Diseases and Conditions - Preeclampsia, Causes, Symptoms, Treatment

Preeclampsia is defined as high blood pressure and excess protein in the urine after 20 weeks of pregnancy in a woman who previously had normal blood pressure. Even a slight increase in blood pressure may be a sign of preeclampsia. Left untreated, preeclampsia can lead to serious — even fatal — complications for both you and your baby.

If you have preeclampsia, the only cure is delivery of your baby. If you're diagnosed with preeclampsia too early in your pregnancy for delivery to be an option, you and your doctor face a challenging task. Your baby needs more time to mature, but you need to avoid putting yourself or your baby at risk of serious complications.

Symptoms

Preeclampsia can develop gradually but often starts abruptly, after 20 weeks of pregnancy. Preeclampsia may range from mild to severe. If your blood pressure was normal before your pregnancy, signs and symptoms of preeclampsia may include:

• High blood pressure (hypertension) — 140/90 millimeters of mercury (mm Hg) or greater — documented on two occasions, at least six hours but no more than seven days apart
• Excess protein in your urine (proteinuria)
• Severe headaches
• Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
• Upper abdominal pain, usually under your ribs on the right side
• Nausea or vomiting
• Dizziness
• Decreased urine output
• Sudden weight gain, typically more than 2 pounds (0.9 kilogram) a week

Swelling (edema), particularly in your face and hands, often accompanies preeclampsia. Swelling isn't considered a reliable sign of preeclampsia, however, because it also occurs in many normal pregnancies.

When to see a doctor

Contact your doctor immediately or go to an emergency room if you have severe headaches, blurred vision or severe pain in your abdomen.

Because headaches, nausea, and aches and pains are common pregnancy complaints, it's difficult to know when new symptoms are simply part of being pregnant and when they may indicate a serious problem — especially if it's your first pregnancy. If you're concerned about your symptoms, contact your doctor.

Causes

Preeclampsia used to be called toxemia because it was thought to be caused by a toxin in a pregnant woman's bloodstream. This theory has been discarded, but researchers have yet to determine what causes preeclampsia. Possible causes may include:

• Insufficient blood flow to the uterus
• Damage to the blood vessels
• A problem with the immune system
• Poor diet

Other high blood pressure disorders during pregnancy

Preeclampsia is classified as one of four high blood pressure disorders that can occur during pregnancy. The other three are:

• Gestational hypertension. Women with gestational hypertension have high blood pressure, but no excess protein in their urine. Some women with gestational hypertension eventually develop preeclampsia.
• Chronic hypertension. Chronic hypertension is high blood pressure that appears before 20 weeks of pregnancy or lasts more than 12 weeks after delivery. Usually, chronic hypertension was present — but not detected — before pregnancy.
• Preeclampsia superimposed on chronic hypertension.This condition occurs in women who have chronic high blood pressure before pregnancy who then develop worsening high blood pressure and protein in the urine during pregnancy.

Risk factors

Preeclampsia develops only during pregnancy. Risk factors include:

• History of preeclampsia. A personal or family history of preeclampsia increases your risk of developing the condition.
• First pregnancy. The risk of developing preeclampsia is highest during your first pregnancy.
• New paternity. Each pregnancy with a new partner increases the risk of preeclampsia over a second or third pregnancy with the same partner.
• Age. The risk of preeclampsia is higher for pregnant women younger than 20 and older than 40.
• Obesity. The risk of preeclampsia is higher if you're obese.
• Multiple pregnancy. Preeclampsia is more common in women who are carrying twins, triplets or other multiples.
• Prolonged interval between pregnancies. This seems to increase the risk of preeclampsia.
• Diabetes and gestational diabetes. Women who develop gestational diabetes have a higher risk of developing preeclampsia as the pregnancy progresses.
• History of certain conditions. Having certain conditions before you become pregnant — such as chronic high blood pressure, migraine headaches, diabetes, kidney disease, rheumatoid arthritis or lupus — increases the risk of preeclampsia.

Other possible factors

Researchers are studying whether these factors may be associated with a higher risk of preeclampsia:

• Having other health conditions. There's some evidence that both urinary tract infections and periodontal disease during pregnancy are associated with an increased risk of preeclampsia, which may indicate that antibiotics could play a role in prevention of preeclampsia. More study is needed.
• Vitamin D insufficiency. There's also some evidence that insufficient vitamin D intake increases the risk of preeclampsia, and that vitamin D supplements in early pregnancy could play a role in prevention. More study is needed.
• High levels of certain proteins. Pregnant women who had high levels of certain proteins in their blood or urine have been found to be more likely to develop preeclampsia than are other women. These proteins interfere with the growth and function of blood vessels — lending evidence to the theory that preeclampsia is caused by abnormalities in the blood vessels feeding the placenta. Although more research is needed, the discovery suggests that a blood or urine test may one day serve as an effective screening tool for preeclampsia.

The concluding part of this article will be posted tomorrow.  Remember, health is wealth.