Pregnancy is generally thought of as a wonderful, magical time. Although that certainly can be so, it’s also a time of great risk for a woman’s health.
Women’s bodies change in many ways to accommodate pregnancy, but sometimes these changes lead to health conditions such as diabetes, high blood pressure, blood clots, excessive bleeding, infection, liver dysfunction, kidney problems, heart failure and depression. These conditions can be life-threatening, and the U.S. shockingly is the only developed nation with a rising rate of maternal mortality, with state-specific rates of maternal death ranging between 5.9 to 40.7 women for every 100,000 live births, according to the American College of Obstetricians and Gynecologists.
One of the leading causes of maternal mortality worldwide is preeclampsia. In my practice, I’ve found that many women are unaware of preeclampsia or mistakenly believe it to be a malady of the past. Some are familiar with it only as the condition that took the life of Lady Sybil in the fictional TV series Downton Abbey in 2013. However, preeclampsia — which can be dangerous for both the mother and the baby — is responsible for 8 percent of maternal deaths in the U.S., according to a recent report by NPR and ProPublica.
What is it?
Preeclampsia begins early in pregnancy with abnormal development of the vessels of the placenta within the womb.
The disease doesn’t typically begin to show any outward signs, however, until the second half of pregnancy, usually in the third trimester and most of the time not until the pregnancy is at term. Women often present with symptoms such as fluid retention, headaches, vision changes, upper abdominal pain and high blood pressure.
In the setting of preeclampsia, blood pressure can become so high that it causes a woman to have a stroke.
It can contribute to poor functioning of the placenta, low fluid around the baby and small growth of the baby. It may lead to premature separation of the placenta from the uterus (called a placental abruption).
Preeclampsia can cause temporary and permanent damage to multiple organs in the mother; or the mother’s lungs may fill with fluid (called pulmonary edema), leading to restricted oxygen for her and the baby.
Women have seizures when preeclampsia progresses to eclampsia, most often in the 48 hours postpartum, the condition TV viewers observed with Lady Sybil after the birth of her daughter.
Who’s at risk?
Preeclampsia can develop in any pregnancy — including in mothers with otherwise normal blood pressure — but factors that place women at highest risk include:
- First pregnancy
- History of preeclampsia in a previous pregnancy
- Age 40 or older
- High blood pressure outside
- of pregnancy
- Kidney disease
- Pregnancy conceived by in-vitro fertilization
- Twins or multiples.
What are the signs?
Preeclampsia is sometimes difficult to immediately diagnose as potential symptoms can be vague and common in pregnancy in general — and women with it don’t always feel unwell.
The severity and number of symptoms are important to consider: Women might experience headaches, vision changes (blurry vision or spots in the vision), difficulty breathing, pain in the middle or right side of the upper belly or a sudden increase in swelling, particularly in the hands and face. Women should always mention these symptoms to a health-care provider during pregnancy.
One of the big reasons women are seen so frequently later in pregnancy is for blood-pressure monitoring to detect sudden elevations. Although it’s part of normal pregnancy physiology for blood pressure to increase at the end of pregnancy, measurements that fall in the range of hypertension aren’t expected.
If there’s a concern about preeclampsia, in addition to watching your blood pressure closely, your health-care provider will likely order tests to look at your blood counts, liver function, kidney function and the protein content of your urine.
How is it treated?
The best treatment for preeclampsia is delivery of the baby.
Depending on how far along a woman is in her pregnancy, the risks of preeclampsia and its severity must be closely weighed against the risks of prematurity of the baby before an early delivery is pursued.
Depending on the severity of preeclampsia, medications may be a part of management. This includes medications to prevent blood pressure from becoming dangerously high and IV-delivered magnesium sulfate to reduce the risk of seizures.
What happens after delivery?
Although delivery of the baby is a big part of treatment, health risks to the mother persist after delivery. Sometimes the condition doesn’t even arise until the postpartum period, up to six weeks after delivery.
Most women who ultimately die from preeclampsia die postpartum. Women who have had preeclampsia during the pregnancy are seen back in the office sooner and more frequently postpartum than women who had uncomplicated pregnancies.
They may be instructed to take their own blood pressure at home or set up to have a nurse perform this assessment for them.
All women should continue to monitor for symptoms of preeclampsia postpartum and present to their health-care provider’s office or emergency room if they have persistent headaches, vision changes (spots or blurry vision), chest pain, troubles breathing, pain in the upper belly or sudden onset of severe swelling.
How can it be prevented?
Women at high risk for the development of preeclampsia may be able to reduce their risk by taking a daily baby aspirin throughout the pregnancy.
There are no other interventions that have been shown by research to decrease the risk or to prevent the disease altogether.
If you have more questions about preeclampsia and how it might affect your pregnancy, talk to your health-care provider.
Dr. Erin Stevens sees patients at the Edina location of Clinic Sofia, a leading OBGYN clinic known for its personalized approach to women’s health care. She is a member of the American College of Obstetrics and Gynecology. Learn more at clinicsofia.com.