Last month, Macaroni Kid Stork published an article that talked about how the rate of maternal mortality is climbing in the United States, and that one of the reasons in this increase is due to preeclampsia, a very serious condition that affects around 3-5 percent of pregnant women in the United States.
Dr. Alyssa Dweck, an OB/GYN at Mount Kisco Medical Group in New York who is on the Medical Advisory Board for healthy mama, answers some questions about preeclampsia risks and symptoms that all pregnant women should understand.
Why is preeclampsia such a danger for pregnant women?
Dr. Dweck: Women with preeclampsia have smaller-than-normal blood vessels supplying the major maternal organs, including the placenta. The cause of this is not known. There are no reliable tests to predict who will get preeclampsia, and there is no way to prevent it. Women with high blood pressure, kidney disease, lupus, pre-gestational and gestational diabetes, multiple gestation, prior preeclampsia, obesity, and age under 20 and possibly over 35-40 have an increased risk of developing preeclampsia. Conversely, women who do not develop preeclampsia in their first pregnancy are at low risk of developing it in a subsequent pregnancy.
Women with preeclampsia are at higher risk for stroke, seizures, placental abruption, hemorrhage and in rare cases, death. The effects on the baby include abnormal fetal monitoring, poor fetal growth, decreased amniotic fluid, and premature birth.
What are some of the most common signs of preeclampsia?
Dr. Dweck: The signs and symptoms of preeclampsia occur, in part, due to changes inside the small arteries, which decreases blood flow to major maternal organs such as the kidney, brain, and liver, as well as the placenta. Most women with mild preeclampsia do not feel any different than usual. Signs and symptoms of moderate-to-severe preeclampsia include a bad headache, visual changes such as floating spots, flashes of light or blurry vision, abdominal pain specifically in the right upper quadrant, notable swelling in the hands, feet and face, nausea and vomiting, high blood pressure, excess protein in the urine (proteinuria), and abnormal liver function blood tests.
Mild preeclampsia can worsen and become severe. This usually occurs over several days to weeks, but may occur more quickly.
During what part of pregnancy does preeclampsia occur?
Dr. Dweck: Preeclampsia can appear anytime during the last half of pregnancy (after 20 weeks of pregnancy) or in the first few days postpartum and typically resolve within a few days after delivery. It can also happen during labor or after the baby is born. In the United States, preeclampsia occurs in 5 to 8 percent of pregnancies. Most cases occur after 37 weeks of pregnancy; 10 percent of cases occur before 34 weeks of pregnancy.
Why is proper prenatal care so important?
Dr. Dweck: Most women with preeclampsia never experience anything more than mild high blood pressure and a small amount of excess protein in the urine. These changes do not cause symptoms. Frequent prenatal visits to obtain weight, check blood pressure and measure urinary protein are scheduled in the last half of pregnancy in order to identify a problem as soon as possible. While preeclampsia is not preventable, early diagnosis is imperative.
What should women do if they are diagnosed with preeclampsia?
Dr. Dweck: The only cure for preeclampsia is delivery of the baby and placenta. Bed-rest and taking high blood pressure medication can lower blood pressure and reduce the risk of stroke. These treatments do not improve the abnormalities in the mother's blood vessels, however.
The most effective treatment for preeclampsia at or near term is delivery. If mild preeclampsia occurs before term, it may be possible to delay delivery to allow the baby more time to grow and mature, while monitoring the woman and baby closely either in the hospital or at home. Maternal monitoring usually includes blood pressure measurements and blood and urine tests to check liver and kidney function. Fetal monitoring includes a combination of non-stress tests and ultrasound examinations. Women with preeclampsia can develop eclampsia (seizures) and thus many are treated during and after delivery with intravenous magnesium to prevent seizure activity. Severe hypertension is treated with one or more high blood pressure medications to lower the risk of a maternal stroke.
How do you know the difference between edema and the swelling that often occurs during pregnancy?
Dr. Dweck: Swelling (edema) was once considered to be a sign of preeclampsia, especially when it occurred in the face or hands. However, since many women who do not have preeclampsia also develop swelling, it is no longer considered a reliable sign of the disease. In general, when significant swelling develops in combination with high blood pressure, significant and sudden weight gain, and proteinuria, the diagnosis of preeclampsia is more likely.
Be Aware of Symptoms and Tell Your Doctor
Women should also remember that they can and should mention possible preeclampsia symptoms to their family physician. Dr. Bola Oyeyipo, a family doctor with Healthgist in San Antonio, TX, reminds women that if they are experiencing puffy ankles, elevated blood pressure, headache, and blurry vision, that they should report this to their doctor.
To learn more about preeclampsia and how the new Merck for Mothers initiative is pouring resources into communities around the United States to combat maternal mortality, visit Merck for Mothers.
