Pregnancy

Pregnancy & Preeclampsia with Dr. Fraser

Dr. Candice Fraser, edited by: Reem Abdalla

“My mother had preeclampsia, my sister had preeclampsia, if I get pregnant I will have preeclampsia.” 


I’ve said these words more times than I can count, but only one detail is 100% accurate. My sister was diagnosed with preeclampsia and was able to continue her pregnancy to 37 weeks, at which time she had an induced labor. I have a strong suspicion my mother had preeclampsia based on her birthing journey; my sister and I were delivered when my mother was young, at 21 and 25 years respectively, during which she reported elevated blood pressure and early deliveries. She was diagnosed with chronic hypertension (high blood pressure) afterwards. There are various factors, such as family history, that increase someone’s chance of developing preeclampsia during or after pregnancy. 


“Should the same fate await me if I choose to be pregnant, I’ve decided to protect myself by taking a deeper look at preeclampsia.”


So what is preeclampsia? 


Previously called toxemia of pregnancy, preeclampsia makes its most common appearance when pregnant or recently postpartum people are found with high blood pressure. The organs affected by this disorder can create a cacophony of disruptions throughout the body, from the kidneys to the placenta.


When the kidneys are impacted it causes proteinuria (too much protein in the urine). When the liver and brain are thrown into the mix, people experience headaches and changes in vision. Upper right or mid abdomen pain can be a tell tale sign the liver is being damaged. Preeclampsia can lead to seizures, which is called eclampsia at this point.


Preeclampsia is not only a concern for pregnant people. The placenta’s ability to carry oxygen and nutrition to the developing baby can be hampered, lowering amniotic fluid and showing other concerning signs during ultrasound and fetal testing.


Wait, what role does the placenta play?


Health conditions usually have many causes at play, but the placenta tends to be the biggest player when it comes to preeclampsia.


The placenta connects the parent to the baby, bringing oxygen and needed nutrients. In early stages of placenta development, blood vessels are formed and embed themselves into the uterus. This helps carry blood to the blood vessels in the umbilical cord.  


When blood vessels in the placenta do not develop as they should they can look narrower. With time, narrow blood vessels become damaged. This reverbetes to blood vessels in other parts of the parent’s body, such as kidneys, liver, and brain (see how that all came together?)


What increases a person’s risk of developing preeclampsia?


So here’s some big news: family history isn’t the biggest contributing factor, even though I hooked you into this blog post with it (wink).


Before I discuss other risk factors, I should mention having one or multiple risk factors does not guarantee a person will develop preeclampsia. Other risk factors include: 

  • first pregnancies 
  • a history of high blood pressure before pregnancy 
  • preeclampsia in a previous pregnancy 
  • gestational diabetes (diabetes caused by pregnancy) 
  • being pregnant with more than one baby (twins, triplets etc) 
  • obesity 
  • being younger than 20 or older than 35 


Like most things (*sigh*) black people are at higher risk of developing preeclampsia than other races, the reason for this can not be completely explained by having other health conditions.

How is it diagnosed?


Pregnant people and women have 10-14 prenatal care visits. Their doctor or midwife runs blood pressure checks during these visits, and if anything concerning is noted they usually recommend further testing - for example checking the urine for protein and blood evaluation tests for the kidneys, liver and platelet count. 


In addition any of the symptoms we mentioned above should be discussed with your doctor or midwife to determine if they are related to preeclampsia.


Can preeclampsia be prevented?


Unfortunately, we don’t know if preeclampsia is preventable.... yet. 


Those who are pregnant or considering pregnancy can discuss preeclampsia risk reduction with their OBGYN or midwife. Meeting with a women’s health doctor before pregnancy can help a person identify risk factors and take the necessary steps to improve their health.  Making sure blood pressure and blood sugar (for those that have diabetes) are well controlled is important before getting pregnant. Having an established exercise routine, sticking to a well balanced diet and working towards a healthy weight as determined by you and your clinician, are also good risk reducing strategies for preeclampsia.  Finally, in recent years, aspirin has been found to be helpful in preventing preeclampsia in those who have high risk factors; never start aspirin in pregnancy without consulting your doctor first.

https://www.acog.org/womens-health/faqs/preeclampsia-and-high-blood-pressure-during-pregnancy

How is preeclampsia treated?


The only cure for preeclampsia is delivery of the baby and placenta.  If preeclampsia is diagnosed before full-term, a person’s doctor will determine if they need to be delivered right away or if other management options such as blood pressure medication can be used to give the baby more time to develop.  If a pregnant person’s life is in danger due to preeclampsia, immediate delivery may be the only option. 


While delivery is the cure for preeclampsia, the disease does not disappear the minute the baby is born, but may take up to 12 weeks to completely resolve. Preeclampsia diagnosis can also happen after a person gives birth.


Now that you know so much more about preeclampsia, don’t run off!  If you plan to get pregnant in the future, schedule an appointment with a women’s health physician to discuss your fertility plans and identify any activities you can start now to stay proactive with your health.


Sources:

Women's Health at ACOG

Preeclampsia with Up To Date

Mayoclinic - Preeclampsia