Pregnancy and Preeclampsia
Hi, I’m Saba, homemaker, cake baker, mother to a beautiful (ever-so-terrible) two year old and in my previous life (reads: when I had a life) I was a biomedical scientist. My journey of life thus far, has been full of amazing experiences and I am grateful for all the opportunities I have had.
To tell you a bit about my educational background, I have a degree in Biomedical Sciences and a published research project focusing on preeclampsia. Further to this, I have worked in scientific publishing and as a health consultant for Save the Children.
Going forward I will be discussing various health topics with you all. From common health problems to more serious ones, I’ll be going through a whole range of them. And of course, if there is anything in particular you would like to know about, feel free to let me know and maybe I can cover that too.
Today, I’d like to talk to you all about Preeclampsia (PE). If you’ve experienced pregnancy, you may have heard of this at some point. Unless you’re one of the lucky ones (and I hope you all are), pregnancy can be a very challenging time; from swollen ankles, nausea to aches and pains in places you didn’t even know existed! And for those women that have experienced PE, they can tell you it’s not the best of conditions to have. So here goes…
What is PE?
Preeclampsia (PE) is a multifactorial medical condition characterized by hypertension, proteinuria, edema and/or organ dysfunction that occurs after 20 weeks gestation, complicating 2-5% of all pregnancies. Though PE is asymptomatic (i.e. it may not show any obvious symptoms) it can have a significant impact on the health of both the mother and baby. The first time you may hear about this condition is at one of your regular antenatal appointments. It is therefore strongly advised to attend your appointments regularly, as an early detection of PE is paramount in its treatment.
What are the Signs, Symptoms and Diagnosis?
As aforementioned, PE is asymptomatic so symptoms are not usually very obvious. Many tests have been proposed as possible markers for the prediction of PE, however most have been shown not to be clinically useful as a screening test for PE. Your doctor or health care professional will usually pick up signs when they take your blood pressure and samples of urine.
The two initial diagnostic factors are hypertension and proteinuria.
- Hypertension, also known more commonly as high blood pressure can be defined as systolic blood pressure at 140mmHg and diastolic pressure at 90mmHg. Any readings higher than these classify as having high blood pressure (BP). Even if PE is not present, hypertension can be an indicator of other problems and thus your doctor may require you to monitor your BP more often. The BP to diagnose PE must be taken on two occasions at least 6 hours apart for a diagnosis to be made.
- Proteinuria can be defined as the presence of 300mg/L or more protein in a 24-hour urine specimen. Both hypertension and proteinuria must be present for mild PE to be diagnosed.5
Other signs and symptoms associated with PE are:
- Edema (swelling). Whilst it is quite normal to have some swelling during pregnancy, more severe swelling in your hands, face and feet could be a sign of PE.
- Rapid weight gain
- Problems with vision. Usually, not being able to tolerate bright or flashing lights.
- Severe headaches that don’t seem to go away with over the counter medication.
- Pain just below the ribs
Conversely, the diagnosis of severe PE includes the involvement of a number of other symptoms. Severe PE is diagnosed when the systolic blood pressure exceeds 160mmHg and diastolic blood pressure is above 110mmHg, and there is 500mg/L or more proteinuria in a 24-hour urine specimen.
It is essential that the severity of the condition be diagnosed correctly, since mild and severe PE require different management. Other than the clinical criteria, laboratory evaluation can help determine the severity of the disease; for example elevated levels of serum creatinine concentration suggest renal deficiency and serum alanine and aspartate aminotransferase concentrations (ALAT and ASAT) indicate sever PE and HELLP syndrome.6
Whilst most cases of PE are mild and improve soon after the baby is delivered, there is a chance of more serious complications arising if left undiagnosed and untreated. Complications could include renal failure, HELPP syndrome (haemolysis, elevated liver enzymes, and thrombocytopenia), seizures, coma, stroke or even death.1
When compared to healthy pregnant women, women with PE have a decreased rate in both renal blood flow and glomerular filtration rate. Renal injury often leads to liver complications including the HELLP syndrome and hematological changes involve an increase in platelet turnover and disseminated intravascular coagulation (DIC). Another major complication in PE is thrombocytopenia; one of the most frequent coagulation abnormalities.4
Other symptoms include epigastric or right upper quadrant pain/ elevated transaminases, persistent visual disturbances, severe headaches, hyperreflexia, fetal growth restriction and pulmonary edema (in severe PE) along with other organ dysfunction.
In more severe cases, PE can lead to Eclampsia, which can cause neurological disorders and convulsions due to poor cerebral perfusion. Eclampsia often leads to seizures, coma and death.
Risk factors for PE include:
- Past obstetrical history of preeclampsia
- Advanced maternal age
- Maternal co-morbidities, such as chronic hypertension, obesity, diabetes, kidney disease
- Multiple gestation
- Genetic factors and paternal factors.2
(Your chances of having PE are high if you have two or more of the above-mentioned risk factors together.)
The exact pathophysiology or etiology of PE is unknown though the general consensus is that the pathology is caused by endothelial cell disorder resulting in mild to severe microangiopathy of target organs such as the placenta, liver and kidney.
As aforementioned, the exact pathophysiology or etiology of PE is unknown and there is no known cure either. The only curative treatment available is the delivery of the baby. So usually a woman with PE will be closely monitored, sometimes hospitalized up until the point she is able to deliver her child, usually after 37 weeks gestation. Numerous prophylactic treatments are available for the management of PE such as the use of antihypertensive drugs to control mildly elevated blood pressure, corticosteroids to promote fetal lung maturity and anticonvulsant therapy to prevent severe PE developing into Eclampsia.
However, one of the most common treatments and the drug of choice, used in the management of PE is magnesium sulfate. Many research studies have shown the effectiveness of the use of magnesium sulfate. Results from the Magpie trial7 showed that magnesium sulfate halves the risk of eclampsia; and probably reduces the risk of maternal death. But the most important thing is to attend antenatal appointments on time, reporting any symptoms you may feel are concerning, and then to be monitored closely up until the safe arrival of your child.
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1 Lal H, Gulati N, Sandooja N, Chugh
- (1995) Plasma and erythrocyte magnesium levels in patients with preeclampsia/eclampsia.
Indian Journal of Clinical Biochemistry; 103-‐105
2 Duckitt K, Harrington
- (2005) Risk factors for preeclampsia at antenatal booking: systematic review of controlled studies.
- (2002) Contemporary concepts of the pathogenesis and management of preeclampsia.
- (1990) Diagnosis, controversies, and management of the syndrome of haemolysis elevated liver enzymes, and low platelet count.
Obstet Gyencol; 460-‐5
- (2006) Searching for genetic clues to the causes of preeclampsia.
The Biochemical Society, Journal of Clinical Science; 443
- (2001) Primary, secondary and tertiary prevention of preeclampsia.
The Lancet. Vol. 357; 209-‐215
7 The Magpie Trial Collaborative Group.
- (2002) Do women with preeclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomized placebo controlled trial.
The Lancet. Vol. 359; 1877-‐1890