Doctor's Notes on Preeclampsia
Preeclampsia is a dangerous pregnancy complication associated with high blood pressure, edema (swelling), and protein in the urine. Preeclampsia typically occurs some time after the 20th week of pregnancy, and less commonly, it can occur after giving birth. Risk factors for developing preeclampsia include being pregnant with multiples, maternal age over 35, history of high blood pressure, obesity, and diabetes.
The most common and sometimes the only symptom of preeclampsia is high blood pressure. Other symptoms of preeclampsia that affect the mother include protein in the urine, swelling (edema) of the legs, hands, or face, rapid weight gain over a few days (more than 2 pounds a week), blurred vision, seeing spots, severe headaches, convulsions, blindness (occasionally), pain in the upper part of the abdomen that may be confused with indigestion or gallbladder disease, and excessive bruising. Some changes from preeclampsia can affect the baby. Symptoms that result from problems with blood flow to the placenta include inadequate nutrition that causes the baby to not grow properly and be smaller than expected, or a baby that will appear sluggish or seem to have decreased activity.
The various changes and symptoms that occur with preeclampsia vary according to the organ system or systems that are affected. These changes can affect the mother only, baby only, or more commonly affect both mother and baby. Some of these symptoms give the woman warning signs, but most do not.
- The most common symptom and hallmark of preeclampsia is high blood pressure. This may be the first or only symptom. Blood pressure may be only minimally elevated initially, or can be dangerously high; symptoms may or may not be present. However, the degree of blood pressure elevation varies from woman to woman and also varies during the development and resolution of the disease process. There are also some women who never have significant blood pressure elevation.
- The kidneys are unable to efficiently filter the blood (as they normally do). This may cause protein to be present in the urine. The first sign of excess protein is commonly seen on a urine sample obtained in the health care professional's office. Rarely does a woman note any changes or symptoms associated with excess protein in the urine. In extreme cases affecting the kidneys, the amount of urine produced decreases greatly.
- Swelling of the legs, or of the face
- Rapid weight gain over a few days (more than 2 pounds a week)
- Nervous system changes can include blurred vision, seeing spots, severe headaches, convulsions, and even occasionally blindness. Any of these symptoms require immediate medical attention.
- Changes that affect the liver can cause pain in the upper part of the abdomen and may be confused with indigestion or gallbladder disease. Other more subtle changes that affect the liver can affect the ability of the platelets to cause blood to clot; these changes may be seen as excessive bruising.
- Changes that can affect the baby can result from problems with blood flow to the placenta, and therefore, the baby does not receive proper nutrients. As a result, the baby may not grow properly and may be smaller than expected, or worse the baby will appear sluggish or seem to have decreased activity. Call the doctor immediately if the baby's movements decrease.
No one knows exactly what causes preeclampsia. It is believed to be a dysfunction in the lining cells of blood cells (endothelial cells).
Since what causes preeclampsia is not known, no effective tests predict when preeclampsia will occur, and no treatments prevent preeclampsia from occurring (or re-occurring).
Some factors are known to increase as woman's risk of developing preeclampsia.
- Multiple gestations
- Women older than 35 years of age
- History of high blood pressure before pregnancy
- Preeclampsia in a previous pregnancy
- Other medical problems (such as connective tissue disease and kidney disease).
For unknown reasons, African American women in the US are more likely to develop preeclampsia than white women.
Preeclampsia may run in families, although the reason for this is unknown.
Preeclampsia is also associated with problems with the placenta, such as too much placenta, too little placenta, or how the placenta attaches to the wall of the uterus. It also may be associated with a hydatidiform mole, in which there is no normal placenta and no normal baby.
There is nothing that any woman can do to prevent preeclampsia from occurring.
Regular exercise during pregnancy is important for your health and well-being. It can improve posture, prevent backaches, decrease fatigue, relieve stress, and build stamina you will need for labor and delivery. It may also help prevent a type of diabetes that develops during pregnancy (gestational diabetes).
Most aerobic, resistance, and flexibility exercises are safe during pregnancy, but because each woman and each pregnancy is different it's important to consult your doctor before starting any exercise program while pregnant.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.