How is Preeclampsia Detected and Treated During and After Pregnancy?
- Preeclampsia is a serious pregnancy complication affecting 2 – 8% of pregnancies worldwide
- It is marked by the onset of high blood pressure and protein in the urine
- In some countries, an early detection blood test is now available
- New research indicates some women at high risk for preeclampsia can reduce their risk by taking low doses of aspirin
If you’re pregnant—or trying to get pregnant—you may have heard of preeclampsia: a serious and progressive hypertensive (high blood pressure) disorder in pregnancy. It’s usually marked by the onset of high blood pressure and the presence of proteins in your urine, a sign that the kidneys are not functioning properly. It’s one of the most serious pregnancy complications, affecting 2 – 8% of pregnancies worldwide.
But the good news is that exciting new developments are being made in the diagnosis and treatment of preeclampsia.
This post will cover:
- What you need to know about preeclampsia
- Cutting-edge research on how it is detected
- The latest news on how it is treated
What is preeclampsia?
Preeclampsia can come on quite quickly, often without warning and sometimes even without symptoms. The condition can cause your blood pressure to rise and put you at risk of brain injury or organ failure. It usually occurs after the 20th week of pregnancy, but it can also happen any time during your pregnancy and up to 6 weeks after the baby is born.
It’s estimated that over half a million infants and over 75,000 women worldwide die from preeclampsia each year, with a large majority of cases in developing countries. Preeclampsia can also quickly progress to eclampsia—which is a life-threatening condition characterized by seizures and coma.
Why do I need to know about preeclampsia?
If you’re pregnant, it’s important to be aware of the preeclampsia signs and symptoms. If you do have any of the risk factors, your doctor will monitor you more closely because, if left untreated, it can lead to serious, even fatal, complications for you and your baby. So, awareness is key as it can save lives.
How is preeclampsia diagnosed?
Until very recently, the only way doctors could diagnose preeclampsia was by examining previous pregnancies, blood pressure levels, and other symptoms. And in the past, a diagnosis typically wouldn’t happen until the final weeks of pregnancy, when a mother became seriously ill.
But the good news is that some major developments have been made in better detecting preeclampsia, allowing for early intervention.
In Australia, a blood test called the “pre-eclampsia ratio test” is now available. This test was developed after a study at Melbourne Royal Women’s Hospital found it to be 95% accurate in determining whether women with symptoms (like nausea, high blood pressure, and headaches) would go on to develop preeclampsia in the following month. The test also allows doctors to determine the severity of the disease, to determine the best course of treatment for mother and baby.
The SPREE trial in the U.K. was also found to be 82% effective in early detection of preeclampsia. This trial combined maternal risk factors and medical history with testing for four predictors of preeclampsia in the 11th to 13th weeks of pregnancy.
The predictors used were:
- Mother’s blood pressure
- Blood flow in the arteries that supply blood to the uterus
- Levels of two placental hormones: plasma protein-A and placental growth factor (a protein that helps placental blood vessels grow)
Another very recent study also found that RNA molecules from a mother’s blood plasma can detect preeclampsia. This provides more proof that blood tests are a promising way for doctors to detect preeclampsia earlier.
Unfortunately, a blood test to detect preeclampsia is not yet available in the United States. But it is available in some countries, such as Australia. And since the movement towards early detection for preeclampsia seems to be growing—you should ask your doctor about the latest available tests.
How is preeclampsia treated?
If you are diagnosed with preeclampsia, your doctor will monitor you very closely and consider a variety of factors (like your age and health, how far along you are, and how quickly the disease is progressing) in determining how to proceed.
One recent study showed that women at high risk for developing preeclampsia can successfully reduce that risk by taking low doses of aspirin from the 16th week until the end of pregnancy. The study showed that if women took the low dose of aspirin before the 16th week, it cut the risk of preeclampsia in half. Previous studies showed that taking the aspirin after the 16th week didn’t have a significant impact.
What causes preeclampsia?
The exact cause of preeclampsia is unknown, but researchers believe that it has something to do with the way maternal arteries map during pregnancy. Early on in a normal pregnancy, the spiral arteries (which are the maternal blood vessels that feed the uterus) open up into the shape of a funnel. This allows blood and oxygen to pass to the placenta and fetus easily. But in preeclampsia, it’s believed that this funnel develops abnormally and is too narrow to provide an adequate blood supply.
Preeclampsia symptoms and signs include:
- Persistent high blood pressure
- Excessive swelling
- Intense abdominal pain
- Vision changes
- Decreased blood platelets
Who gets preeclampsia?
Preeclampsia most commonly occurs in first pregnancies. But, research published in the British Medical Journal shows that women who have had preeclampsia in past pregnancies are seven times more likely to get preeclampsia in a subsequent pregnancy. While this sounds serious, and the odds are higher than the general population, is still overall fairly low—you’re still more likely to not get preeclampsia again than to get it.
Here are the risk factors, according to the same research above:
- Chronic high blood pressure
- Kidney disease
- Age (Women over the age of 40 are more likely to get preeclampsia)
- Being pregnant with multiples
- African American ethnicity
- Family history of preeclampsia
A variety of studies (linked below) show that preeclampsia is also more common among women with the following health conditions:
- Headaches and migraines
- Rheumatoid arthritis
- Urinary tract infections
- Gum disease
- Polycystic ovary syndrome
- Multiple sclerosis
- Gestational diabetes
- Sickle cell disease
Preeclampsia is also more common in pregnancies resulting from in vitro fertilization, egg donation, or donor insemination. It’s important to also note that women with no known risk factors— who are otherwise completely healthy and have unremarkable pregnancies—can also get preeclampsia.
How does it affect pregnancy?
If you have preeclampsia while pregnant, it creates a balancing act of allowing the baby enough time to grow in utero while also not putting you or the baby at risk.
What’s concerning is that preeclampsia can often be “silent,” showing up unexpectedly during a routine blood pressure or urine test. Your doctor will work with you figure out the way to treat it and may recommend bed rest, medication or even hospitalization to monitor your blood pressure.
Can preeclampsia occur after the baby is born?
Yes—this is called postpartum preeclampsia. While preeclampsia usually develops during the first trimester, it can appear anytime during pregnancy and even up to 6 weeks postpartum. After delivery in particular, it can be overlooked; Mothers not feeling well in the days and weeks after delivery may attribute it to normal post-birth recovery.
So, if you feel any of the symptoms listed above (such as headaches, stomach pains, nausea, vision problems, increased swelling or just feeling “off”) contact your doctor right away.
How does it affect the baby?
Worldwide, preeclampsia is responsible for up to 20% of the 13 million preterm births each year.
And the sad reality is infant death is one of the most devastating consequences of preeclampsia. In the U.S. approximately 10,500 babies (and an estimated half a million worldwide) die from preeclampsia each year.
How can I prevent preeclampsia?
Though there is not yet a way to definitively prevent preeclampsia, the best thing you can do is to get excellent prenatal care. Talk to your doctor about the latest research and screenings, especially if you have any of the known risk factors.