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What is Pre-eclampsia?

 Pre-eclampsia is a pregnancy complication characterised by high blood pressure and signs of damage to organ systems, most often the liver and kidneys.

It usually begins after 20 weeks of pregnancy and in women whose blood pressure had previously been normal. Although less common, pre-eclampsia can also occur four to six weeks after your baby has been delivered.

It affects approximately 5% to 8% of all pregnancies in the United States and approximately 6% in the UK and has been on the rise over the last two decades.

Symptoms of Pre-eclampsia

Without regular blood pressure readings and urine tests, pre-eclampsia can be easily missed as it can often be asymptomatic and is a condition that can develop suddenly and out of the blue.

Often, patients say they just feel “off.” They feel lethargic, their head feels spacey and similar to how you might feel when coming down with a cold.

To know if you have pre-eclampsia, you should look out for the following signs and symptoms. These symptoms can both develop gradually or come on rapidly. As they’re often mistaken for normal pregnancy complaints, having regular antenatal check-ups is important.

  • High blood pressure (hypertension): Pre-eclampsia is characterised by an increase in your blood pressure (anything higher than 140 over 90). This can be detected during routine antenatal appointments where your blood pressure will be checked.
  • Protein in your urine (proteinuria): Another sign of pre-eclampsia is the presence of protein in your urine. This can also be detected during routine urine tests conducted during antenatal care.
  • Severe headaches: Some women with pre-eclampsia may experience persistent and severe headaches that do not go away with simple painkillers.
  • Vision problems: Blurring or flashing of vision can be a symptom of pre-eclampsia.
  • Pain just below the ribs: Some women may experience pain or discomfort in the upper abdomen, just below the ribs.
  • Vomiting: In some cases, pre-eclampsia can cause vomiting.
  • Sudden swelling of the face, hands, or feet: Swelling, particularly in the face, hands, or feet, can be a symptom of pre-eclampsia.

It’s important to note that these symptoms can vary in severity and not all women with pre-eclampsia will experience all of them. If you notice any of these symptoms, it is recommended to seek medical advice.

Early detection and monitoring of pre-eclampsia is crucial for the well-being of you and your baby. Regular antenatal appointments and close communication with healthcare providers are essential to identify and manage pre-eclampsia effectively.

Causes, Risk Factors, and Life Expectancy for Pre-eclampsia

The exact cause of pre-eclampsia is still unclear, but it is thought to be related to issues with the placenta. Potential factors include insufficient blood flow to the uterus, damage to blood vessels, or a problem with the immune system’s response to the pregnancy.

Risk factors for pre-eclampsia include first-time pregnancies, family history of pre-eclampsia, maternal age over 40, obesity, and multiple pregnancies (twins, triplets). Pre-existing medical conditions like chronic hypertension, kidney disease, autoimmune diseases, and type 1 or 2 diabetes can also increase your risk.

Studies have also shown that among women with no history of pre-eclampsia, a new father increased the risk of pre-eclampsia by 30%.

Pre-eclampsia doesn’t typically affect life expectancy, but it can cause serious health problems for the mother and baby if not properly managed. These complications may include premature birth, low birth weight, eclampsia, stroke, or organ failure.

Women affected by pre-eclampsia have also been shown to have an increased risk of developing hypertension later in life.

Diagnosis of Pre-eclampsia

Diagnosis of pre-eclampsia involves regular monitoring of blood pressure and checking for protein in the urine during antenatal visits.

Other diagnostic tests may include blood tests to evaluate liver and kidney function, ultrasound scans to monitor the baby’s growth, and Doppler scans to check the blood flow to the placenta.

Treatment and Medication for Pre-eclampsia

While the only definitive cure for pre-eclampsia is the delivery of the baby, healthcare providers aim to manage the condition and prolong the pregnancy to a safe gestational age for delivery.

This involves careful monitoring of the mother and baby, medications to lower blood pressure, and possibly steroid injections to help the baby’s lungs mature faster in case of premature delivery.

Severe cases of pre-eclampsia might require hospitalisation, or if the condition is life-threatening, early delivery might be necessary, sometimes via caesarean section.

In rare cases, a severe and potentially life-threatening complication of pre-eclampsia, known as eclampsia, can occur, characterised by the onset of seizures during or shortly after pregnancy.

The exact frequency of pre-eclampsia progressing to eclampsia varies, but it is estimated that eclampsia occurs in approximately 1 out of 200 patients with pre-eclampsia.

Prevention of Pre-eclampsia

Prevention strategies for pre-eclampsia involve reducing known risk factors and common-sense healthy lifestyle choices.

These include maintaining a healthy weight before pregnancy, taking regular physical activity, eating a diet rich in fruits and vegetables, and avoiding alcohol and tobacco.

For women at high risk of pre-eclampsia, healthcare providers may recommend low-dose aspirin after the first trimester. This decision is made on a case-by-case basis and should be discussed with your healthcare provider.

Scientific Studies on Pre-eclampsia

Research is ongoing to better understand pre-eclampsia, with studies focusing on various aspects like genetics, immunology, and placental biology.

Genomic research is shedding light on genes that may predispose women to pre-eclampsia, while immunological studies are investigating the role of the maternal immune response. Studies on the placenta are aiming to understand why it doesn’t develop correctly in pre-eclampsia.

Emerging research is also focusing on potential biomarkers for early detection and new therapeutic targets for managing the condition. One promising avenue is the use of antihypertensive drugs and antioxidants to mitigate oxidative stress, a key factor in the development of pre-eclampsia.

Summing up Pre-eclampsia

Pre-eclampsia is a complex and potentially serious condition that requires careful monitoring and management.

It is one of the three leading causes of maternal morbidity and mortality worldwide alongside cardiovascular conditions and infections.

But in developed countries, there has been a significant reduction in the rates of pre-eclampsia, maternal mortality, and maternal morbidity over the past 50 years due to universal access to antenatal care, timely care, and proper management of the condition.

With ongoing research and advancements in medical care, healthcare providers are becoming better equipped to manage the condition, ensuring safer pregnancies and healthier outcomes for both mother and baby.

Knowing about pre-eclampsia is crucial for pregnant women and their families. The bottom line is that the earlier it’s diagnosed, the better.

Date of prep: 18th August 2023      Job Number: CNX0004

 

References

https://academic.oup.com/ije/article/30/6/1323/651782

https://emedicine.medscape.com/article/1476919-overview

https://www.nhs.uk/conditions/pre-eclampsia/

https://www.tommys.org/pregnancy-information/pregnancy-complications/pre-eclampsia-information-and-support

https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745

https://www.preeclampsia.org/signs-and-symptoms

https://www.sciencedirect.com/science/article/pii/S1050173808001023

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03992-2

https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/preeclampsia-and-eclampsia

https://healthmatters.nyp.org/preeclampsia-during-pregnancy-your-questions-answered