Although it’s relatively uncommon, affecting just 3.4 percent of pregnancies in the US each year, preeclampsia is a complication that can have serious long-term health effects for mom and baby. The condition is characterized primarily by higher-than-normal blood pressure during pregnancy or after giving birth. Postpartum preeclampsia typically occurs within 48 hours of delivery but can also develop in the weeks following. It may also involve elevated levels of protein in urine and a decrease in blood platelets. Preeclampsia typically occurs after 20 weeks of pregnancy, about half-way through a woman's second trimester. Without proper medical attention, it can increase the mother's risk of organ damage and seizures, among other serious outcomes, and potentially lead to stillbirth.
We spoke with Jennifer Guggenheim, MD, an OBGYN with Presbyterian/St. Luke's Medical Center, to learn more about the risks and causes of preeclampsia, as well as the treatment options you need to know about.
Spot the signs
It's possible for preeclampsia to develop without any symptoms at all, in which case it will likely be detected only during routine screenings. Although a case of asymptomatic preeclampsia is often less severe than one that presents with symptoms, the condition is progressive, so even mild cases should be closely monitored by a healthcare provider. Your doctor will track blood pressure throughout your pregnancy. A level that exceeds 140/90 millimeters of mercury (mm Hg) on two different occasions (at least four hours apart) is considered abnormal and requires attention. Blood pressure readings greater than 120/80 millimeters of mercury (mm Hg) may not signal preeclampsia, but they're not normal for pregnant woman, and may prompt your doctor to watch your levels more closely.
Some women with preeclampsia do present with outward symptoms, including:
- Severe headaches
- Vision changes, including blurred vision and light sensitivity
- Nausea and vomiting
- Difficulty breathing
- Swelling of the arms, legs, hands, feet and face
- Abdominal pain
"For patients who have any of these symptoms, it's worth calling their physician's office," Dr. Guggenheim says. "It's so much better to call with a concern than to miss something and end up in trouble."
Understand the causes
"It's not totally clear why some women develop preeclampsia," Guggenheim says. The cause may have to do with improper development of the placenta, the organ responsible for providing a growing fetus with, blood, oxygen and nutrients. When the blood vessels that supply the placenta are too narrow or don't function properly, which is common in women with preeclampsia, blood flow to the baby may be limited.
Know your risks
Despite the lack of a definitive cause of preeclampsia, there are factors that predispose women toward the condition. Many of those risk factors are unmodifiable, meaning there isn't much a woman can do to prevent them, but it’s helpful to be aware of them:
- First pregnancy
- Family history of preeclampsia
- Age over 40
- African-American descent
- Being pregnant with twins or other multiples
There are also a host of risk factors that are within a woman's control. "If they already have hypertension,” Guggenheim says, “women should get it under control prior to pregnancy. If they're overweight, weight loss would be advised."
It may not be possible to reverse certain conditions, but managing them is a crucial step. If you plan to get pregnant, speak with your healthcare provider about existing conditions like obesity and hypertension, as well as kidney disease and diabetes.
Be clear about complications
Preeclampsia poses risk to moms-to-be during and after pregnancy. Although 75 percent of cases of preeclampsia are considered mild and the condition typically subsides 6 weeks after childbirth, there is still the potential for long-term complications, including brain, kidney and liver damage, organ failure and stroke and heart disease. Eclampsia, which is a condition characterized by seizures, is another potential complication stemming from preeclampsia. Although rare, preeclampsia-related death is possible, and is responsible for an estimated 10 to 15 percent of maternal deaths worldwide.
The baby faces risks too, including impaired growth, preterm delivery and even death. Infants born to mothers with preeclampsia may be at an increased risk of blindness, epilepsy, learning disorders and cerebral palsy.
Ask about treatment
Delivery minimizes the risk of serious complications for mother and baby. If a woman has carried her child for 37 weeks (or longer) without serious preeclampsia-related symptoms, her doctor will likely induce delivery. Mothers with severe symptoms may be induced after 34 weeks. Preeclampsia typically goes away in the days and weeks following delivery. But if the condition is detected early in the pregnancy, delivery may not be feasible.
"Preeclampsia with severe features is managed differently," Guggenheim explains. "Those patients are typically hospitalized, and we would deliver them when the risk outweighed the benefits of keeping the patient pregnant." If your doctor deems early delivery unsafe, she may recommend bed rest or hospitalization, in which case mother and child can be monitored closely. She may also prescribe medications including blood-pressure lowering drugs, corticosteroids to improve liver and platelet function and promote fetal lung maturation and anticonvulsant medicine to prevent seizures.
Recognize the post-delivery risks
Although rare, women can develop postpartum preeclampsia within days of delivery or even up to six weeks or more after giving birth. This can occur even though they had normal blood pressure during pregnancy. If a mother experiences severe headaches, changes in vision or vision loss, upper abdominal pain or decreased urination, notify a healthcare provider immediately.
Postpartum preeclampsia and preeclampsia that persists after giving birth require immediate treatment, without which a new mother may experience seizures, organ damage and stroke. This postpartum condition can be treated with the same medications as preeclampsia during pregnancy, which prevent seizures and lower blood pressure. Your doctor may also recommend more frequent blood pressure monitoring.
Postpartum preeclampsia, while generally rare, can pose serious risks to you and your baby. If you suspect a problem, speak with your healthcare provider soon to help ensure delivery and motherhood are happy and healthy experiences.