All you need to know about: preeclampsia

The exact cause of preeclampsia remains unknown, but researchers believe it may have something to do with blood supply and circulation in the placenta being affected. Photograph used for representational purposes only
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Last week, on May 22, World Preeclampsia Day was observed, to increase awareness about preeclampsia, a serious pregnancy complication. This year’s theme, ‘Ask me about preeclampsia’, aimed at initiating open conversations and raising awareness about the condition. With that in mind, here is all you need to know about preeclampsia.

What is preeclampsia?

Preeclampsia is a serious condition that develops during pregnancy, usually after 20 weeks or so, often marked by high blood pressure and protein in the urine. Because the condition can also affect other organs of the body including the kidneys, liver and brain, it requires careful monitoring and management. Untreated preeclampsia can have serious, even fatal consequences for the mother and baby. In some women, preeclampsia may develop after the delivery of the baby; this is known as postpartum preeclampsia.

What causes preeclampsia?

The exact cause of preeclampsia remains unknown, but researchers believe it may have something to do with blood supply and circulation in the placenta being affected. The placenta is an organ that develops in the uterus during pregnancy, connecting mother and baby via the umbilical cord. It provides oxygen and essential nutrients to the growing foetus and removes waste products.

According to the World Health Organization (WHO), preeclampsia affects 2–8% of pregnancies worldwide. There are around 46,000 maternal deaths due to pre-eclampsia per year and around 5,00,000 foetal or newborn deaths. Preeclampsia and eclampsia (a complication of preeclampsia) are responsible for approximately 10% of maternal deaths in Asia and Africa, it says.

Who is at risk of preeclampsia?

Risk factors for preeclampsia include being pregnant with more than one baby, pre-existing conditions such as diabetes, hypertension or kidney disease, obesity, a history of preeclampsia in a past pregnancy or a family history of it, as well as a first time pregnancy, being 35 or older and a time gap of 10 years or more since a previous pregnancy.

What are the signs and symptoms of preeclampsia?

For many, there are no signs and symptoms of preeclampsia, and it is often only diagnosed during a visit to a healthcare provider. In some cases, symptoms can include: high blood pressure, proteinuria (excess protein in the urine), severe headaches, changes in vision such as blurred vision, light sensitivity or flashing, upper abdominal pain (just below the ribs), nausea and vomiting and swelling of the face, hands and feet.

How is it diagnosed?

Preeclampsia is diagnosed, the WHO states, based on the onset of hypertension (blood pressure ≥140/90 mm Hg) and proteinuria (≥0.3 g/24 hours) after 20 weeks of gestation. However, recently, there has also been recognition of the condition without proteinuria. The Federation of Obstetric and Gynecological Societies of India (FOGSI), in its 2019 good clinical practice recommendations, defines preeclampsia as a multisystem inflammatory disorder beyond 20 weeks of pregnancy with significant proteinuria characterized by de novo onset of hypertension (BP =/>140/90 mmHg). It adds however that an atypical variant of preeclampsia has been recognised which is accompanied by neurological, hematological, hepatic, renal manifestations or foetal growth restriction, in the absence of proteinuria.

As per the American College of Obstetricians and Gynecologists guidelines, the diagnosis of preeclampsia no longer requires the detection of high levels of protein in the urine (proteinuria). Preeclampsia is now to be diagnosed by persistent high blood pressure that develops during pregnancy or during the postpartum period that is associated with a lot of protein in the urine or the new development of decreased blood platelets, trouble with the kidney or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances.

What are the complications that can develop?

If untreated, pre-eclampsia can cause severe complications to both mother and baby. These may include: eclampsia, in which the patient develops seizures and may go into a coma; HELLP syndrome (haemolysis, elevated liver enzymes, low platelet count), a liver and blood clotting disorder, which is potentially risky to both mother and baby and organ damage to the liver, kidneys, brain and lungs of the mother. Placental abruption, which is the placenta separating from the inner wall of the uterus before delivery is another potential complication.

Complications to the baby include premature birth, as well as foetal growth restriction, which happens when the baby does not receive adequate oxygen and nutrients, leading to slow growth.

How is it treated?

Treatment involves managing the condition and close monitoring until it is the best time for the baby’s delivery. This depends on the severity of the condition and the gestational age of the foetus. The goal of treatment is to prevent complications and ensure a safe outcome for the mother and baby. Medications may include antihypertensive drugs, anticonvulsant medication and corticosteroids.

Generally, preeclampsia goes away within some weeks after birth. However, blood pressure and other signs/symptoms may need to be monitored closely for some time after the birth.

If postpartum preeclampsia develops, it requires immediate medical attention.

Can preeclampsia be prevented?

Maintaining a healthy lifestyle including staying at a healthy weight, with adequate exercise and a well-balanced diet are some factors that could help. Healthcare providers may also prescribe low-dose aspirin in case a patient is at risk of preeclampsia. It is important to consult a doctor before taking any medication or supplements.