Recognizing the Risk Factors and Signs of Preeclampsia
Most pregnant women faithfully fill their urine cup at each doctor’s visit without truly knowing why. One of the complications this test screens for is preeclampsia, a serious blood pressure disorder that can occur during pregnancy, usually in the third trimester.
According to Dr. Heather Owens, an obstetrician and gynecologist with Saline Memorial Hospital in Benton, the urine screening is used in part to detect the presence of protein. “Preeclampsia can affect all organs in the body—particularly the heart, kidneys and liver,” she explains. “When there is abnormal kidney function, protein spills into the urine.”
But the first sign of preeclampsia is most likely to be blood pressure elevation, she says. Mild to moderate blood pressure elevation is 140-159/90-109; severe is 160+/110+.
“I also ask the patient if she has had headaches that won’t go away, even after she’s taken Tylenol or other medication,” says Dr. Owens.
Other symptoms include swelling of the hands and face, changes in vision that might include seeing spots, abdomen pain, nausea and vomiting in the second trimester, and sudden weight gain, which indicates the woman is retaining fluid. This is particularly dangerous because fluid retention is possible in the lungs.
Since some of these symptoms are common in many “normal” pregnancies, blood pressure is monitored closely at each prenatal care visit.
Risk Factors
Dr. Owens says preeclampsia has been described in obstetrician literature for a long time. “It was described by Hippocrates in the fifth century,” she explains. “It used to be referred to as ‘toxemia’ because of the belief that there was some toxin in women that produced these symptoms. After all these years and research, we still don’t know what causes preeclampsia, but there are certain risk factors associated with it.”
These include obesity; pre-existing high blood pressure; chronic hypertension; family history; having had the condition in prior pregnancy; carrying multiples (i.e. twins); history of kidney disease; or other medical conditions such as diabetes, lupus or thrombophilia—a disorder in which the blood doesn’t clot appropriately.
Dr. Owens says women ages 40 and older are typically more susceptible to preeclampsia, as are women who become pregnant through IVF. “We don’t know exactly why,” she says of the latter group, “but it is probably linked to the likelihood of carrying multiples, which is a risk factor.”
Prevention
“Identifying what risk factors the patient has in the first place are the key to preventing preeclampsia,” says Dr. Owens. She recommends pre-conceptual counseling (also known as pre-conception counseling) as the first step toward identifying and then minimizing those risks. “If the patient is overweight, she needs to lose weight,” she explains. “If she is diabetic, she needs to go into the pregnancy with good blood sugar control.”
Incidentally, Dr. Owens recommends pre-conceptual counseling to all patients, even if just to establish a relationship between the woman and her doctor.
Treatment
The good news is that preeclampsia is not a foregone conclusion. It affects 2-8 percent of women. Dr. Owens says she has had patients who had preeclampsia in one pregnancy, but did not develop it in the next.
Now that medication is available, a woman’s severe blood pressure can be optimally managed in consult with her doctor. Although worldwide the mortality rate of mother and fetus due to preeclampsia is still high, it is uncommon in the United States. According to Dr. Owens, 29,000 women worldwide died in 2013 from hypertensive disorders of pregnancy.
Unfortunately, the earlier it occurs in pregnancy, the greater the risks are for the woman and her baby. Because preeclampsia is primarily a placental disease, the “cure” is delivery, Dr. Owens explains. This means that sometimes induced labor and delivery may be required. After delivery, women may expect their blood pressure to return to normal within 12 weeks, but usually much sooner.
Although blood pressure medication is administered in part to reduce the risk, preeclampsia can lead to seizures. Eclampsia—which is essentially preeclampsia plus seizures—can develop. Because eclampsia can have serious consequences for both mother and baby, delivery generally becomes necessary, regardless of how far along the pregnancy is. If a patient’s preeclampsia is severe, her doctor may prescribe an anticonvulsant medication, such as magnesium sulfate, to prevent a first seizure.
For more information on preeclampsia, Dr. Owens recommends the Centers for Disease Control and Mayo Clinic as reliable sources.
“Delivering babies is a very positive, rewarding experience,” she says. “It is such an adrenaline rush and never gets old. I get to see the happiness of patients when they get to hold their baby for the first time, and I get to be part of it.
“Ninety-five percent of the job is really happy and positive. The other 5 percent—when things go badly—is why we have to be trained to do what is necessary to protect the mother and baby.”