Preeclampsia: You've probably heard of this pregnancy condition...but what's really happening?

While May is usually marked by the appearance of the infamous Justin Timberlake meme on your Twitter and Instagram feeds, but it just so happens to be Preeclampsia Awareness Month, too. Preeclampsia is a disorder that impacts up to 4.6 percent of pregnancies worldwide. TBH, some friends have admitted to occasionally nodding when they hear the term “preeclampsia.” But in reality, they have zero clue what it actually means. (Hey, we’ve all been there.) So what is preeclampsia, actually? As a Women’s Health Nurse Practitioner (WHNP), here’s how I break it down for patients and friends:

Preeclampsia basics

Preeclampsia is a condition that is only seen in pregnancy and the immediate postpartum period. While preeclampsia is a vascular issue at its core (AKA arteries and veins), it can also affect the lungs, kidneys, and liver, to name a few. Experts at The Mayo Clinic write, “Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal. Even a slight rise in blood pressure may be a sign of preeclampsia.” Quick refresher: Blood pressure refers to the amount of pressure your blood is exerting against your artery walls when the heart is beating and resting.

Preeclampsia, if not well-controlled or managed, can lead to something called eclampsia. This refers to the presence of a seizure in the pregnant mother, which is serious and due to high extremely high blood pressure. The term “eclampsia” actually comes from the Greek word for “thunder,” and was first used to describe the condition in 1619. However, there is written evidence from Hippocrates in the fourth century describing “a headache accompanied by heaviness and convulsions during pregnancy” (Bell, 2010).

Preeclampsia can be found listed in the top four causes of maternal deaths in the United States and is responsible for up to 10 to 15 percent of maternal deaths worldwide. Because it is a vascular condition, it can also impact the baby. (After all, the mother and the baby are physically connected through the placenta — the baby’s lifeline.) Here’s how this works: Preeclampsia can prevent proper nutrient transport to the fetus. Because of this, it’s not uncommon to see intrauterine growth restriction (IUGR). This occurs when the baby falls under the tenth percentile on growth charts due to poor nutrient transport from placenta to the fetus.

Let’s talk symptoms
Here’s the thing: preeclampsia is a particularly difficult condition to diagnose because it’s multifactorial. One symptom (like elevated blood pressure) makes providers look closer, but more labs and monitoring are needed before a diagnosis can be made. Meaning, just because you have high blood pressure doesn’t necessarily mean you have or are developing preeclampsia.

It’s important to come to your prenatal visits as frequently as your provider advises, since this is the opportunity to gather information, potentially diagnose, and provide care. While prenatal visits may feel quick, a lot of information can be gathered from your blood pressure, urine, and straight from your mouth — seriously. It’s always important to tell your provider if you’re experiencing anything unusual. In the chart below, common signs and symptoms of preeclampsia are listed in both medical textbook (and human!) terms.

Talk text book to me

Elevated blood pressure

  • Blood pressure is recorded as two numbers: A top number (systolic) and a bottom number (diastolic). A systolic measures the amount of pressure your blood exerts on the artery walls when your heart is beating. A diastolic measures the same thing, but when the heart is resting. A systolic over 160 and diastolic over 110 indicates high blood pressure.
  • Blood pressure will be checked at every prenatal visit but can also be checked at home if you’ve got an at-home device.

Protein in the urine

  • Nope — they’re not looking for chicken in your pee. While this will show up on a urine test, it’s not visible to the naked eye.
  • Come to all your prenatal visits with a full bladder, as this will get checked at every visit.

Edema

  • AKA swelling. With preeclampsia, it occurs in more than just your hands or feet—which is common with pregnancy. Your legs, arms, and face may be affected.

Headache and visual changes

  • Headaches and seeing spots can indicate high blood pressure.

Right upper-quadrant pain

  • Pain in the upper stomach, especially on your right side. This can easily be confused with heartburn — something common in pregnancy.
  • Your provider can help you differentiate, so make sure to tell them if this is something you’re experiencing.

Pulmonary edema

  • Difficulty breathing or taking a deep breath. While this may be a normal during pregnancy (babies press on your diaphragm, making it harder to breathe), it’s still important to mention to your provider.

What causes preeclampsia and what are the risk factors?

The medical community is saying “TBD” regarding what exactly causes preeclampsia, but they have a few strong hunches. “Experts believe preeclampsia begins in the placenta — the organ that nourishes the fetus throughout pregnancy,” write experts at The Mayo Clinic. “Early in pregnancy, new blood vessels develop and evolve to efficiently send blood to the placenta. In women with preeclampsia, these blood vessels don't seem to develop or function properly. They're narrower than normal blood vessels and react differently to hormonal signaling, which limits the amount of blood that can flow through them.”

OK — but what’s behind this placental issue? Possibly a few things, including insufficient blood flow to the uterus, damage to the blood vessels, a problem with the immune system, or certain genes. In terms of genes, African American women and those with a family history of the condition (even more of a reason to talk to your mom) are more likely to deal with preeclampsia.

Preeclampsia tends to be seen more often in first-time pregnancies, those pregnant with twins or more, and women with a history of vascular disorders, lupus, or renal disease. Obesity, primary hypertension, and type 1 or type 2 diabetes, are also known to predispose someone to developing preeclampsia.

Can I prevent this from happening?

While not all cases of preeclampsia can be prevented (thanks to those good ‘ol genes), don’t worry: there are things you and your provider can do to prevent and treat preeclampsia. First and foremost: Proper prenatal care is hugely important for early diagnosis and proper management. (AKA: when you become pregnant, don’t skip a visit!) Each appointment gives your provider the opportunity to check your urine, check your blood pressure, and discuss how things are going outside of the doctor’s office. After all, you know your body best and will be able to clue us in on any possible early signs of preeclampsia.

In addition to attending your regularly scheduled visits, weight loss is encouraged for women who are overweight or obese prior to pregnancy, as obesity is a risk factor for developing preeclampsia. Proper weight management may also stave off diabetes, which is another a risk factor for developing preeclampsia. If you are considering getting pregnant and are worried about your weight, pay your provider a visit to help you come up with a plan.

Once diagnosed, how is preeclampsia treated?

The ultimate treatment for preeclampsia is delivery of the baby and of the placenta. Think of it this way: Since the condition likely develops in the placenta, removing the placenta from the body is a form of treatment. However, this isn’t always the best option, especially if you’re early in your pregnancy. In this case, managing preeclampsia rather than treating it is the best option.

Management typically involves close follow-up and observation. Meaning, your blood pressure, urine, and the baby’s growth (checked via ultrasound) will be monitored more frequently. Occasionally, blood pressure medications are used. These work to decrease the mother's risk of a stroke, but do little else in managing the condition. A medication called magnesium sulfate may also be used to aid in prevention of eclampsia (again, this is a seizure that can result from severe preeclampsia). In most cases, delivery of the placenta treats the condition entirely.

So once I deliver, I’m in the clear?

Not quite, unfortunately. There are some possible long-term effects of developing preeclampsia in pregnancy. The rate of recurrence in subsequent pregnancies is 16 percent. There is also an increased risk of cardiovascular disease, but risk varies based on the severity of preeclampsia. The more severe, the higher the likelihood of developing cardiovascular disease.

Preeclampsia can also be initially diagnosed after delivery (bizarre, I know — it baffles me, too). This is known as postpartum preeclampsia. While the medical community is not certain sure why this happens, there’s a possibility that preeclampsia may develop after two days postpartum, but less than six weeks postpartum. Risk factors and symptoms of postpartum preeclampsia are the exact same as risk factors for preeclampsia.

What this means for you, right now

Preeclampsia is a serious, life-threatening condition that can affect women both during and immediately following pregnancy. If you’re considering pregnancy as a part of your future, here’s what you can do: first, take steps to ensure your body is healthy before conceiving, like keeping your weight in a healthy range. Second, learn as much as you can about pregnancy complications like preeclampsia. Even if you’re a ways away from conceiving, there’s zero harm in getting up to speed on issues encountered during pregnancy. When the time eventually comes, you’ll be able to confidently tackle whatever comes your way.


Kara Earthman

Kara Earthman is a Women's Health Nurse Practitioner (WHNP) and writer living and working in Nashville, TN. You can find more of Kara's work on her blog EarthWoman.

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