Pregnancy comes with a lot of worrying, much of it unwarranted but natural and—dare I say?—unavoidable. But a few things are actually worth knowing about, if not actively worrying about. One of those things is preeclampsia. Preeclampsia is a pregnancy complication that causes high blood pressure and protein in the urine, and it needs immediate attention. Why? Left untreated, it can lead to kidney and liver failure, stroke, seizures, and maternal death and/or stillbirth. It is therefore important to be aware of the symptoms so you can spring into action quickly if you sense that something is off.
What is preeclampsia?
“Honestly, most of us are still trying to figure this out!” says Kerry Price, MD, an OB-GYN at Orange Coast Women’s Medical Group in Orange County, California. “It is the number one thing … that [OB-GYNs] still need a definite cause for, and discovering its cause is one of the most researched topics in our field.” Here’s what doctors believe: Preeclampsia is a disorder of the vessels in the placenta that causes increased resistance. This increases pressure gradients, which causes maternal blood pressure to rise and puts greater demands on the vital organs. In short, the problem is in the placenta—which is why delivery is the cure. [pullquote align=”center”]Never doubt that you know your body best and continue to seek out the best medical attention you can find.[/pullquote] High blood pressure caused by preeclampsia can come on slowly over time or very suddenly, which is why your OB checks your urine and blood pressure at every single visit and why it’s important for pregnant women to be aware of all the symptoms. That said: The condition can be treated and managed—how effectively is really a question of how early it is diagnosed and how close the mother is to delivery.
How common is preeclampsia?
Preeclampsia affects between 3 and 10 percent of pregnancies. In fact, it’s one of the most common complications of pregnancy. Price says she’s seeing a rise in cases in the U.S. due to two main factors:
- The average age of mothers is on the rise. In other words, more women are having babies at age 35 and older.
- More women are overweight and obese—and these are both risk factors for preeclampsia.
Signs and Symptoms of Preeclampsia
You know how your urine is tested at every single doctor’s visit? Preeclampsia is one of the things she’s testing for. (We know it’s annoying, but so, so necessary!) At your 20-week appointment—and then at every other subsequent visit—your OB will likely go over the signs and symptoms of preeclampsia with you, but it’s good to keep them in mind for yourself, too. Here’s what to look out for:
- A headache that is not responsive to rest, Tylenol, or fluids
- Blurred vision
- Epigastric and right upper quadrant abdominal pain
- Swelling of the hands and face
- General malaise
- Fluid in the lungs
- Signs of kidney trouble
- A seizure, which is a very late-onset symptom that would actually mean a woman has moved from preeclampsia to eclampsia
Risk Factors for Preeclampsia
There are a few risk factors associated with preeclampsia:
- History of preeclampsia in a previous pregnancy
- Chronic hypertension (or elevated blood pressure)
- Advanced maternal age (over 35 but especially over 40)
- Young maternal age (under 25)
- Type 2 diabetes
- Kidney disease/dysfunction
- Smoking/tobacco use
- Systemic lupus
- Connective tissue diseases
- Multiples (twins or higher)
- Women who develop gestational hypertension or gestational diabetes during their pregnancies are also at increased risk for developing preeclampsia
- Women who got pregnant via in vitro fertilization (IVF), donor insemination, or egg donation
One very important point: Women of color—especially African American women—are more likely to develop preeclampsia. According to a recent feature story in The New York Times Magazine, their symptoms are often ignored by medical professionals, causing a range of medical complications, including stillbirth. Never doubt that you know your body best and continue to seek out the best medical attention you can find.
In order to be diagnosed with preeclampsia, a woman needs to show signs of two things:
- Elevated blood pressure: This means 140 or higher systolic, and 90 or higher diastolic, so 140/90 or higher. Ideal blood pressure is less than 120/80.
- Proteinuria, or protein in the urine
You can have elevated blood pressure and not have preeclampsia, and you can spill protein in your urine and not have it. You need both to be diagnosed. Price explains that there are varying stages of preeclampsia: mild preeclampsia and preeclampsia with severe features. These are indicative of a more serious disease state. “The gold standard for any evaluation is a 24-hour urine protein collection, which can be done as an outpatient or inpatient depending on the severity of the patient’s condition,” Price explains. That said, high blood pressure at one appointment does not mean you have preeclampsia! This is why your doctor will probably test your blood pressure again four hours later and monitor you closely for at least 24 hours and for the remainder of the pregnancy.
If you are experiencing any of the signs or symptoms above, you should contact your doctor’s office immediately and ask for an evaluation. If your OB’s office is closed, Price advises going to labor and delivery for an evaluation or speaking to your doctor’s on-call physician to see if an evaluation is warranted. “A patient should never wait hours or days to contact her physician about this,” Price says, “because if preeclampsia is truly there, time is of the essence.” Treating preeclampsia depends entirely on the severity of the symptoms and the gestational age of the fetus. Milder cases and those closer to term might not necessitate hospitalization or a super-early delivery. These are most often treated with frequent outpatient visits, blood pressure medication, and non-stress testing with amniotic fluid checks. Bed rest doesn’t help with preeclampsia. [pullquote align=”center”]“A patient should never wait hours or days to contact her physician about this because if preeclampsia is truly there, time is of the essence.” —Kerry Price, MD[/pullquote] More severe cases require IV antihypertensive medications, inpatient hospital admission, and more continuous monitoring of the baby. Your doctor is trying to prevent the condition from causing a stroke, fetal abruption, seizures, or severe bleeding. The baby will undergo more monitoring as well: non-stress tests and frequent ultrasounds. That said, if you are diagnosed with preeclampsia, you will not deliver your baby any later than 37 weeks—it’s simply not safe for you or the baby. More severe cases require preterm delivery to save both mom and baby from the worse outcomes, which can include brain damage or death. This is what makes preeclampsia so tricky: The only “cure” is delivering the baby. An OB’s goal is to keep the mother and baby safe for as long as possible—and not push it a moment longer.
There is no way to definitively prevent preeclampsia, but there are ways of improving your odds of staying healthy throughout your pregnancy. Though you should always consult your own physician, here are Price’s recommendations:
For Women at High Risk
As soon as you find out you’re pregnant, take a daily 81 mg dose of aspirin. This has been shown to significantly reduce the risk of developing preeclampsia.
For Women Planning to Get Pregnant (Who Have Risk Factors)
Work on getting to a healthy weight and have any chronic medical conditions (elevated blood pressure, diabetes, kidney disease, lupus, etc.) under control.
For Women Without Risk Factors
Make sure you exercise regularly, eat a healthy diet, and avoid excess weight gain during pregnancy. Excess weight gain is linked to gestational hypertension and gestational diabetes, both of which are risk factors for preeclampsia.
Can preeclampsia come on suddenly?
“Yes it can, which is very scary and why your OB is constantly on the lookout!” Price says.
Can preeclampsia occur before 20 weeks?
In short, no. The longer answer is a little more complex. “While there are case reports out there of an earlier diagnosis, there is almost always a very significant underlying medical condition, so it is not a true diagnosis of preeclampsia,” Price explains. If your blood pressure is high before 20 weeks, it probably indicates chronic hypertension (usually diagnosed if your blood pressure is significantly elevated in the first trimester) or another underlying medical condition
How does preeclampsia affect mom?
If the case is mild and managed well, preeclampsia is mostly just uncomfortable and annoying—there are the symptoms (headaches, etc.) and all the trips to the hospital for frequent checkups. If the case is severe, you can develop HELLP syndrome, which is dysfunction and/or a shutting down of the kidneys and liver. This can lead to uncontrolled bleeding, stroke, and death. Preeclampsia can also evolve into eclampsia, which involves seizures. These can cause brain damage because of lack of oxygen and aspiration pneumonia if vomit winds up in the lungs. Again, this is in very severe and unmonitored cases. The long and short of it is: If you suspect something is wrong, contact your doctor immediately.
Does preeclampsia affect my baby?
Yes. The baby is affected because preeclampsia is a placental issue. “The main fetal effects we see are growth restriction and low amniotic fluid volumes,” Price explains. “This can lead to significant developmental issues, especially if this happens earlier in gestation.” If preeclampsia develops at term and is diagnosed in a timely manner, the baby is usually unaffected and does very well—which is what makes accurate and timely diagnosis very important. “This is why we dip people’s urine at every visit!” Price says.
Is preeclampsia hereditary?
Nope. So just because your mom or grandmother had it doesn’t mean you will.