Preeclampsia in pregnancy is a condition characterized by high blood pressure and high protein in the urine during pregnancy or right after delivery. It usually develops after 24 to 26 weeks of pregnancy and rarely before 20 weeks. Occasionally, preeclampsia may even develop in the first six weeks of postpartum. Early-onset preeclampsia may occur before 34 weeks of pregnancy and is often accompanied by severe symptoms. Preeclampsia can occur in pregnant women with existing chronic hypertension or previously normal blood pressure. The US Centers for Disease Control and Prevention (CDC) reports that the condition affects one in 25 women (1). The disorder affects the woman’s organs and risks the unborn baby’s health. Learn more about the symptoms of preeclampsia in pregnancy, its causes, risk factors, prevention, diagnosis, and treatment.
Signs And Symptoms Of Preeclampsia
The early symptoms and signs of preeclampsia may include (2):
Hypertension (high blood pressure) Proteinuria (proteins in the urine)
High blood pressure alone cannot suggest preeclampsia, and this may indicate other problems. A combination of these symptoms suggests the presence of preeclampsia. Pregnant mothers do not often notice these symptoms and are often identified during medical checkups in routine antenatal (prenatal) visits. Pregnant mothers may experience the following symptoms as the preeclampsia progresses (2).
Severe headaches
Nausea and vomiting Severe heartburns Vision issues such as seeing flashing lights or blurred vision Pain below ribs Weight gain due to fluid retention Sudden edema (swelling) on face, hands, legs, and feet Feeling unwell
It is recommended to contact your doctor right away if you notice any of these symptoms rather than waiting for the next prenatal visit.
Risk Factors And Causes Of Preeclampsia
The exact causes of preeclampsia are not identified in many cases. However, placental problems are often associated with the development of preeclampsia in many women. This can also be due to poor development of placental blood vessels in women with preeclampsia in early pregnancy (3). The following conditions or factors may increase the risk of developing preeclampsia (3) (4).
Maternal age less than 20 or more than 40 History of chronic hypertension History of preeclampsia in previous pregnancies Expecting the first baby Overweight or obese
Positive family history of preeclampsia and chronic hypertension Kidney diseases Diabetes Multiple gestations Immune system disorders such as rheumatoid arthritis and lupus In vitro fertilization Short or long intervals between pregnancies, such as having babies with less than a two-year gap or more than a ten-year gap New paternity may increase the risk of preeclampsia than next pregnancies with the same partner
Complications Of Preeclampsia
Pregnant mothers with uncontrolled preeclampsia are at higher risk of complications. Some of the complications are medical emergencies since, if left untreated, it can be life-threatening for both the mother and the unborn baby. You may seek emergency medical care if you notice any complications of preeclampsia at any time during the pregnancy. Possible complications of preeclampsia may include (4):
Fetal growth restriction: Preeclampsia may reduce the blood flow in placental blood vessels. This may lead to inadequate delivery of oxygen and nutrients to the fetus, causing slow growth and low birth weight.
Premature birth: Severe preeclampsia can be harmful to both mother and baby and often require early delivery by C-section or labor induction. Doctors may give certain medications to enhance the baby’s lung maturity and plan the delivery based on the health status of the mother and the baby.
HELLP syndrome: This syndrome includes hemolysis (destruction of erythrocytes or red blood cells), low platelet count, and increased liver enzyme levels in the body. Headaches, nausea, vomiting, and upper right abdomen pain are symptoms of HELLP, and it indicates multiorgan damage. HELLP syndrome is the most severe form of preeclampsia, leading to life-threatening risks to the mother and the baby. This can have sudden onset even before the onset of symptoms or before detecting high blood pressure.
Placental abruption: This is a condition where the placenta separates from the uterine wall before delivery. Severe abruption can be life-threatening to the mother due to heavy bleeding and the baby due to inadequate or lack of blood supply.
Eclampsia: Preeclampsia with seizures (convulsions) is called eclampsia, and it is a medical emergency. This is usually when the preeclampsia is uncontrolled. There are no warning signs or symptoms to predict the risk of eclampsia, and this may pose serious health risks to the mother and the baby.
Multiorgan damage: Preeclampsia can damage kidneys, lungs, liver, heart, and eyes in the mother. This can also increase the risk of strokes that may result in brain injury. The severity of organ damage may depend on the severity of preeclampsia.
Cardiovascular diseases: Preeclampsia may increase the risk of cardiovascular diseases in the future. The risk can be higher for mothers who had preeclampsia in more than one pregnancy and had a preterm delivery. However, maintaining weight, following a healthy diet, avoiding smoking, and regular exercise throughout life can minimize the risk.
The severity and risks of preeclampsia can be higher if it occurs in early pregnancy. In some cases, an early delivery through cesarean section (C-section) is recommended to avoid severe complications to both mother and the baby.
Prevention Of Preeclampsia
There are no clear strategies to prevent preeclampsia. However, trying to be healthy, such as keeping weight in the normal range, and managing chronic conditions, such as hypertension or diabetes, can be helpful to reduce the risk of preeclampsia, especially if you had it before. Seeking regular prenatal care can help to limit complications if you are already pregnant. The following medications may reduce the risk of preeclampsia in some women (4):
Low-dose aspirin: Daily low-dose aspirin can be prescribed for pregnant women with certain risk factors for preeclampsia from 12 weeks of pregnancy. Usually, 81 milligrams of aspirin is prescribed for women with risk factors such as kidney diseases, chronic hypertension, autoimmune diseases, diabetes, multiple pregnancies, and a history of preeclampsia.
Calcium supplements: Women with calcium deficiency before or during pregnancy may benefit from calcium supplements to prevent preeclampsia. Calcium deficiency is less common in the US and many other developed countries.
Restricting calories, reducing salt consumption, and consuming fish oil or garlic are not scientifically proven to prevent preeclampsia. Vitamin C and E intake are also not shown to have many benefits in preeclampsia prevention. Although some studies show that vitamin D is beneficial to lower preeclampsia risks, others fail to establish the link. So you may inform your doctor before taking any medications or supplements.
Diagnosis Of Preeclampsia
Blood pressure measurements and urine tests can help determine preeclampsia. If these test results indicate the presence of preeclampsia, doctors may order liver and kidney function tests and platelet measurements through blood tests. In later stages, fetal ultrasound and biophysical profile help determine the unborn baby’s health. Prenatal ultrasounds may also help to identify placental abnormalities and growth restrictions due to preeclampsia (5).
Treatment For Preeclampsia
The most effective treatment for preeclampsia is delivery. Hospitalization is needed for preeclampsia with severe features. Delivery is recommended as early as 34 weeks of pregnancy. However, you may wait for delivery if the condition is stable. Delaying delivery allows time to give corticosteroids to enhance fetal lung maturity. In addition, mothers may receive antihypertensive medications to decrease blood pressure and anticonvulsants to prevent seizures. However, if the condition is not stable, immediate delivery is recommended (5). If the benefits outweigh the risks, doctors may recommend an early delivery by labor induction with medications or cesarean section to prevent life-threatening complications in both mother and baby.
