What causes pre-eclampsia and how do I know if I have it? By Paula Dillon

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Pre-eclampsia is a potentially life-threatening condition which can develop in pregnancy, usually after the 20th week and often gone within six weeks of you giving birth.  It is typically characterised by a sudden onset of high blood pressure (hypertension) and protein in your urine (proteinuria). Often there are no symptoms and it may be picked up at your routine antenatal appointments when you have your blood pressure checked by your doctor or midwife. Many cases of pre-eclampsia are mild and aren’t troublesome, however the condition can worsen and lead to “eclampsia” which is more serious, involving seizures. If pre-eclampsia goes unmanaged it can also cause other pregnancy complications, such as slowed baby growth, and/or premature birth, and can be life-threatening for both mother and baby.

Attending your routine antenatal checks is key to the early detection and management of pre-eclampsia. Most women with the condition initially feel fine and don’t even know they have it.

Below is some further information about pre-eclampsia. If you’d like to know more, please call Eve Health and make an appointment with our midwife or one of our obstetricians who are happy to help with any questions you may have.

 

Who is at risk of pre-eclampsia?

Current statistics show that about three or four out of every 100 pregnant women in Australia and New Zealand develop pre-eclampsia.  Exact causes of the condition aren’t known; however, research is indicating women may be at higher risk of developing pre-eclampsia if they:

  • are having their first baby
  • are carrying multiple babies (ie. twins, triplets)
  • are aged under 18 or over 40
  • have pre-existing high blood pressure or diabetes
  • have a family history of pre-eclampsia (ie. your mum or sister had it during her pregnancy)
  • conceived via IVF
  • are overweight at the start of pregnancy, with a Body Mass Index of 35 or higher
  • have had pre-eclampsia in a previous pregnancy
  • it has been 10 years since their last pregnancy
  • have an autoimmune disorder such as rheumatoid arthritis.

 

What are the signs and symptoms of pre-eclampsia for the mother?

Pre-eclampsia can come on quite suddenly over a few hours or develop gradually. Symptoms can include any or all of the following:

  • Severe swelling of the hands and face
  • Swelling of ankles that doesn’t go away after 12 hours of rest
  • Sudden excessive weight gain that isn’t related to eating
  • Pain in the upper abdomen just below the ribs and often just to the right
  • Blurred or double vision, spots or stars in front of the eyes
  • Headaches that don’t go away with paracetamol or rest
  • A rise in blood pressure
  • Protein in the urine
  • Nausea and vomiting
  • A decrease or sudden change in your baby’s movements
  • Generally feeling unwell.

 

How might pre-eclampsia affect my baby?

Pre-eclampsia affects the development of the placenta, which may prevent your baby growing as he or she should. There may also be less fluid around your baby in the womb. If the placenta is severely affected, your baby may become very unwell. In some cases, the baby may even die in the womb. That is why monitoring is important as it aims to pick up those mothers or babies who are most at risk.

 

How is it pre-eclampsia diagnosed?

Usually, pre-eclampsia is diagnosed if you have more than one high blood pressure reading (140/90 mmHg or higher) and with a urine test and blood test. Your urine will be tested for protein which can be a sign that your kidneys have been affected by pre-eclampsia. The blood test will be looking at how well your liver is functioning, as pre-eclampsia can affect liver function and blood clotting.

 

What can happen if I have pre-eclampsia?

In more serious cases, if pre-eclampsia is untreated it can lead to seizures, kidney or liver failure, blood clotting problems or death.

Fortunately, for most women who are receiving regular antenatal care, pre-eclampsia is usually picked up and managed by medication early on, and they experience the same positive pregnancy they would as if they had normal blood pressure.

 

What is the treatment for pre-eclampsia?

Pre-eclampsia does not go away until after the baby is born. If you are diagnosed with pre-eclampsia your treatment will likely include bed rest at home or admission into hospital, plus frequent blood pressure monitoring and urine tests. Your baby and how well your placenta is functioning will also be monitored via ultrasound, and your doctor may start you on some medication to lower your blood pressure.  Occasionally, pre-eclampsia may be the reason a baby is delivered early – and you may be offered an induction of labour or a caesarean section. If your baby is to be born prematurely, your doctor will often recommend you have a couple of steroid injections to speed up baby’s lung maturity.  Many premature babies will go to neonatal intensive care (NICU) or special care nursery (SCN) for some time after birth, depending on how early they were born and how well or sick they are.

In most cases, women with pre-eclampsia recover completely, with a return to normal blood pressure within about six weeks after birth.

 

What can you and your practitioner do?

Regular prenatal care is the best way to diagnose pre-eclampsia in its early stages. Your practitioner may notice protein in your urine or a rise in your blood pressure, which are early signs of pre-eclampsia and which you yourself might not notice.

More progressive symptoms of pre-eclampsia include fluid retention – which often results in sudden swelling of the feet, ankles, face and hands. Swelling of the feet and ankles can be a common pregnancy-related symptom, especially late in the day, however this usually resolves once your feet are elevated. If the onset of swelling is sudden, it could be a sign of pre-eclampsia.

 

What causes pre-eclampsia?

The exact cause of pre-eclampsia is unknown, however genetic factors are assumed to play a role, as you are more at risk of pre-eclampsia if your mother or sister had pre-eclampsia.

Medical researchers are continuing to look for ways to predict pre-eclampsia and are investigating if specific genes may be responsible. It is hoped there will eventually be a pre-pregnancy test for the condition.

For sources and further online reading about pre-eclampsia visit:

For an overview on pregnancy and tips about common conditions, and emotions visit:

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