• Pre-eclampsia

    (Toxemia of Pregnancy; Pregnancy-induced Hypertension; Preeclampsia)

    Definition

    Pre-eclampsia is a problem that occurs in some women during pregnancy. Blood pressure increases and protein appears in the urine. This usually occurs during the second half of the pregnancy.
    Cardiovascular System and Kidneys
    Woman with BP
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    Causes

    The cause of pre-eclampsia is unknown.

    Risk Factors

    Pre-eclampsia is more common in African-American women, and in women aged 40 years and older. Other factors that may increase your chance of pre-eclampsia:
    • Pre-eclampsia in a previous pregnancy
    • First pregnancy
    • Family history, such as a mother or sister who also had the condition
    • Carrying multiple babies such as twins
    • Chronic high blood pressure
    • Obesity
    • Kidney disease
    • Diabetes
    • Overweight or obese
    • Sleep-disordered breathing—abnormal breathing during sleep ranging from snoring to sleep apnea
    • History of polycystic ovary syndrome
    • Antiphospholipid antibody syndrome

    Symptoms

    Women with pre-eclampsia may have no symptoms. It is important to see your doctor regularly during pregnancy to detect problems early.
    In women with symptoms, pre-eclampsia may cause:
    • Headaches
    • Bloating or water retention
    • Noticeably swollen ankles or feet, worse than the normal swelling that occurs during pregnancy
    • Swelling of the face and upper body
    • Vision troubles
    • Upper abdominal pain
    • Nausea or vomiting
    • Feeling short of breath
    • Chest pain
    • Urinating less

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. Preeclampsia is diagnosed if a pregnant woman has high blood pressure and significant protein in her urine.
    Tests may include:
    • Blood pressure measurement to see if the blood pressure is 140/90 or higher
    • Urine tests to look for elevated protein levels
    • Blood tests—to check general body health and kidney and liver function

    Treatment

    Treating pre-eclampsia early can prevent its progression to eclampsia, which is seizures caused by severe pre-eclampsia.
    Treatment may include:

    Delivery of the Baby

    The only way to cure pre-eclampsia is to deliver the baby. The decision for delivery depends on a combination of factors, such as:
    • How many weeks along you are in your pregnancy
    • Condition of you and your baby
    • Severity of the pre-eclampsia
    • Risk of other pregnancy complications
    Labor may happen naturally or it may be induced. If there are life-threatening circumstances for either you or your baby, a cesarean section may be required. During labor, you may need medication to control your blood pressure and prevent seizures.

    Medication

    Mild pre-eclampsia can often be managed with rest and medication if the baby is close to term. Your doctor may recommend medications to:
    • Lower your blood pressure
    • Reduce the risk of seizures
    • Help fetal lung development in case of premature labor

    Home Treatment

    If your home situation is stable and you live close to the hospital, your doctor may recommend that you rest at home in a quiet environment. Home treatment may include:
    • Taking frequent blood pressure readings
    • Getting plenty of rest
    • Obtaining help to prepare meals, do housework, and care for family members
    • Monitoring your baby's health, which may include:
      • Watching for fetal movement
      • Tracking kick counts
      • Follow-up visits to monitor conditions inside the uterus

    Admission to the Hospital

    If pre-eclampsia is moderate or your home situation is not restful, the doctor may admit you to the hospital. Treatment may include:
    • Lowering your blood pressure with medication
    • Taking medications to prevent eclampsia
    • Monitoring your baby's condition
    • Making sure you get enough rest

    Prevention

    To help reduce your chance of pre-eclampsia or other pregnancy complications:
    • Get early and regular prenatal care. Early treatment of pre-eclampsia may prevent eclampsia.
    • If you have chronic high blood pressure, keep it under control during pregnancy.
    • Get your doctor's approval before taking any prescription or over-the-counter medications.
    • Do not smoke or drink alcohol during pregnancy.
    • Eat regular, healthful meals, and take prenatal vitamins.
    • Ask your doctor if you should take a daily calcium supplement. In women who have a low calcium intake, supplementation may reduce the risk of pre-eclampsia, eclampsia, and premature birth .
    • Your doctor may recommend that you take aspirin to lower your risk of pre-eclampsia.

    RESOURCES

    Family Doctor—American Academy of Family Physicians http://familydoctor.org

    The American Congress of Obstetricians and Gynecologists http://www.acog.org

    CANADIAN RESOURCES

    The Canadian Women's Health Network http://www.cwhn.ca

    The Society of Obstetricians and Gynaecologists of Canada (SOGC) http://sogc.org

    References

    High blood pressure in pregnancy. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/resources/heart/hbp-pregnancy. Accessed June 6, 2016.

    Hypertensive disorders of pregnancy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 22, 2016. Accessed June 6, 2016.

    Preeclampsia and high blood pressure during pregnancy. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq034.pdf?dmc=1&ts=20130314T1318525934. Updated September 2014. Accessed June 6, 2016.

    Pregnancy-induced hypertension. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/pregnancy-induced-hypertension.html. Updated April 2014. Accessed June 6, 2016.

    9/30/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Samuels-Kalow ME, Funai EF, Buhimschi C, et al. Prepregnancy body mass index, hypertensive disorders of pregnancy, and long-term maternal mortality. Am J Obstet Gynecol. 2007;197(5):490.e1-e6.

    7/6/2006 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Villar J, Abdel-Aleem H, Merialdi M, et al. World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women. Am J Obstet Gynecol. 2006;194(3):639-649.

    7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Kumar A, Devi SG, Batra S, Singh C, Shukla DK. Calcium supplementation for the prevention of pre-eclampsia. Int J Gynaecol Obstet. 2009;104(1):32-36.

    8/6/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Bujold E, Roberge S, Lacasse Y, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol. 2010;116(2 Pt 1):402-414.

    6/9/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Qin JZ, Pang LH, Li MJ, Fan XJ, Huang RD, Chen HY. Obstetric complications in women with polycystic ovary syndrome: A systematic review and meta-analysis. Reprod Biol Endocrinol. 2013;11:56

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