You've Been Diagnosed with Preeclampsia: Now What?
Q&A with Dr. Emma Rodriguez, maternal fetal medicine specialist
Preeclampsia is a serious health problem for pregnant women around the world. It is one of the more common pregnancy complications, affecting about 5 to 8 percent of pregnant women in the U.S. It is also the leading cause of premature birth, contributing to 15 percent of all premature deliveries in the U.S.
The disease is sometimes referred to as a silent killer because most pregnant women can’t “feel” their blood pressure going up. As a result, patient awareness of the early warning signs is one of the most important tools around to successfully help pregnant women receive the immediate care they need.
So, what exactly is preeclampsia, and how can it be managed effectively? We recently sat down with Dr. Emma Rodriguez to talk about preeclampsia and what women need to know. What is preeclampsia? What symptoms should I be looking out for?
Preeclampsia is a serious medical condition characterized by high blood pressure that can happen after the 20th week of pregnancy or after giving birth (called postpartum preeclampsia). Symptoms include high blood pressure, protein in urine, swelling, headaches and blurred vision. This condition needs to be treated by a health-care provider. If left untreated, preeclampsia can endanger the health of the mom and her unborn baby. In the most severe cases, preeclampsia can cause organ failure and even death.
How is preeclampsia diagnosed?
Preeclampsia is diagnosed by measuring a woman’s blood pressure and conducting routine urine tests during prenatal visits. The purpose of the urine test is to see if there is protein in the urine, which can indicate a kidney problem. If the blood pressure reading is high (more than 140/90), especially after the 20th week of pregnancy, and there is protein in the urine, a diagnosis of preeclampsia is made. To determine the severity of the diagnosis, more extensive lab tests may be ordered, including blood tests to evaluate the level of platelets in the blood and to test for abnormally high levels of serum creatinine and liver enzymes in the blood that may suggest impaired kidney and liver function.
Pulmonary edema (excess fluid in the lungs) is another symptom of severe preeclampsia that may present as shortness of breath. What is the typical medication/treatment for a pregnant woman with preeclampsia?
Treatment during pregnancy will depend on the severity of a patient’s high blood pressure and the health of her and her unborn baby. In general, prenatal care may include frequent prenatal visits, close monitoring of blood pressure, adjustments to blood pressure medications as needed, and regular maternal blood testing to check for signs of the condition worsening. In mild cases, patients are monitored more closely as previously mentioned. In severe cases of preeclampsia, treatment may include giving anticonvulsant medications to prevent seizures, corticosteroids to speed up the baby’s lung development and early delivery may be indicated.
What are some common risk factors associated with preeclampsia?
There are certain risk factors that predispose a woman to develop preeclampsia. First, if you had it before with another pregnancy, the likelihood of you developing it again is greater. Also, if you have chronic (pre-existing) hypertension, are pregnant with more than one baby, or have underlying health conditions like type 1 or type 2 diabetes, kidney disease or certain autoimmune diseases, you may be at higher-than-average risk for preeclampsia during pregnancy. Other risk factors include being African American, having a family history of preeclampsia, or having a body mass index (BMI) of 30 or higher.
How can you prevent and/or reduce your risk of developing this condition?
As with most pregnancy-related complications, the best way to prevent preeclampsia is to keep up on all your prenatal appointments, and let your doctor know if you are experiencing any unusual symptoms that need attention. Other ways to decrease your preeclampsia risk is to eat healthy, exercise, and maintain a healthy weight. That means staying away from sugary and processed foods and eating more nutrient dense foods including high-fiber fruits and vegetables, lean proteins, whole grains and dairy. Also, incorporating exercise into your daily routine, like taking a 30-minute walk during the day, will also help. You should consult your doctor about how much exercise you should be getting. For high-risk women, taking a low-dose aspirin (81 mg) daily after 12 weeks of pregnancy may reduce their risk of preeclampsia. Before taking any medications during your pregnancy, check with your doctor first.
What causes preeclampsia?
No one knows for sure what causes preeclampsia, although experts believe it begins in the placenta as your body amps up your blood production to support your growing baby. A decreased blood supply to the placenta in some women may lead to preeclampsia. The genetic makeup of a fetus could predispose a pregnancy to preeclampsia. Because a family history also increases the risk, your own genetics may play a role as well.
How can you manage preeclampsia during pregnancy?
If a woman has been diagnosed with preeclampsia, it is important for them to get plenty of rest and to take prescribed medications to manage their blood pressure. It’s also important to go to regular prenatal visits for close blood pressure monitoring and weekly labs to make sure the preeclampsia hasn’t gotten any worse. Frequent ultrasounds to monitor amniotic fluid and baby’s growth are also very important. Slow fetal growth is often associated with preeclampsia.
How does preeclampsia affect pregnancy and the baby?
Preeclampsia is one of the most common causes of premature births. Unmanaged preeclampsia can prevent a developing fetus from getting enough blood and oxygen and damage a mother’s liver and kidneys. In rare cases, untreated preeclampsia can progress to eclampsia, a much more serious condition involving seizures, or HELLP syndrome, another serious condition that can lead to liver damage and other complications. Additionally, if the condition is not monitored closely and treated promptly, it can also cause the placenta to suddenly separate from the uterus (called placental abruption), which can lead to serious pregnancy complications and death.
If you have preeclampsia, can you carry your baby to full term?
It depends. Your doctor will determine when to deliver based on how far along your baby is, how well your baby is doing in your womb, and the severity of your preeclampsia. If your baby has developed well and preeclampsia is mild, delivery at 37 weeks is recommended. In severe cases of preeclampsia, or if there is evidence of worsening disease, preterm delivery may be indicated. Your doctor may want to induce labor or do a cesarean section to keep preeclampsia from getting worse. The only cure for preeclampsia is to give birth.
Do preeclampsia symptoms go away after your baby is born?
The symptoms of preeclampsia usually go away within six weeks after delivery. In some women, the symptoms stop almost immediately after birth. However, in others, high blood pressure sometimes gets worse the first few days after delivery. Even if you were not diagnosed with preeclampsia before delivery, you are still at risk for preeclampsia for up to six weeks after delivery.
Xochitl Scott developed preeclampsia during her pregnancy. She and her husband leaned on their faith and the expertise of doctors at The Children’s Hospital of San Antonio. Xochitl shared her story with us in January 2022.