What you should know about pre-eclampsia

Researchers don’t know the exact causes of the pregnancy disorder called pre-eclampsia, but they do recognize some of the risk factors. Here’s how to tell if you might be at risk—and what to do if you’re diagnosed with the condition.

What is pre-eclampsia?
Pre-eclampsia is also referred to as toxemia or pregnancy-induced hypertension (PIH). It is characterized by high blood pressure (hypertension) of ≥140/90 mmHg, and protein in the urine. Signs of preeclampsia can appear anytime after 20 weeks or in the first few days postpartum, and typically resolve within a few days after delivery. However, only about 10 percent of cases occur before 34 weeks of pregnancy, while most cases of preeclmpsia occur at or near term (after 37 weeks of pregnancy).

How is pre-eclampsia treated?
Most women with mild preeclampsia don’t tend to experience any symptoms since they usually have mild high blood pressure and a small amount of excess protein in the urine. Because these changes do not usually cause symptoms, it is important to schedule frequent prenatal visits in the last half of pregnancy to check blood pressure and measure urinary protein in order to detect the disorder early enough to avert any serious complications.

If your doctor determines that you have pre-eclampsia, the treatment will depend on your gestational week, and the severity of your condition. (The only cure for preeclampsia is delivery of the baby and placenta.) When the condition develops before term and is mild, monitoring the mother and baby in order to allow the baby time to grow and mature is an option. Depending on the severity of the condition, monitoring may consist of bed rest at home with frequent physician visits. You might also need to take high blood pressure medication to lower blood pressure and reduce the risk of stroke.

Partial bed rest, while lying on the left side, relieves pressure on major blood vessels, and may also help by improving circulation to the uterus and other organs. Some midwives also advocate regular immersion in a warm, shoulder-deep tub or swimming pool, which some studies suggest may push fluid back into the circulation and dilate blood vessels, thus producing a blood pressure dip. In the meantime, blood pressure will be closely monitored and urine frequently checked to detect any rapid deterioration in condition. This helps the caregiver balance any risk of continuing the pregnancy against the effects on the baby’s health that can come from being born too soon. The aim is to buy enough time for the baby’s lungs and other organs to mature before delivery becomes necessary.

When severe pre-eclampsia develops before term, however, delivery is often necessary to prevent complications in the mother and baby. If blood pressure and urine protein continue to escalate, or if other symptoms develop, admission to the hospital may be necessary so mother and baby can be watched more closely.

While the extra stress accompanying this kind of intense scrutiny can be tough on expectant parents, it’s important to keep in mind that often these precautionary measures are all that’s needed. In most cases, women with pre-eclampsia end up delivering at or near term.

Danger Signs
Seek immediate medical attention if you experience any of the following:

  • Severe or persistent headaches 
  • Worsening persistent swelling (particularly of hands and face) 
  • Reduced urine output 
  • Pain in right upper abdomen under the ribs 
  • Shortness of breath 
  • Sudden weight gain (over a few days) 
  • Agitation and confusion 
  • Vision changes, such as double vision, seeing spots or flashing lights, or squiggly lines, loss of vision 
  • Increased sensitivity to light

Risk Factors
While doctors can’t predict who will develop pre-eclampsia, the following factors are linked to a higher risk of the disorder:

  • Personal or family (sister or mother) history of pre-eclampsia 
  • First pregnancy or first pregnancy with a new partner 
  • Age younger than 20 or over 35-40 
  • Women who are carrying multiples, i.e., twins and triplets 
  • Women who develop gestational diabetes 
  • Certain maternal conditions, such as chronic high blood pressure, diabetes, kidney disease, lupus, gestatational diabetes and obesity