Swollen ankles, aches, pains and nausea are common problems that can make even healthiest pregnancy feel uncomfortable at times. But these “typical” pregnancy complaints shouldn’t be ignored, because they can sometimes indicate a serious complication called preeclampsia, a condition that affects five to eight percent of pregnancies in the United States. However, sometimes women who develop preeclampsia have no symptoms at all, making regular prenatal visits key to catching it before it becomes life-threatening, for both mother and baby.
Preeclampsia, sometimes called toxemia, is defined as high blood pressure plus elevated protein in the urine of a woman who is at least 20 weeks pregnant. High blood pressure alone - called gestational hypertension or pregnancy-induced hypertension - isn’t enough to make the diagnosis, although about one-quarter of women who have gestational hypertension will develop preeclampsia.
According to the Preeclampsia Foundation, preeclampsia and its complications (including eclampsia, defined as preeclampsia plus seizures) are responsible for about 18 percent of maternal deaths in the United States. And it’s the leading known cause of premature birth, responsible for about 15 percent of all premature births in the United States.
Preeclampsia can develop anytime in the second half of pregnancy, during labor or even (though rarely) up to six weeks after delivery. Most commonly, it occurs in the last few weeks of pregnancy.
“Most women are asymptomatic. And the whole rhythm of prenatal care, if you will, is built around the frequency of visits with the increasing chance of developing preeclampsia,” says Thomas Easterling, professor of obstetrics and gynecology at the University of Washington in Seattle.
Those weekly office visits during the last six weeks or so of pregnancy may seem inconvenient - especially when all you really want to do is fold and re-fold piles of teeny-tiny baby clothes. But regular visits at the end of pregnancy are crucial to detecting problems early.
Often, the path to a preeclampsia diagnosis begins with an elevated blood pressure reading at a regular prenatal appointment. The doctor may then order a urine test to check for protein. If that comes back positive, blood tests are often done to check liver and kidney function. The baby’s condition is also monitored with ultrasound and non-stress tests.
Regular prenatal visits helped Kinnari Cowell-Shah’s doctors identify a rare and serious form of preeclampsia called HELLP Syndrome (which stands for hemolysis, or destruction of red blood cells; elevated liver enzymes; and low platelet count) when she was pregnant with her second son, in 2008. She had protein in her urine at her 37-week visit, and hadn’t the week before.
“So I am pretty confident that they caught it very early, and, in fact, possibly the very day it started to manifest,” says Cowell-Shah. “So I had the baby via C-section that evening. And was fine immediately.”
The only cure for preeclampsia is delivery of the baby. If a woman’s pregnancy is full-term - at least 37 weeks along - her baby is often delivered right away, either by inducing labor or by Cesarean section. Before 37 weeks, doctors have to balance the risks of premature birth with the risks of continuing the pregnancy. It’s a delicate balance, because preeclampsia can progress quickly and unpredictably.
Jill Siegel recalls that she was feeling fine when her preeclampsia was diagnosed when she was 30 weeks pregnant with her daughter, who is now five and a half. That was on a Friday.
“By Sunday night I was very, very sick, and had to have an emergency C-section on Monday morning,” she says. “I really had no strong signs, but then once it was confirmed, it really overtook me very quickly.”
If doctors decide on “expectant management,” or trying to control preeclampsia so that the baby can stay inside for as long as possible, a woman will likely be prescribed bed rest and medication to lower her blood pressure. She may be given magnesium sulfate to prevent seizures, and steroid shots to help the baby’s lungs mature in case urgent delivery becomes necessary.
Research conducted by the Preeclampsia Foundation has shown that half of women don’t know the signs and symptoms of preeclampsia (see the list at the end of this article). Eleni Tsigas, the foundation’s executive director, says, “That’s concerning because the patient could often be the first responder if they know what they’re looking for,” particularly if preeclampsia develops earlier in pregnancy when prenatal visits are not as frequent.
Many preeclampsia symptoms, particularly swelling and weight gain, are similar to normal pregnancy symptoms and can be hard to interpret, especially for a woman who is pregnant for the first time. Christine Streets recalls that during the second trimester of her pregnancy, in early 2008.
“All of a sudden I’m gaining five pounds in two days. Weight was packing on real quick.”
Soon she was weak and dizzy, her legs numb, her tissues so full of fluid that her skin took on a plastic sheen. Not wanting to be “that ‘dramatic’ pregnant lady,” she was initially reluctant to go to the doctor.
“I just thought it was pregnancy. I didn’t know the signs and symptoms. I didn’t know what to expect.”
Fortunately, this story has a happy ending: her daughter is now a healthy two-year-old, and Streets, who was recently crowned Mrs. Iowa United States 2010, has dedicated herself to raising awareness of preeclampsia.
Who is at risk?
Scientists don’t know what causes preeclampsia. Certain groups are at higher risk, including women with a family history of the condition, women carrying multiple babies, African American women, and women under 20 or over 40. It’s more common in first pregnancies - and once a woman has had preeclampsia she’s at higher risk of developing it again in a future pregnancy, but it doesn’t always recur. In fact, there’s no way to predict which pregnancies will be affected by preeclampsia, and no way to prevent it.
Such uncertainty can be unsettling, but it also means that if you do develop preeclampsia it’s not your fault.
Warning signs of preeclampsia include:
Edema, or swelling: Though some swelling, especially of the feet and legs, can be normal during pregnancy, it’s cause for concern if it’s severe, doesn’t go away with rest or is obvious in your hands and face.
Rapid weight gain: More than two pounds in a week or six pounds in a month
Severe headaches*: Like a migraine that doesn’t go away.
Vision changes*: Blurred vision, double vision, seeing stars or spots, temporary loss of vision.
Dizziness, extreme drowsiness*
Abdominal pain: Especially on the right side of the body, under the ribs. This is sometimes mistaken for heartburn, but it doesn’t go away if you take an antacid.
Nausea and vomiting: Especially severe symptoms that begin in the second or third trimester.
Reduced fetal movement*: Preeclampsia can reduce blood flow to the uterus and placenta, resulting in slower growth of the baby, low amniotic fluid and - what a mother might notice - less movement.
*Any of these symptoms mean that you should call your doctor, but neurological symptoms or changes in the baby’s movement patterns signal a need for immediate help.
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