Preeclampsia: Prevention, Management, and Risks

How to Manage Pregnancy-Induced Hypertension and Its Risks

A pregnant woman has her blood pressure checked.
A pregnant woman has her blood pressure checked. Mike Kemp/Getty Images

Preeclampsia is a pregnancy disorder that involves high blood pressure along with other symptoms, such as protein in the urine. Other names for preeclampsia include toxemia, pregnancy-induced hypertension (PIH), and gestosis. Preeclampsia is one of four hypertensive disorders of pregnancy, and can be very serious for pregnant women and their babies. If you have high blood pressure during your pregnancy, your doctor will want to find out if preeclampsia is the cause.

What Causes Preeclampsia?

Doctors aren't sure what causes preeclampsia. The formation and implantation of the placenta seem to play a role, but this isn't always the case. There are many women with placentas that form normally who develop the disorder, and there are many women with poorly formed placentas who go on to have healthy pregnancies.

Although doctors don't know what causes preeclampsia, they do know that certain women are at greater risk than others. Risk factors include:

  • First pregnancy
  • Teen pregnancy
  • Obesity
  • Chronic hypertension
  • Diabetes
  • Twin/multiple pregnancy
  • Previous history of preeclampsia
  • Advanced maternal age
  • Donor egg pregnancies

Because these risk factors are so broad, doctors test every pregnant woman for signs of preeclampsia by measuring blood pressure and checking the urine for protein, usually at every prenatal appointment.

How Does Preeclampsia Affect Pregnant Women?

Preeclampsia is a disease that can cause great harm, and even death, to both mothers and babies.

Even in cases where preeclampsia seems mild, it can become very serious very quickly. If you have preeclampsia, even if you only have a few, mild symptoms, visiting your doctor often is very important.

The first symptom that many people notice is increased blood pressure. Blood pressure usually drops during the first trimester, reaches a low point around 22-24 weeks, then gradually increases.

In women with preeclampsia, blood pressure rises more than normal during the last half of pregnancy.

Because preeclampsia affects many organ systems in the body, increased blood pressure is only one of many symptoms that may be present. Other symptoms of preeclampsia include increased protein in the urine and generalized swelling.

In some women, preeclampsia becomes very severe. Signs that the condition is worsening should be reported to your doctor immediately and include:

  • Reduced urine output
  • Trouble with vision
  • Abdominal pain
  • Headache
  • Nausea/vomiting
  • Seizures

Severe, untreated preeclampsia can lead to HELLP syndrome (a multi-organ syndrome) or eclampsia (a seizure disorder). Both complications are very serious and can lead to death of the mother if not treated promptly.

How Does Preeclampsia Affect Babies?

Preeclampsia affects babies primarily by reducing the amount of blood that flows through the placenta. Because the placenta is the fetus's only source of nourishment, this can cause babies to grow poorly, a condition called intrauterine growth restriction (IUGR).

If a baby is not growing well or if the disease puts the mother's life in danger, doctors may decide that preterm delivery is the safest approach. If there is time and the baby will be very early, doctors may administer steroids to the mother to speed the baby's lung development, or magnesium sulfate to prevent eclampsia in the mother and to help prevent cerebral palsy.

Risks from preterm delivery depend on how many weeks gestation the baby is at delivery. Preeclampsia usually happens near the end of pregnancy, when the baby has mostly matured and will have only mild consequences of prematurity. In some cases, though, the baby must be delivered much earlier and may have more serious health issues. Prior to 23 to 24 weeks gestation, the baby is too young to survive outside the mother.

How is Preeclampsia Treated?

If you are pregnant and have high blood pressure that seems to be related to preeclampsia, your doctor will probably want to watch you very carefully. You may need to schedule more frequent doctor's appointments, and your doctor may ask you to collect your urine for 12 or 24 hours to measure its total protein.

If you have signs of severe or worsening preeclampsia, you may require observation or treatment in a hospital setting. You will be monitored for signs of HELLP syndrome or eclampsia, and your baby's health and growth will be monitored.

Medical treatments for preeclampsia can only address the symptoms, not the disorder itself, and include medicines to lower blood pressure and magnesium sulfate to prevent seizures. Your doctor may prescribe blood pressure medicine for you to take at home, but magnesium sulfate must be given in the hospital.

Although medication may reduce symptoms, it will not cure the disorder. The only cure for preeclampsia is delivery of the baby. Once the baby and placenta have been delivered, the mother will recover. Recovery is not immediate, and the mother may need to be in the hospital for several days or even weeks until she recovers fully.

How Can I Prevent Preeclampsia?

Unfortunately, there is no way to prevent 100% of cases of preeclampsia. Studies have shown that calcium supplementation or low dose aspirin may help some women in specific circumstances, but not enough to recommend them for all pregnant women.

Leading a healthy lifestyle can help you to reduce your risk for preeclampsia. Regular exercise and a diet high in vegetables and low in processed foods have been shown to reduce the incidence of the disorder for some women. Exercise and a healthy diet can also help to control obesity, chronic hypertension, and diabetes, which are all risk factors for preeclampsia.

Sources:

World Health Organization. "WHO Recommendations for Prevention and Treatment of Pre-eclampsia and Eclampsia." (2011) Accessed April 10, 2012.

Schroeder, B. "ACOG Practice Bulletin on Diagnosing and Managing Preeclampsia and Eclampsia." American Family Physician July 15, 2002: 66, 330-334.

Lindheimer, M., Taler, S., Cunningham, G. "ASH Position Article: Hypertension in Pregnancy." Journal of the American Society of Hypertension 2008: 2, 484-494.

Steegers, E., von Dadelszen, P., Duvekot, J., Pijnenborg, R. "Pre-eclampisa." Lancet 2010: 376, 631-644.

Brantsæter, A., Haugen, M., Samuelsen, S., Meltzer, H. "A Dietary Pattern Characterized by High Intake of Vegetables, Fruits, and Vegetable Oils Is Associated with Reduced Risk of Preeclampsia in Nulliparous Pregnant Norwegian Women." Journal of Nutrition Jan 2009: 139, 1162–1168.

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