Preeclampsia is a pregnancy-related condition that occurs in 5% of all pregnancies. Preeclampsia is defined as the presence of new-onset hypertension and proteinuria (protein in the urine) after 20 weeks of gestation. In preeclampsia, your blood pressure may be normal at first but then increase suddenly and dangerously. If you have this condition, you may experience symptoms like blurred vision, severe headaches, sudden weight gain or loss, swelling of your hands or feet, nausea and vomiting, and sudden pain in your abdomen.
Preeclampsia may lead to serious health problems for the mother and the baby. Preeclampsia is a leading cause of premature delivery, preterm labor, and low birth weight babies. It also increases your risk of dying from complications like eclampsia (severe seizures).
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When does preeclampsia occur?
Preeclampsia can occur at any time during pregnancy. Most women with preeclampsia will have symptoms during the second half of their pregnancies. Symptoms are usually first noticed in late pregnancy (after 20 weeks). Your doctor may test you at any time if you think you are pregnant. You may be tested as soon as a week after you missed your period or as late as 2 weeks before your due date.
What are the symptoms?
You may have symptoms of preeclampsia if you are pregnant for the first time or if you have had preeclampsia before. However, symptoms don’t always occur with every case of preeclampsia. In fact, some women who have this condition don’t experience any symptoms at all until they deliver their babies. Preeclampsia usually occurs in the second half of pregnancy; it usually begins in the third trimester but may occur earlier. The symptoms of preeclampsia are often the same as those of high blood pressure or gestational hypertension:
- The most common symptom of preeclampsia is new-onset hypertension or high blood pressure (see High Blood Pressure), which means your blood pressure is higher than it should be and is measured at 140/90 or more on two occasions, 4 hours apart. If you have preeclampsia, your blood pressure is likely to increase more quickly and be harder to control than it would in a normal pregnancy. Your blood pressure may also increase at any time during pregnancy. However, it usually begins in late pregnancy (after 20 weeks).
- Preeclampsia also causes proteinuria (protein in the urine), which means that your urine will be dark red or brown because protein has passed into it from your kidneys. The protein in the urine may be albumin, a type of protein that normally makes up about one-tenth of all the proteins in your body.
- Elevated blood pressure in the late second trimester or early third trimester is not related to fluid retention.
- A sudden increase in weight gain (sometimes accompanied by swelling of the abdomen) after 20 weeks of gestation.
- Painful, sudden increases in weight gain and swelling of the hands, feet, or face after 20 weeks gestation. This is called proteinuria (the presence of protein in the urine), and it can be detected by a urine test.
- Fever after 20 weeks gestation; headache; blurred vision; shortness of breath; nausea or vomiting (especially if you are carrying your baby in your abdomen); or abdominal pain and pain during urination.
Other symptoms may occur depending on which organ system is affected:
- Severe headaches (the most common symptom) are usually caused by hypertension that affects the blood vessels around your brain (intracranial hypertension). These headaches may be caused by bleeding in the brain or swelling of the brain tissue.
- Unexplained abdominal pain, cramping, and diarrhea (often accompanied by nausea or vomiting) are caused by hypertension that affects your kidneys.
- Red eyes (redness of the eyelids) are usually caused by hypertension that affects your eyes (ocular hypertension). These headaches may be preceded by a feeling of fullness in your stomach.
- Vaginal bleeding is sometimes a sign of preeclampsia; it is more common if you have not had any prior pregnancies. Vaginal bleeding may be caused by a number of problems besides preeclampsia, including:
- Bleeding from the placenta after 20 weeks of gestation; can lead to premature labor.
- Uterine contractions that cause backache and leg cramps; these contractions usually occur at night and are accompanied by severe nausea and vomiting. You may have increased urination at night because urine flow increases during pregnancy for the same reason.
If you experience any of these symptoms, contact your doctor immediately. Be sure to tell him or her that you are pregnant. Your doctor may decide to monitor your blood pressure every day and take an ultrasound at the beginning of labor if the hypertension is severe or worsening.
What causes preeclampsia?
In preeclampsia, your blood vessels may become too rigid and constrict (narrow) to the point where they block off tiny blood vessels in your kidneys. This leads to a sudden drop in the amount of protein you can make and pass into your urine. If this happens, your kidneys will try to make more protein to replace the protein that is being lost. Your body also makes more antibodies (proteins that help fight infection) because it thinks you are fighting an infection in your blood vessels. These antibodies can cross the placenta into your baby’s bloodstream and cause problems for his or her developing organs.
The exact cause of preeclampsia is unknown. It may be a combination of factors that lead to a change in the way that blood flows through your body’s blood vessels, causing them to become too rigid and constricted (narrow). The most common risk factors are:
- High blood pressure, usually in the second half of pregnancy. High blood pressure can damage your kidneys and may cause the protein to pass from your kidneys into your urine.
- Pregnancy-related changes affect the way the placenta grows and develops. A baby born to a mother with preeclampsia has a higher chance of developing problems later in life than a baby born to a mother without this condition.
- A family history of preeclampsia means that one or more members of your family have had this condition before. If you have preeclampsia, you are twice as likely to have it again if one or more members of your family also have it.
What are the complications of Preeclampsia?
Preeclampsia is often called “hypertensive” or “high blood pressure” pregnancy because high blood pressure is common in women who have this condition during pregnancy. The most serious complication is eclampsia, which occurs when preeclampsia is accompanied by seizures. It is rare, but it can be deadly to both the mother and baby.
If you have preeclampsia, you will usually have normal blood pressure before the onset of the symptoms of this condition. However, once the symptoms develop, your blood pressure may rise very high. You also may have headaches or stomachaches or feel nauseated and vomiting in addition to having these symptoms:
- Increased edema (swelling) in your hands and face (oedema)
- Unusual weight gain during pregnancy or a rapid weight gain after delivery that continues for more than 2 weeks after your baby is born
- A drop in blood platelet count (thrombocytopenia), may cause bleeding into areas such as your vagina or through your uterus during labor
- A headache that doesn’t go away even after you have been resting for a while (pulseless headache). You may also experience a headache that is different from your usual headaches.
How to manage Preeclampsia?
As long as you are having normal blood pressure before the symptoms of preeclampsia develop, it is important to follow up with your doctor or midwife. Preeclampsia can usually be prevented or delayed by taking certain steps during pregnancy:
- Watching your weight throughout pregnancy and following a healthy diet plan that includes lots of fruits and vegetables. A woman’s weight gain is usually between 12 and 20 pounds during pregnancy, but you may gain more than this amount if you are over 240 pounds (before pregnancy). If you gain more than the recommended amount, you will be at an increased risk for preeclampsia.
- Exercising regularly before pregnancy to improve circulation in your body. You can also exercise while pregnant. This will help keep you feeling energetic throughout your pregnancy and may improve circulation in your body.
- Taking certain medications (such as folic acid) to prevent problems with your baby’s development.
- Taking a medication called progesterone to help your body prepare for pregnancy.
- Avoiding stress, such as smoking and excessive alcohol use, may cause the blood vessels in your body to constrict and may increase your risk for preeclampsia. You should avoid exposure to secondhand smoke, too.
- Expecting a stressful life event can actually trigger preeclampsia, so you should try to avoid these events if you can.
- Having routine checkups during your pregnancy with a doctor or midwife who specializes in high-risk pregnancies. Preeclampsia usually develops early in pregnancy, so it is important to get the proper treatment as soon as possible after you find out that you are pregnant. Some women with preeclampsia have more severe symptoms later in their pregnancies than others do; therefore, it is important to follow up with your doctor regularly throughout the rest of your pregnancy and into labor and delivery (after delivery).
Able to handle stress, having a strong support system, and participating in activities that provide you with positive energy is important for coping with preeclampsia. Some of these activities include:
- Keeping up with your prenatal checkups and treatment (for example, taking medication for high blood pressure)
- Staying active through walking, swimming, dancing, or yoga
- Participating in a pregnancy support group that provides you with emotional support from other women who have preeclampsia. Your doctor or midwife may be able to refer you to such a group if one is available near you. You can also ask your doctor about going to the library or checking the Internet for information on preeclampsia. You may find it helpful to read books and magazines about pregnancy and childbirth as well as books about preeclampsia. A good book is Born Without A Net: Pregnancy Loss & Infertility Support by Nancy M. Brown; she gives practical advice about the emotional, financial, and physical aspects of pregnancy loss.
Lifestyle factors that can contribute to the development of preeclampsia include:
- Being overweight or obese before pregnancy. This can make it harder to get your body ready for pregnancy by losing weight or developing an exercise plan.
- Excessive stress and anxiety may occur with changes in your lifestyle during pregnancy. Stressful life events may trigger preeclampsia; if you have preeclampsia, these events are likely to trigger more severe symptoms of the disease.
- Poor nutrition before, during, and after pregnancy (for example, consuming too much salt). If you have high blood pressure or are being treated for high blood pressure while pregnant, your doctor will advise you about a healthy diet during this time period. You should avoid eating foods that have a lot of salt or other added ingredients (such as processed foods) because these foods may cause extra water retention in your body and lead to more swelling in your legs and feet.
- A history of severe allergic reactions to medications, foods, or other substances (such as an allergic reaction to latex). A history of allergies can affect your baby’s health by causing the baby to have a poor immune system.
- High levels of caffeine (found in coffee, tea, soda pop) or alcohol before pregnancy. Caffeine may increase your blood pressure during pregnancy. Alcohol may cause fetal alcohol syndrome (FAS) or other problems for your baby; it can also cause miscarriage and premature labor. If you drink alcohol while pregnant, you should drink no more than one drink per week.
- Smoking cigarettes (for example, quitting smoking now). Nicotine causes the blood vessels to narrow and can lead to high blood pressure during pregnancy; if you quit smoking now, you will avoid this problem when you are pregnant again later on.
- Lack of sleep before or during pregnancy; lack of rest can also contribute to the development of high blood pressure during pregnancy.
- Stressful life events (such as divorce, loss of a job, death of a loved one) before or during pregnancy.
- Not exercising enough before, during, and after pregnancy (for example, by walking regularly). You should try to develop an exercise program that you will maintain throughout your pregnancy. You can start with small exercises like walking at a slow pace around the block once or twice each week. If you are having trouble getting into shape before you become pregnant again, your doctor may recommend you take up an exercise program when you begin to show signs of pregnancy.