Preeclampsia, also known as toxemia, is a life-threatening condition that affects only pregnant women, usually late in the second or third trimester, and postnatal women in the first six weeks after delivery. Preeclampsia can range from mild to severe and often develops suddenly, with two major symptoms of protein in the urine and high blood pressure.
Preeclampsia affects about one in 20 pregnant women and their unborn children, and is the leading cause of maternal death worldwide. It is also a leading cause of fetal complications, including low birth weight, premature birth, and stillbirth. If not treated, preeclampsia can worsen into eclampsia, a potentially fatal condition that causes seizures.
Preeclampsia can only cured by ending the pregnancy, either by induction of labor or cesarean. If it is too early for the baby to be delivered, your doctor will work with you to minimize symptoms and risk of complications until you can deliver safely.
While researchers do not know the specific cause or causes of preeclampsia, they do know that the result of preeclampsia is a narrowing of blood vessels. Because of this narrowing, women with this condition can experience decreased blood flow to the:
Liver
Brain
Retina
Kidneys
Placenta.
While the cause of preeclampsia is unknown, doctors do know that certain factors will increase a woman's chances of developing the condition. These are known as preeclampsia risk factors. These risk factors include:
Having chronic hypertension (high blood pressure) before becoming pregnant
Being obese prior to pregnancy
Having developed high blood pressure or preeclampsia during a previous pregnancy, especially if these conditions occurred early in the pregnancy
Being pregnant under the age of 20 or over the age of 40
Being pregnant with more than one baby
Having diabetes, kidney disease, rheumatoid arthritis, lupus (SLE), or scleroderma.
preeclampsia cannot happen until at least the 20th week of pregnancy. Most cases occur in the third trimester (from week 27 to the birth of the baby).
Pregnant women with preeclampsia develop the following symptoms first:
high blood pressure (hypertension)
proteinuria (protein in the urine)
You probably won't notice these symptoms, but your doctor or midwife should pick them up during your antenatal appointments.
High blood pressure affects 10-15% of all pregnant women, so this alone does not suggest preeclampsia. However, the presence of protein in the urine is a good indicator of the condition.
As preeclampsia develops, it can cause fluid retention (edema), which often causes sudden swelling of the feet, ankles, face and hands.
Edema is another common symptom of pregnancy, but it tends to be in the lower parts of the body, such as the feet and ankles. It will gradually build up during the day. If the swelling is sudden, and it particularly affects the face and hands, it could be preeclampsia.
As preeclampsia progresses, it may cause:
severe headaches
vision problems, such as blurring or seeing flashing lights
pain in the upper abdomen (just below the ribs)
vomiting
excessive weight gain due to fluid retention
feeling generally unwell
If you notice any symptoms of preeclampsia, seek medical attention immediately.
Without immediate treatment, preeclampsia may lead to a number of serious complications, including:
eclampsia (convulsions)
HELLP syndrome - a combined liver and blood clotting disorder
stroke
However, these complications are rare.
The main sign of preeclampsia in the unborn baby is slow growth. This is caused by poor blood supply through the placenta to the baby.
The growing baby receives less oxygen and fewer nutrients than it should, which can affect development. This is called intra-uterine growth restriction, or intra-uterine growth retardation.
If you have a mild case of preeclampsia, your doctor may recommend bed rest. You should lie on your left side, so the weight of the baby won't press against important blood vessels. Drink a lot of water to help you urinate and get rid of excess fluids. Your health care provider may want to monitor your blood pressure and urine every couple of days. The goal is to manage your symptoms until at least 36 weeks in your pregnancy, when the baby may be safely delivered.
If you have severe preeclampsia, it may not be possible to wait that long. Your doctor may admit you to the hospital, where you will receive drugs to induce labor, or have a cesarean section.
Your doctor may prescribe the following drugs intravenously (IV):
Magnesium sulfate or hydralazine, to reduce your blood pressure
Calcium gluconate, if your blood pressure falls too low
Furosemide, to help you urinate more
In severe cases, your doctor may prescribe medications to lower your blood pressure. Your doctor may also give you corticosteroids to help the baby's lungs develop faster before an early delivery.
If you have preeclampsia, you should be under the care of an obstetrician. Do not try to self-treat preeclampsia with complementary and alternative therapies. If you want to use complementary and alternative therapies along with conventional medical treatment, be sure that your obstetrician supervises all your therapies. Some of the more common therapies are described below.
Some supplements may help prevent preeclampsia but do not help once you have the condition. Others, intended to reduce symptoms once you have the condition, show mixed results in scientific studies. Note: If you are pregnant, do not take any of these supplements without a doctor's supervision.
Preventing preeclampsia:
Calcium (2,000 mg per day) -- If you have low levels of calcium or are at risk for high blood pressure, some studies show 2,000 mg of calcium per day may lower the risk of developing preeclampsia. Taking calcium does not seem to reduce risk of developing preeclampsia in healthy women, and not all studies show the same result.
Vitamin D -- Some studies suggest that having low levels of vitamin D raise a pregnant woman' s risk for preeclampsia. And one preliminary study found that taking vitamin D supplements appeared to reduce risk of preeclampsia. However, women in the study also consumed high levels of omega-3 fatty acids (found in fish oil), so researchers aren't sure if it was vitamin D or the combination that reduced risk.
Folic acid (5 mg per day) and vitamin B6 (250 mg per day) may help prevent symptoms in women with a history of preeclampsia and high homocysteine levels.
Vitamin C (1,000 mg per day) and vitamin E (400 IU per day) may help reduce risk of preeclampsia. Some studies have found no effect, however. Neither seems to help once you have the condition.
Lycopene (2 mg two times per day). Further studies are needed to confirm results.
Magnesium (200 mg two to three times per day) was shown to help reduce risk in one study, but another study showed no effect.
Treatments for preeclampsia:
These treatments require close supervision by your doctor.
Studies show mixed results for l-arginine, an amino acid, given either intravenously (IV) or orally. Your doctor should determine the dose. Some studies suggest that it may help when given long-term throughout pregnancy.
Magnesium sulfate, given by injection, can help lower blood pressure.
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to determine a diagnosis before pursuing treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink two to four cups per day. You may use tinctures alone or in combination as noted.
Note: Do not use these herbs without your doctor's supervision.
No studies have found any herbs effective for preeclampsia. Herbs that have traditionally been used to treat mild high blood pressure in pregnancy include:
Hawthorn berries (Crataegus laevigata)
Cramp bark (Viburnum opulus)
Milk thistle (Silybum marianum)
Use equal parts of each in a tincture, 20 drops three to four times a day.
May help lower blood pressure and increase circulation.
If preeclampsia is not diagnosed and monitored, a number of serious complications can develop.
Although complications from preeclampsia are rare, having severe preeclampsia or continuing to smoke with preeclampsia increases the risk of complications.
Eclampsia is a term that describes a type of convulsion (involuntary contraction of the muscles) that pregnant women can experience, usually from week 20 of the pregnancy, or immediately after the birth. Eclampsia is quite rare and in the UK there are around 5 cases of eclampsia for every 10,000 births.
During an eclamptic convulsion, the mother's arms, legs, neck or jaw will twitch involuntarily in repetitive, jerky movements. She may lose consciousness and may wet herself. The convulsions usually last less than a minute.
While most women make a full recovery after having eclampsia, there is a small risk of permanent disability or brain damage if the convulsions are severe. Of thoses who have eclampsia, around 1 in 50 will die from the condition. Unborn babies can suffocate during a seizure, and 1 in 14 may die.
Research has found that magnesium sulphate can halve the risk of eclampsia and reduce the risk of the mother dying. It is now widely used to treat eclampsia after it has occurred, and to treat women who may be at risk of developing eclampsia.
HELLP syndrome is a combined liver and blood clotting disorder that can affect pregnant women. It is most likely to occur immediately after the baby is delivered, but can appear any time after week 20 of the pregnancy.
The letters in the name, HELLP, stand for each part of the condition:
H is for haemolysis. This is where the red blood cells in the blood break down.
EL is for elevated liver enzymes (proteins). A high number of enzymes in the liver is a sign of liver damage.
LP is for low platelet count. Platelets are cells in the blood that help it to clot.
HELLP syndrome is potentially as dangerous as eclampsia, and it is slightly more common. The only way to treat the condition is to deliver the baby as soon as possible. Once the mother is in hospital and is receiving treatment, it is possible for her to make a full recovery. The main danger to the baby is from premature birth (being born before the 37th week of pregnancy).
Premature babies often have a low birth weight and find it hard to breathe on their own. It is likely they will need to stay in neonatal intensive care for close supervision. If the baby's birth weight is less than 1,500g (3.5lbs), the baby has a one in six chance of dying before their first birthday.
Blood supply to the brain can be disturbed as a result of high blood pressure. This is known as a cerebral haemorrhage, more commonly stroke. If the brain does not get enough oxygen and nutrients from the blood, brain cells will start to die.
Pulmonary edema is where fluid builds up in and around the lungs. This stops them from working properly by preventing them from absorbing oxygen.
Kidney failure is when the kidneys cannot filter waste products from the blood, causing toxins and fluids to build up in the body.
Liver failure causes disruption to the functions of the liver. The liver has many functions, including digesting proteins and fats, producing bile, and removing toxins. Any damage that disrupts these functions could be fatal.
The mother's blood clotting system can break down (known medically as disseminated intravascular coagulation) and the proteins that control blood clotting become abnormally active.
If you wear rings, take them off as soon as you start having symptoms. Swollen fingers can make it difficult (or even impossible) to remove rings, and they may begin to cut off circulation in your fingers.
Symptoms of preeclampsia can appear gradually and suddenly get worse -- or you may not have any visible symptoms at all. The best way to prevent any complications from preeclampsia is to get regular prenatal care. Your health care provider can recognize early signs of preeclampsia and get treatment for you immediately.
Preeclampsia that happens early in your pregnancy and preeclampsia that is severe may put you at higher risk for heart disease. Your health care provider may recommend more frequent screening for heart disease risk factors.