulation of excess fluid can be a concern when it occurs in your face, around your eyes, or in your hands. Dull or severe, throbbing headaches, often described as migraine-like that just won’t go away, is cause for concern.
• Sharp, more acute pain in your ribs may be a sign of HELLP Syndrome (HELLP stands for hemolysis, elevated liver enzymes, and low platelet count) or a related problem in the liver. This syndrome occurs in about 5%-12% of preeclampsia patients and is one of the most severe forms of preeclampsia. It typically occurs late in pregnancy and it can affect the breakdown of red blood cells, how the blood clots, and liver function. Your baby will need to be delivered immediately if you develop this syndrome.
• Vision changes are one of the most serious symptoms of preeclampsia. They may be associated with central nervous system irritation or be an indication of swelling of the brain (cerebral edema).
• Shortness of breath, a racing pulse, mental confusion, a heightened sense of anxiety, and a sense of impending doom can be symptoms of preeclampsia. If these symptoms are new to you, they could indicate an elevated blood pressure, or more rarely, fluid collecting in your lungs (pulmonary edema).

Who has an increased risk of developing preeclampsia?

There are several factors that increase a woman’s chances of developing preeclampsia.

They include:

• First-time pregnancies
• Women who have a previous history of preeclampsia
• Women who have a family history of preeclampsia
• Women under 20 years of age or over 35
• Women who have Polycystic Ovarian Syndrome
• Women carrying multiple babies
• Women who have a history of high blood pressure, diabetes or kidney disease before their pregnancy
• Women with autoimmune disorders like lupus, rheumatoid arthritis, sarcoidosis or multiple sclerosis
• Women who develop gestational diabetes
• Obesity (having a body mass index (BMI) of 30 or greater)

What can I do to prevent preeclampsia?

1. At prenatal appointments, make sure you get weighed, get your blood pressure checked and your urine tested for protein. Do not be afraid to question your provider if any of these tests are omitted.
2. Eat a diet full of vitamins, minerals, and the basic food groups and reduce your consumption of processed foods, refined sugars, and caffeine. Eliminating alcohol and any medication not prescribed by a physician is also essential.
3. Get regular exercise throughout your pregnancy. Exercise can help reduce your blood pressure and prevent excess weight gain. Try walking, swimming, or prenatal yoga for low impact exercises. Discuss with your OB/GYN before you start any exercise routine to determine if it is safe for you and your baby.
4. Monitor your weight. Two of the major risk factors of developing preeclampsia are obesity (having a BMI of 30 or higher) and gestational diabetes. If you have plans to become pregnant, weight management will be important to make sure you are at a healthy weight before your pregnancy. Consult with your doctor on what a healthy BMI for you is.
5. If you think your face is becoming excessively puffy, find a picture of yourself from just before pregnancy to share with your healthcare provider. If the swelling in your hands and feet becomes severe, you may notice “pitting edema” (when you press your thumb into your skin, an indentation remains for a few seconds) or discoloration of your legs. If you suspect this kind of edema, notify your healthcare provider.
6. If you have tried taking over-the-counter medication without relief for a headache or if your headache is very painful, and accompanied by light sensitivity, or vision changes, check your blood pressure and call your provider immediately for their recommendations.

Lydia Lewis, MD, is board certified in obstetrics and gynecology and practices at Ochsner Health Center – Zachary. Dr. Lewis received a Bachelor of Science degree from the University of California-Berkley. She then received a Master of Science degree in Public Health from the University of Washington, School of Public Health & Community Medicine. She went on to earn a Doctor of Medicine degree from the University of Wisconsin-Madison Medical School. Dr. Lewis completed an obstetrics and gynecology internship and residency at Kaiser Permanente Foundation Hospital in Oakland, California. Her special interest is hormone replacement therapy.