Do you wonder why you have your blood pressure taken at each of your prenatal appointments? It’s because doctors and midwives are checking for one of the most common signs of pre-eclampsia—high blood pressure. Most women with pre-eclampsia experience mild symptoms and deliver a healthy baby, but in rare cases there can be severe complications including maternal or fetal death. “We want moms to be aware this is a possibility, but at the same time reassure them that they are being cared for,” explains Lisa Valle, an OB/GYN at Providence Saint John’s Health Center in Santa Monica, Calif. Here’s what you need to know about pre-eclampsia to keep both you and your baby healthy.
Pre-eclampsia is a pregnancy complication typically characterized by three main symptoms: high blood pressure, swelling in the hands and feet (also known as edema) and protein in the urine. It can also cause damage to another organ system in addition to the cardiovascular, most frequently the liver and the kidneys. Pre-eclampsia usually starts after 20 weeks of pregnancy, and women can experience it up to six weeks postpartum, though it usually resolves 48 hours after delivery. In most cases, the woman had normal blood pressure before. In the United States, pre-eclampsia occurs in about 3.4 percent of pregnancies. It can lead to serious and, in rare cases, deadly complications for both mother and baby.
The precise cause isn’t known, though some experts believe it may be linked to genetics. “Experts think it likely involves the placenta and the way it forms early on in the pregnancy,” explains Valle. It’s believed that causes insufficient blood flow between the uterus and the placenta.
A woman who has a history of pre-eclampsia is more likely to suffer from it again during following pregnancies. Other factors are chronic hypertension, diabetes prior to pregnancy, being of advanced maternal age (over 35), carrying multiples, having kidney disease, having had a previous organ transplant, having lupus and having a family history of pre-eclampsia.
Hypertension after 20 weeks' gestation is the main sign your doctor or midwife will watch out for. “That’s why when a pregnant patient goes to the doctor, they check their blood pressure every time, since it’s usually the first sign,” Valle says. At home, you should also watch out for signs like vision changes. “Some people claim to see stars,” Valle explains. “Other signs are a headache that isn’t relieved by Tylenol, epigastric pain, which is pain near the liver typically caused by heartburn, bloating, gas, sudden swelling in the hands and face and sometimes nausea and vomiting.” Also watch out for extreme weight gain, which your OB or midwife would likely flag at one of your regular checkups.
The only way to treat it is to deliver the baby and the placenta. “If pre-eclampsia develops early in pregnancy, before 34 weeks, we have to weigh the risks versus the benefits,” Valle says. “If it’s a situation where the pre-eclampsia is mild and the patient is stable, we do watchful waiting and follow the labs and symptoms. But if it worsens, we might deliver the baby. And if the mother is at term, then we deliver right away.”
The management of pre-eclampsia often varies from hospital to hospital, but most women are admitted for bedrest once diagnosed, explains Valle. You should expect frequent blood tests to check your liver and kidney function, as well as to measure your platelets. Urine tests will be done to check for protein in your pee. If the disease gets worse, you will be induced and given steroids if the baby is pre-term. In rare cases, pre-eclampsia can turn into eclampsia, which is when you have one or more seizures during pregnancy. To prevent seizures, you’ll be given magnesium sulfate intravenously. Anti-hypertensive medications are administered to help control severely high blood pressure. A vaginal delivery is usually preferred to avoid the potential complications of a C-section.
Unfortunately, pre-eclampsia can affect your baby. That’s why most women are admitted to the hospital, so they can undergo frequent stress tests and ultrasounds to monitor the baby’s growth and hopefully prevent complications, explains Valle. However, there are still risks you need to be aware of. “There is a situation where pre-eclampsia can cause intrauterine growth restriction, where the baby just doesn’t grow as well,” Valle says. “The baby can also have low amniotic fluid.” Since pre-eclampsia can inhibit blood flow to the placenta, it can cause smaller or prematurely born babies. Additionally, in some cases it can impair liver and kidney function and cause blood-clotting issues, pulmonary edema (fluid on the lungs) and seizures. And in severe cases or when left untreated, it can lead to infant death. When pre-eclampsia is diagnosed pre-term and the baby has to be delivered early, that leads to all of the regular issues with a pre-term birth, such as having to go to the NICU to help the baby breathe.
Most moms with pre-eclampsia will deliver their baby and be absolutely fine, but one in 200 women will develop eclampsia, which is characterized by seizures during or post-pregnancy. “It’s a serious disorder, and the most serious aspect of it can lead to liver rupture, hemorrhages, stroke, placenta abruption (where the placenta detaches from the inner wall of the womb) and an emergency delivery via C-section once the mom is stable and the seizure has resolved,” Valle says. “It’s one of the leading causes of maternal death. It’s important that people understand why it’s key to get prenatal care.” This is obviously a scary list of conditions, but it’s important to remember that the doctors and nurses around you are there to answer any questions or concerns.
Valle says moms should also be aware that they are at an increased risk for cardiovascular disease after the pregnancy, and depending on the severity of their pre-eclampsia, they may experience damage to other organs, including their kidneys, liver, lungs, heart or eyes, which can lead to other problems down the road. About 15 percent of moms with pre-eclampsia will develop HELLP (hemolysis, elevated liver enzymes, low platelet count), a complication of pregnancy that involves signs of liver damage and blood-clotting abnormalities.
“If the doctor recognizes a higher risk of getting pre-eclampsia at an initial visit, he or she can prescribe low-dose aspirin to take throughout the pregnancy to try to prevent it,” Valle says. Aside from that, try to maintain general good health—that means eating healthy, exercising regularly, aiming for your healthiest body weight and minimizing stress where possible. Sometimes, there isn’t much a woman can do to prevent pre-eclampsia, so it’s important to educate yourself on the signs so you can take action as soon as possible.