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Preeclampsia: Causes, Symptoms, Diagnosis And Treatment

Preeclampsia Causes, Symptoms, Diagnosis And Treatment

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Preeclampsia is a condition where a woman experiences high blood pressure and protein in the urine during pregnancy or soon after delivery. This usually occurs after 24 to 26 weeks of pregnancy, and it is rare before 20 weeks. Although rare, preeclampsia may develop in the first six weeks of postpartum. Early-onset preeclampsia may occur any time before 34 weeks of pregnancy and can often be associated with severe symptoms.

According to the US Centers for Disease Control and Prevention (CDC), preeclampsia may occur in one in 25 pregnancies (1). Pregnant mothers with existing chronic hypertension and previously normal blood pressure can develop preeclampsia. This disorder can affect various organs in a woman’s body and pose certain risks to the unborn baby.

Read this post to know about the symptoms, causes, risk factors, prevention, diagnosis, and treatment of preeclampsia.

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.

Preeclampsia during pregnancy may occur without any discernible reasons. Early and regular prenatal visits help to diagnose preeclampsia from early stages. This may help to limit complications and plan delivery accordingly. Early delivery helps to avoid potential risks and complications to the mother and baby. You may seek advice from your obstetrician to know the best management of preeclampsia based on individual factors.

References:

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Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made... more