Preventing Preeclampsia - All You Need to Know

Introduction

Preeclampsia is a serious condition seen only in pregnancy, typically after 20 weeks of pregnancy. It is a multisystem disorder in which pregnant women have de novo hypertension (increased blood pressure), protein in the urine, blurred vision, headaches, and swelling. It is seen in around two to five percent of pregnancies. It requires treatment by a healthcare provider and usually resolves once the baby is delivered. Preeclampsia is a major contributor to perinatal and maternal morbidity and mortality. Strategies to prevent preeclampsia include antenatal care, lifestyle changes, medications, and nutritional supplementation.

What Is the Cause of Preeclampsia?

The exact cause of the condition in pregnant women is not known. The placenta is the organ that is essential to provide nutrients and oxygen to the developing fetus. It is believed that improper placental function or placental health could cause preeclampsia. It leads to insufficient blood flow to the placenta, which can affect the fetus and the mother. In addition, risk factors such as immune function disorders, stress, family history, poor diet, and improper maternal nutrition could also lead to eclampsia.

What Happens When a Pregnant Woman Has Preeclampsia?

In preeclampsia, the maternal blood pressure is higher than normal (greater than 140/90 mmHg), and the protein levels in the urine (due to kidney function loss) are also high. Due to its multisystemic effect, preeclampsia increases the stress on the pregnant woman's heart and other vital organs, leading to serious complications such as HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), impaired liver and kidney function, and fluid build-up in the lungs. In severe preeclampsia, pregnant women might experience seizures (eclampsia).

In addition, the blood supply to the baby (placenta) is also affected. Preeclampsia can lead to preterm delivery, in which the baby is delivered early. Such babies have an increased risk of low birth weight, breathing issues, and other health complications.

Who Is More Prone to Preeclampsia?

Pregnant women with the following risk factors are more prone to preeclampsia.

1. First pregnancy.

2. History of previous preeclampsia.

3. History of high blood pressure (gestational hypertension) in the previous pregnancy.

4. Family history (indicating mothers and sisters have had preeclampsia).

5. Pregnant women with multiple fetuses.

6. Women with a medical history of high blood pressure before pregnancy.

7. Women with a medical history of kidney disease before pregnancy.

8. Obese pregnant women (with a body mass index (BMI) of 30 or greater).

What Are the Common Symptoms Seen in Preeclampsia?

The condition may develop without any obvious symptoms. The first symptom of preeclampsia is usually high blood pressure. The blood pressure rise may occur slowly or suddenly. Thus, it is important to monitor pregnant women for any changes in blood pressure. To confirm the diagnosis of preeclampsia, the blood pressure is measured on two separate occasions that are at least four hours apart. If both readings are high, exceeding 140/90 millimeters of mercury (mmHg), it is considered abnormal, and the patient is monitored for preeclampsia. The symptoms differ depending on the severity of the condition.

1. Mild Preeclampsia:

   1. High blood pressure.

   2. Water retention.

   3. Protein in urine.

2. Severe Preeclampsia:

   1. Headaches.

   2. Blurred vision.

   3. Inability to see or tolerate bright light.

   4. Nausea or vomiting.

   5. Fatigue.

   6. Urinating less and in small amounts.

   7. Pain in the upper right abdomen.

   8. Shortness of breath.

   9. Bruise easily.

It is essential that the pregnant woman contacts her healthcare provider immediately if she experiences severe symptoms such as blurred vision, abdominal pain, severe headaches, shortness of breath (due to fluid in the lungs), and infrequent urination (kidney impairment).

How Is Preeclampsia Diagnosed?

The doctor checks weight gain, urine, and blood pressure during routine prenatal appointments. If the doctor suspects the possibility of preeclampsia, additional blood and urine tests and fetal ultrasound will be done to confirm the diagnosis. Doppler scans may also be done to measure the placental blood flow. Signs of liver or kidney damage (as indicated by the blood tests and urine proteins), low platelet count, visual impairment, fluid in the lungs, headaches, dizziness, and elevated blood pressure indicate severe preeclampsia.

How Is Preeclampsia Managed?

The treatment depends on the preeclampsia severity, how far along the patient is in her pregnancy, and the patient's general health condition:

• The baby will be delivered early if the pregnant woman is 37 weeks pregnant or close to full term. Medications are administered to help the fetus's lung development and manage the mother's blood pressure.

• If the condition develops earlier in pregnancy, the pregnant woman will be monitored continuously with additional prenatal visits, tests, and ultrasounds, to prolong the pregnancy (so that the fetal development is not affected).

• The patients must also closely monitor their blood pressure at home.

• For mild preeclampsia, the doctor might suggest the following:

  • Rest.

  • Sleep on the left side (to ensure the baby does not press onto the major blood vessels).

  • Frequent prenatal checkups.

  • Less salt intake.

  • Increase water and fluid intake.

  • Increase protein intake.

• In severe cases, the doctors prescribe blood pressure medications until it is safe to deliver the baby, along with dietary changes, rest, and supplements.

• During delivery, the patients are administered magnesium intravenously to prevent the development of seizures from preeclampsia (eclampsia).

How Can We Prevent Preeclampsia?

There is no effective prophylaxis or preventive measure for preeclampsia currently. However, women can take a few steps before and during pregnancy to lower the chance of preeclampsia. These include:

1. Losing weight before pregnancy if the person is obese or overweight.

2. If the person has a history of hypertension and diabetes, maintaining blood pressure and sugar levels is essential before and during pregnancy.

3. Regular exercise routine.

4. Getting sufficient sleep.

5. Consuming healthy food.

6. Getting proper prenatal care.

7. Including garlic, marine oil, and antioxidants (such as vitamins C and E, zinc, and iron) in the diet.

8. Taking calcium supplements

9. Decreasing salt intake.

10. Avoid caffeine.

11. Increasing fluid and water intake (at least six to eight glasses per day).

12. Avoiding junk or fried food.

13. Avoiding alcohol.

14. Keeping feet elevated several times a day.

15. Taking the prescribed medications on time.

16. Intake of the prescribed supplements.

17. For patients with a higher risk of preeclampsia, the doctor may prescribe Aspirin in early pregnancy.

Conclusion

Preeclampsia endangers the health of the mother and the fetus. Though there are no sure methods to prevent it currently, doctors must identify high-risk patients and ensure their health safety through close monitoring of the pregnant woman’s condition. Strategies to prevent preeclampsia include antenatal care, lifestyle changes, medications, and nutritional supplementation. Preeclampsia incidence can be reduced if the women at high risk are identified by the health care providers and given proper antenatal care.