Preeclampsia

What is it?

Preeclampsia is a serious pregnancy disorder. The 2 primary characteristics of preeclampsia are high blood pressure (hypertension) and protein in urine (proteinuria). It is most commonly diagnosed after 20 weeks, and can also develop within 6 weeks of birth.

In Australia, between 5-8% of all pregnancies result in a diagnosis of preeclampsia. Of that percentage, 1-2% develop severe preeclampsia which threatens the life of the pregnant person and baby. Globally, someone dies from preeclampsia and its complications every 6 minutes.

Delivery of the baby and placenta is the only thing that can stop the progression of preeclampsia.

The cause of preeclampsia is still unknown, even though there are several risk factors that may increase a person’s chance of developing it.

For the pregnant person, preeclampsia poses a risk of kidney, liver and neurological functioning, and can lead to life threatening complications like strokes, seizures (eclampsia) and HELLP syndrome. For the baby, preeclampsia can impact placental function and lead to restricted growth, and there is a higher risk of placental abruption. Preeclampsia is responsible for 5-8% of preterm deliveries in Australia.

Although preeclampsia can’t be cured, it can be managed and treated. This may include medications that help stabilise blood pressure, prevent seizures and lessen the risk of blood clotting.

Preeclampsia is unpredictable, and can escalate without warning. Medical care is essential for ongoing management of blood pressure and any other complications.

Consult your healthcare provider as soon as possible if you think you may have preeclampsia, or if you have any questions.

Who gets it?

It’s important for survivors of preeclampsia to know that there isn’t a known cause, and it can’t be prevented. There is nothing you could have done or not done in order to avoid your diagnosis, It was not your fault!

That being said, there are risk factors that are important to know about.

Having any of the following doesn’t mean you will get preeclampsia. On the flip side, not having any doesn’t mean you won’t get it.

Risk factors include:

• First pregnancy
• Personal or family history of preeclampsia
• Pregnant with multiple babies
• Chronic hypertension prior to pregnancy
• Preexisting kidney disease
• Body Mass Index (BMI) above 30
• Over the age of 35
• Gestational or preexisting diabetes
• Polycystic ovarian syndrome
• Preexisting autoimmune disorders
• IVF or assisted conception
• 10 or more years between pregnancies

Social factors can also increase the risk of developing preeclampsia. This is also true for other pregnancy complications or health conditions.

People who are disadvantaged, disempowered and oppressed have a higher risk of struggling with their physical and mental health. This is often related to inequality in access to healthcare and support.

What are the symptoms?

For a diagnosis of preeclampsia, hypertension and proteinuria are the key features looked for by healthcare providers. These are the 2 things that are checked at every prenatal appointment.

Preeclampsia has many other symptoms that may be present before or after a diagnosis that pregnant people should look out for as the pregnancy progresses.

The following are the most common symptoms of preeclampsia:

• Chronic or gestational hypertension
• Proteinuria
• Headaches
• Upper right abdominal pain
• Right shoulder pain
• Visual disturbances (blurry, spots)
• Light sensitivity
• Shortness of breath
• Swelling in the face or hands
• Rapid weight gain
• Confusion and increased anxiety
• Nausea and vomiting

It’s important to know that hypertension and proteinuria often have no symptoms. High blood pressure often doesn’t cause feelings of being unwell. Preeclampsia is often referred to as an invisible illness, with many pregnant people being diagnosed with no noticeable symptoms.

Attending prenatal appointments is essential so that blood pressure is regularly checked and managed.

Is there a long term impact?

Preeclampsia can only be stopped or slowed down by delivery of the baby and placenta. Following birth, preeclampsia continues to be a risk for the first 6 weeks postpartum. It is possible to develop postpartum preeclampsia even if you haven’t had preeclampsia during the pregnancy.

People who have preeclampsia often require ongoing healthcare after delivery to determine any lasting damage to renal and liver function and blood pressure.

90% of people will come off blood pressure medication within 3 months of delivery, and 95% within 6 months. The remaining 5% will require lifelong blood pressure medication.

Research has shown that survivors of preeclampsia are at increased risk of:

• Ongoing hypertension
• Heart disease and stroke
• Future diabetes
• Preterm labour and delivery
• Preeclampsia in future pregnancies
• Ongoing mental health concerns

More recent studies have shown that 2 out of 3 survivors of preeclampsia will die from heart disease.

This is the devastating and scary reality that preeclampsia survivors face after an already traumatic experience. Even though these risks can’t be removed, there are things survivors can do to stay healthy and decrease the risk. Survivors of preeclampsia are encouraged to do the following things to manage their future risk:

• Reach and maintain a healthy weight
• Adopt a heart healthy diet
• Monitor blood pressure regularly
• Cease or avoid smoking
• Exercise regularly

It’s important for survivors of preeclampsia to have a trusted health professional to help manage the current and future needs and risks. Ongoing mental health care is essential, as many survivors are recovering from traumatic birth experiences. Looking after mental health is as important as our physical health in the short and long term.

I’ve heard some things…are they true?

Preeclampsia is a health condition that’s still unknown and mysterious in lots of ways. There isn’t even an agreement on what we call it! Is it a disease? A disorder?

There’s no definitive cause and no guaranteed cure. It can develop in people who have all of the risk factors or people who have none. In some people, it stays mild and in others it escalates.

Due to it’s unknown nature, there are quite a few myths, misunderstandings and assumptions about preeclampsia:

Eating too much salt causes it. While reduced salt intake is recommended for a generally heart healthy diet, your salt intake (or diet in general) does not cause preeclampsia.

Only overweight people get it. A risk factor, but not a cause.

Delivery cures it. Unfortunately, there is no cure at this time. Delivery of the baby and placenta is the only thing that can slow or stop the progression of preeclampsia, but nothing can cure it.

It’s just high blood pressure. Hypertension is a large element of preeclampsia, but it is a separate issue on its own.

You’ll feel symptoms. Many people don’t have noticeable symptoms, and the diagnosis comes as a surprise. Hypertension and proteinuria in particular are usually asymptomatic.

It doesn’t cause risk to the baby. Babies are at huge risk from preeclampsia. When left unmanaged, it can lead to organ failure, strokes, eclampsia or HELLP syndrome. Anything that is severe or fatal for the pregnant person is a concern for the baby. Preeclampsia can lead to intrauterine growth restriction (IUGR) or placental abruption.

It can’t happen to me or someone I love. Preeclampsia affects 1 in 12 pregnancies. Each year, more than 70,000 adults and 500,000 babies die due to preeclampsia.