What Are the Causes & Symptoms of Preeclampsia?

Preeclampsia is a complication estimated to be present in around 5-7% of all pregnancies and is one of the leading causes of maternal morbidity worldwide. This is characterized by elevated blood pressure and indications of stress to another organ system, typically the liver or kidneys.

This typically arises after the 20th week of pregnancy, linked to around 70,000 maternal fatalities and approximately more than 500,000 significant fetal death rates each year across the globe. It is regarded as a medical emergency for both the mother and the unborn child.

Understanding the symptoms, causes, and potential preeclampsia treatments is crucial, as it enables you to identify symptoms early and seek timely medical attention to avoid potentially fatal complications.

Risk Factors and Causes of Preeclampsia

Preeclampsia is a serious pregnancy complication that necessitates awareness due to its potential to cause severe health risks for both mother and baby. Acknowledging the critical role of early recognition and intervention can help reduce these risks and enhance the safety of pregnancy outcomes.

Age and Ethnicity

Age, ethnicity, and race significantly affect preeclampsia risk. Women under 20 or over 35 face higher risks due to biological and physiological stresses.

Moreover, certain racial and ethnic groups, including women of African and South Asian descent, are more prone to developing this condition. This higher susceptibility may be linked to genetic predispositions and socioeconomic factors that influence access to healthcare and pre-existing health conditions.

Genetics

Your genetic makeup significantly influences your susceptibility to preeclampsia. If your family history includes cases of preeclampsia, you may be at a higher risk of developing the condition yourself.

Genetic predispositions, identified through studies on familial patterns and genetic markers, indicate that if close relatives such as your mother or sister have had preeclampsia, your chances of experiencing it during pregnancy increase.

Pregnancy History

First-time mothers are particularly susceptible to preeclampsia because they have not previously experienced the physiological changes of pregnancy, increasing the likelihood of abnormal responses in placental development and blood pressure regulation.

“New paternity,” where the pregnancy is with a different partner, increases the risk of preeclampsia. This is derived from a theory that exposure to new paternal antigens affects a woman’s immune tolerance during pregnancy, challenging her immune system to adapt to different biological elements each time.

Additionally, pregnancies with multiple babies, such as twins or triplets, carry a higher risk due to the larger placental area and greater hormonal fluctuations. This extra placental tissue exacerbates the vascular resistance and blood pressure issues central to preeclampsia.

Fertility Treatments

Assisted reproductive technology (ART), mostly utilized for couples having challenges with conceiving, such as in vitro fertilization (IVF), is linked to an increased risk of developing preeclampsia. ART may disrupt early placental development, which is crucial for establishing proper blood flow.

It is hypothesized that the hormonal and physiological interventions involved in ART could interfere with natural processes that typically prevent maternal hypertension during pregnancy, leading to abnormalities in the placenta that contribute to the development of preeclampsia. The exact mechanisms behind these disruptions are still under investigation.

Obstetric Health

A woman’s obstetric history significantly influences her risk of developing preeclampsia in subsequent pregnancies. Key risk factors include a history of placental abruption, previous occurrences of preeclampsia, or intrauterine fetal growth restriction (IUGR) experienced during past pregnancies.

Placental abruption, characterized by the early detachment of the placenta from the uterine wall lining, compromises fetal oxygen and nutrient supply and is linked to hypertensive disorders. Both past preeclampsia and IUGR, often related to poor placental perfusion and function, also increase the likelihood of recurrence in future pregnancies.

Health Conditions

Specific pre-existing health conditions may elevate your risk of developing preeclampsia, as they affect how your body reacts to pregnancy. These conditions affect the body’s ability to manage the extra demands of pregnancy, particularly in how the placenta functions.

These include chronic hypertension, diabetes, kidney disease, autoimmune disorders, and obesity, which add stress to the pregnant mother’s body. Each of these conditions can contribute to the complex pathophysiology of the condition, intensifying the strain on the cardiovascular and renal systems already under pressure from pregnancy changes.

Blood Vessel Damage

Preeclampsia can stem from blood vessel damage, particularly in the vessels that supply the placenta. When these vessels are damaged, they can narrow, leading to high blood pressure and reduced blood flow to the placenta, impairing the delivery of oxygen and nutrients to the fetus.

This process involves the vascular endothelial growth factor (VEGF), a critical aspect that regulates blood vessel development needed for a healthy placenta. Abnormal VEGF levels can result in poor placental development, potentially impairing fetal growth due to the decreased blood supply.

Immune System Adaptation

Malfunctions with a mother’s immune system might also be a cause of preeclampsia. During a healthy pregnancy, your immune system adapts to tolerate the fetus genetically different from your body.

However, the immune system may sometimes not adapt properly, leading to an inflammatory response against the placenta, treating it as a foreign body. This inflammation can contribute to the onset of this condition.

Symptoms of Preeclampsia

The symptoms of preeclampsia can vary widely and sometimes develop without warning. Expecting mothers must be aware of and understand this condition to ensure timely medical intervention.

High Blood Pressure

One hallmark symptom of preeclampsia is high blood pressure, which often rises without noticeable symptoms, leaving individuals unaware of health changes until more severe symptoms manifest. Typically, blood pressure varies over the course of a day, yet in this condition, it stays abnormally high, risking serious complications.

High blood pressure is a critical indicator of preeclampsia, signifying its effects on the cardiovascular system. It impairs blood flow to the placenta, limiting the baby’s access to oxygen and nutrients. Consequently, this may result in complications such as preterm birth and low birth weight, in addition to developmental challenges.

Protein in Urine

Protein in your urine, or proteinuria, is another significant symptom. Marked by an abnormally high protein level in the urine, this condition indicates underlying kidney problems.

Normally, kidneys filter and retain essential proteins, but the increased blood pressure associated with preeclampsia can damage the kidneys, causing them to leak significant amounts of protein into the urine.

When the kidneys are compromised due to elevated blood pressure, their ability to efficiently filter blood diminishes. This impairment not only leads to proteinuria but also affects the overall function of the kidneys, resulting in decreased urine production.

Severe Headache

Experiencing severe, persistent headaches can be a symptom of preeclampsia. These headaches may not respond well to over-the-counter pain relief and can be a sign that your brain is being affected by high blood pressure.

These headaches result from significantly elevated blood pressure, which affects brain circulation, causing pain and discomfort. They indicate potential vascular stress in the brain, which, if unmanaged, could lead to serious complications like cerebral edema or stroke.

Nausea or Vomiting

While nausea and vomiting may be expected in early pregnancy, their sudden appearance or worsening in the second half of pregnancy could be related to preeclampsia, particularly when accompanied by other symptoms. This change can indicate your body’s struggle, impacting the digestive system and liver function.

A buildup occurs when the liver cannot effectively process toxins, leading to symptoms like nausea or vomiting. These may also manifest as a result of the severe headaches felt at the onset of the condition or as the situation worsens, indicating increased strain.

Vision Changes

Alterations in vision, such as blurred sight, light sensitivity, or seeing spots, occur because preeclampsia can lead to swelling in the brain, a condition known as cerebral edema. This swelling increases pressure inside the skull, impacting the area of the brain that processes visual information.

Furthermore, high blood pressure can also cause changes in the retinal blood vessels, leading to retinopathy. This condition can damage the retina, the layer of tissue at the back of your eye that senses light and relays images to your brain, resulting in visual disturbances.

Upper Abdominal Pain

Upper abdominal pain, particularly beneath the ribs on the right side, can be a symptom of preeclampsia. This pain arises because the condition can cause the liver to swell and stretch the capsule surrounding it, leading to discomfort or pain.

The liver plays a vital role in pregnancy, processing nutrients for your developing baby, filtering toxins from the blood, and maintaining proper blood clotting. When this condition impacts the liver, it can lead to a range of complications that threaten both maternal and fetal health.

Sudden Weight Gain and Swelling

Sudden weight gain and severe swelling (edema) in preeclampsia are noticeable signs that often occur together, predominantly caused by excessive body fluid retention. Unlike the typical, mild swelling seen in normal pregnancies, edema in this condition can be severe, affecting the hands, feet, and face, especially around the eyes.

This rapid increase in weight is alarming and signals deeper issues with blood pressure and kidney function. These symptoms necessitate urgent medical intervention as they contribute to health concerns and indicate that the body is not managing fluid effectively.

Shortness of Breath

Shortness of breath may indicate that preeclampsia is causing fluid to accumulate in your lungs, known as pulmonary edema. This occurs when high blood pressure from this condition affects the blood vessels in the lungs, causing them to leak fluid and affect breathing.

This symptom requires urgent medical evaluation, as it can severely impact your oxygen and carbon dioxide exchange, affecting you and your baby’s oxygen supply. Pulmonary edema can escalate rapidly, potentially leading to severe respiratory distress or failure.

Confirming Preeclampsia

In diagnosing this condition, medical professionals employ a comprehensive approach, combining multiple tests and careful observations to assess your health and ensure your baby’s well-being. These diagnostic strategies aim at early preeclampsia detection, facilitating prompt and effective intervention.

Medical History and Physical Examination

A detailed medical history is vital for diagnosing preeclampsia. It includes assessing any familial history of preeclampsia, history of pregnancy, chronic hypertension, or other related conditions. Previous pregnancies with hypertensive complications are particularly relevant.

Auscultation and percussion of the lungs are assessed during a physical examination, and pulmonary disturbances in patients with shortness of breath are assessed. Palpation of the upper right quadrant and epigastric areas checks for tenderness, while a thorough evaluation of edema focuses on the face, hands, and feet.

Blood Pressure Measurement

Blood pressure measurement is a fundamental step in diagnosing preeclampsia. Healthcare providers routinely monitor blood pressure levels during prenatal visits to detect significant increases, which can be crucial for early identification of this condition.

A high blood pressure level of 140/90 mmHg or greater on two separate occasions, spaced at least four hours apart, is a primary indicator of this condition. Consistent tracking helps identify changes in blood pressure patterns, allowing for prompt intervention and management of this pregnancy-specific condition.

Urine Test

A urine test is another essential diagnostic tool for preeclampsia. This test screens for protein in your urine, a condition known as proteinuria. It can indicate that your kidneys are not efficiently filtering waste from your blood due to this condition’s effects.

If preeclampsia is suspected, a 24-hour urine collection is initiated, which quantifies protein excretion, providing a precise measure to support a diagnosis of this condition. This test is often recommended when initial assessments suggest abnormalities.

Blood Test

Blood tests can provide detailed information about how preeclampsia is affecting your body. These tests assess liver function, kidney function, and the number of platelets in your blood. Abnormal results can indicate the severity of preeclampsia and help guide treatment decisions.

These tests can detect complications of this condition, such as HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), which requires immediate medical attention.

Fetal Imaging

A fetal ultrasound is an essential diagnostic tool for monitoring your baby’s health when preeclampsia is suspected, assessing growth, amniotic fluid volume, overall well-being, and blood flow through the umbilical cord.

A fetal Doppler specifically monitors the baby’s heartbeat and measures blood flow through the umbilical artery. This tool helps detect early signs of distress linked to compromised placental function, providing critical information to assess fetal well-being.

Doppler flow studies complement these assessments by providing specialized, non-invasive blood flow measurements in the umbilical artery and maternal vessels, which are essential for assessing placental function.

Poor outcomes in these studies, such as reduced or reversed end-diastolic flow, indicate compromised placental efficiency often associated with this condition. These indicators highlight significant risks to fetal health and underscore the importance of integrated ultrasound evaluations in effectively managing pregnancy health.

Fetal Health Assessment

The non-stress test (NST) and biophysical profile (BPP) are essential diagnostic tools used to confirm the impact of preeclampsia on fetal health. This evaluates the baby’s heart rate in response to its movements, ensuring the fetus receives enough oxygen.

The biophysical profile (BPP) combines the NST and ultrasound to evaluate the baby’s movement, muscle tone, breathing, and amniotic fluid, which preeclampsia can impact. A high BPP score suggests a healthy baby, whereas a low score may necessitate immediate intervention for preeclampsia risks.

Managing Preeclampsia

Managing preeclampsia is essential for expectant mothers and their families, as it is a common yet serious condition that can arise during pregnancy. Management aims to reduce potential complications and, more importantly, prevent fatalities.

Delivery

The only definitive cure for preeclampsia is the delivery of your baby. If you’re close to your due date or the condition is severe, your healthcare provider may suggest inducing labor or conducting a cesarean delivery.

In cases where preeclampsia is mild and when the pregnancy is not yet full-term, doctors may wait while closely monitoring your and your baby’s health.

In severe cases, especially with major blood pressure problems or fetal distress, a cesarean section may be necessary. Delivery timing balances prolonging pregnancy for fetal development against the risks preeclampsia poses to both mother and child.

Medications

Medications can be crucial in managing preeclampsia, especially when it comes to controlling your blood pressure. Antihypertensive drugs may be prescribed to keep your blood pressure at safer levels, reducing the risk of complications such as stroke.

Additionally, if your condition is severe, you might be given corticosteroids to improve your baby’s lung development before delivery or magnesium sulfate to prevent seizures, a condition known as eclampsia.

Hospitalization

In some cases, hospitalization is advised to manage preeclampsia. This enables your healthcare team to track your and your baby’s health more closely and address immediate risks as they are presented.

Hospitalization provides immediate access to medical interventions if your condition worsens, including continuous blood pressure monitoring, frequent blood tests, and the ability to quickly respond to changes in your or your baby’s condition.

Prevention Strategies

Awareness of preeclampsia is vital due to its sudden onset and potential severity, impacting both maternal and fetal health. Early engagement with healthcare professionals can mitigate risks and help maintain a healthy pregnancy.

Regular Prenatal Care

Regular prenatal care is paramount in preventing preeclampsia, enabling your healthcare provider to keep track of your health and your baby’s development closely. Through routine checks, such as blood pressure measurements and urine tests, potential signs of preeclampsia can be detected early.

These visits also facilitate a structured assessment of the pregnancy’s progression and aid in constructing a detailed health profile considering perceived risk factors, which is crucial for promptly identifying deviations from normal health patterns.

Healthy Lifestyle

Sustaining a healthy lifestyle is essential for preventing preeclampsia. It includes eating a balanced diet filled with vegetables, whole grains, fruits, and lean proteins, all of which help manage weight and blood pressure as recommended by the healthcare provider.

As advised by your doctor, regular exercise supports heart health and reduces high blood pressure risk. Implementing specific lifestyle changes, increasing your water intake, careful weight monitoring, and maintaining a low-salt diet are important steps in controlling blood pressure.

Additionally, supplementation with vitamin D and calcium might be recommended, particularly when dietary intake is inadequate. These supplements are important for reducing blood pressure levels and preventing preeclampsia.

Avoid Smoking and Other Substances

Avoiding certain substances is critical in reducing your risk of preeclampsia. This includes refraining from smoking, alcohol, and illicit drug use, all of which can negatively impact your blood pressure and overall pregnancy health.

These substances can contribute to the development of this condition and impede the normal function of your placenta. Avoiding them can significantly reduce your risk and support a healthier pregnancy outcome, contributing to a healthier environment for your baby to develop.

Aspirin Prescription

For some women at high risk of preeclampsia, taking low-dose aspirin after the first trimester as prescribed can be beneficial. Aspirin is thought to improve blood flow to the placenta, thereby reducing the likelihood of developing preeclampsia.

However, it’s important only to take aspirin if recommended by your healthcare provider, as it’s not suitable for everyone. It will be prescribed based on a thorough assessment of individual risk factors, ensuring it is safe and appropriate for the patient’s health profile.

Frequently Asked Questions

What are some causes of preeclampsia during pregnancy?

Preeclampsia can be caused by a range of factors, usually developing after the 20th week of pregnancy or shortly after birth. Genetic predispositions play a significant role, especially if there’s a family history of preeclampsia.

Other potential causes include blood vessel damage, especially those supplying the placenta. This immune system malfunction provokes an inflammatory response against the placenta, placental issues, and various underlying health conditions such as chronic hypertension, diabetes, kidney disease, obesity, and autoimmune disorders.

What symptoms can indicate preeclampsia?

Several symptoms can indicate preeclampsia. High blood pressure and protein in the urine (proteinuria) detected during prenatal appointments are key signs of how the condition affects the cardiovascular system and placental function.

Other symptoms include severe headache, nausea or vomiting in the second half of pregnancy, changes in vision due to brain swelling, upper abdominal pain, decreased urine output, shortness of breath indicating pulmonary edema, and sudden weight and swelling gain due to increased body fluid.

How is preeclampsia confirmed and managed?

Preeclampsia is diagnosed using a combination of blood pressure measurements, urine tests to detect proteinuria, and blood tests to evaluate kidney and liver health. Fetal ultrasound, fetal Doppler, and Doppler flow studies are used to monitor the baby’s health.

Fetal well-being is assessed by monitoring the baby’s heart rate and physical movement response. Management involves timely delivery, carefully planned based on the condition’s severity and the baby’s gestational age.

Medications may be prescribed to control blood pressure and prevent severe complications. Sometimes, hospitalization may be required for continuous monitoring and response to urgent situations.

Are there preventive strategies for preeclampsia?

Prevention approaches for preeclampsia involve consistent prenatal check-ups for early identification, sustaining a healthy lifestyle through a balanced diet, routine exercise, and avoiding harmful substances like alcohol, tobacco, and illegal drugs.

For women at high risk, low-dose aspirin after the first trimester and supplements, especially for those with low dietary intake, may be recommended to reduce the risk of preeclampsia. However, these should only be taken if advised by a healthcare provider.