What is preeclampsia and what are the symptoms? It’s one of the most searched terms on the internet — and with good reason.
Also known as toxemia, preeclampsia has been treated the same way for decades: deliver the baby. Yet, it is still responsible for 18 percent of maternal deaths in the United States. And, there’s now evidence that preeclampsia leads to lasting consequences for some women, ranging from postpartum depression (PPD) to a higher risk of kidney and cardiovascular problems in later life.
What Is Preeclampsia & What Are the Symptoms
Preeclampsia is essentially pregnancy-induced hypertension, or high blood pressure. If left untreated, the BP can hit stroke levels, causing organ shutdown of kidneys and causing seizures. If it hits that point, it’s no longer preeclampsia. It’s called eclampsia instead.
Eclampsia leads to death, often rapidly. Remember Sybil from Downton Abbey? She died in a heartbreaking episode (Spoiler alert!) of eclampsia after she delivered her baby.
The symptoms for preeclampsia usually start in the second or third trimester. While the clincher is super high BP, some of the other symptoms are more subtle. They might include things that usually happen in a pregnancy: upper abdominal pain, weight gain, water retention, and headaches. All of these things should be mentioned to an OB, who will probably dipstick your urine and check for protein spillage, indicating kidney involvement.
Other big red flags: blurred vision, decreased urine output, and nausea. If you have any of these things, hustle to a doctor, stat.
Once diagnosed, some women are put on bedrest to drag out the time until the delivery is safer; more time in utero means better lung development and better chance of surviving a premature delivery. Some, however, are induced immediately or have an emergency c-section.
The only true treatment for preeclampsia is to get the baby delivered. Usually that results in an immediate lowering of the life threatening BP levels, although not always.
What Are the Risk Factors?
The typically published risk factors which most pregnant women hear about are fairly specific.
The Preeclampsia Foundation states that women are considered to be at high-risk for preeclampsia if one or more of the following risk factors are present:
- History of preeclampsia, especially if accompanied by a poor outcome
- Multifetal gestation (pregnant with more than one baby)
- Chronic hypertension (high blood pressure)
- Diabetes (Type 1 or Type 2)
- Kidney disease
- Autoimmune disease
University of Chicago Medicine adds on to this list with:
- Younger than 18 or older than 40
- African American race
- First pregnancy or previous history of preeclampsia
- Family history of preeclampsia
- Sickle cell disease
- In-vitro fertilization
Pregnant with Multiple Babies
One common marker for preeclampsia is being pregnant with multiple babies.
Kelly (not her real name) gave birth at age 33, so she wasn’t in the high risk age groups for developing preeclampsia. Likewise, she didn’t have any of the health problems. She did, however, give birth to twins.
Her illness didn’t present normally, and her diagnosis was delayed. She shared her story with Parentology.
“Five days before I gave birth, I was feeling super heavy. It was painful to drive. Hell, it was painful to even just sit! I was experiencing cramping consistently. So my husband and I went to the hospital, just to check in and make sure nothing was wrong. They popped some IV fluids in me, told me it was a UTI and that I was dehydrated. Number one, I NEVER get UTIs and the one time I did, it did not feel like this. And number two, they gave me antibiotics which I did NOT want to take but again, I didn’t want to risk losing the girls.”
Kelly checked into the hospital after bed rest at home didn’t improve her condition. She was then put on IV magnesium sulfate, a common treatment for preventing the seizures–or “eclampsia”–that can occur. Finally, her OB weighed in.
“Then, it’s 10PM and my specialist arrives. He’s this old white dude that has a businessman-Santa vibe that I had been seeing specifically for the twins to get all their limbs measured every month. Huh, that’s weird, my specialist is here, I thought. Again, no one is telling me shit. “Causing trouble, I see,” he says to me. He measures the girls, tells me we’re going to do steroids to speed up their lung growth. “Let’s try and keep them in there until Monday.” Oh, okay?! My husband calls the specialist to get the low down because I’m on magnesium, a bullet-like shot of steroids and watching How To Get Away With Murder, trying not to bawl my eyes out. “
Kelly’s twins were delivered early through a c-section, and they spent 27 days in the neonatal intensive care unit. Kelly felt powerless and extremely vulnerable.
Kelly and her twins are now thriving.
What About When Preeclampsia Won’t Abate?
Usually, the birth of the baby resolves preeclampsia; the ultra high BP drops quickly and both mother and baby are fine. But, sometimes, preeclampsia can continue or begin AFTER birth.
Maggie (not her real name), was a very healthy 33-year-old pregnant woman with no predisposition to developing preeclampsia. Yet, it happened anyway. Maggie told Parentology her story.
“My pregnancy was fairly uneventful until about a week before my due date when I was hit with sudden blurred vision. It actually wasn’t really like blurred vision, it was more like my brain and my eyes stopped communicating. My doctor was out of town but the covering doc told me to go to CVS and test my blood pressure, and if it was higher than 145/90 to go straight to the hospital. I think it was 170/110 or something like that, I can’t quite remember.”
Her BP seemed to go down as she took it at CVS, so she purchased a BP monitor and went home to “watch the Handmaid’s Tale finale.”
Unfortunately, her vision blurred again during the episode. After calling her doctor in a panic, she was told to come into the hospital to be induced.
“When I got to the hospital, she told me the preeclampsia medication would make me feel like I’d been hit by a bus and the second she left the room I said her bedside manner was abysmal. Until they gave me the medication and — holy shit — words cannot do this justice. Hot poison pulsing through my veins. The pain, the heat, the paralysis … At some point I was given fentanyl which barely took the edge off. Then the epidural. I puked every 10 minutes and was pretty much paralyzed from the preeclampsia medication. This all started at 7am. My baby was born perfectly healthy at 7:07pm.”
It all should have resolved then. The baby was out, the mother was alive. However, preeclampsia can be a tricky illness.
“ I was discharged about three days later and happy to put it all behind me. But another three days passed and my vision went weird again. I went to the ER and was immediately chastised for bringing a newborn child with me. But, silver lining, that card gets you seen immediately. I was put back on the dreaded medication, whilst grappling with how to breastfeed, and sat in the ER all night until I was transferred up to the maternity ward. I then stayed there for another night or so until I was given the all clear and discharged again.”
There’s nothing typical about Maggie’s preeclampsia story, but it happens all the time.
Newer Treatments and Diagnostic Tools Are Coming
Currently, the only proactive tool pregnant women can utilize (besides monitoring their own health and hoping doctors listen to them) is taking aspirin.
According to the Preeclampsia Foundation, “The American College of Obstetricians and Gynecologists (ACOG) supports the recommendation to consider the use of low-dose aspirin (81 mg/day), initiated between 12 and 28 weeks of pregnancy, for the prevention of preeclampsia for women with these risk factors. Most experts go further to suggest that any benefits are realized when aspirin is started early by 16 weeks.”
That’s all well and good, if you’re in a risk group, and if you have symptoms. But what if it remains silent until the last trimester?
Researchers at the University of Chicago Medicine are currently investigating biomarkers present in some women, which might indicate vulnerability to preeclampsia development.
“The biomarkers (such as sFlt1 and PlGF) are being tested in patients with suspicion or diagnosis of preeclampsia to predict which women are at risk for adverse outcomes and which women can have their pregnancies safely prolonged,” said high-risk pregnancy obstetrician and researcher Dr. Sarosh Rana (U. of Chicago Medicine). She explained to Parentology, “These markers are already approved in many countries around the world such as Germany, Canada, and India, and are being tested for FDA approval in the United States in a number of centers including [the] University of Chicago. We are a few years away from their approval, but hopefully we can use these as a tool to better diagnose preeclampsia and improve outcomes of pregnant women.”
Preeclampsia Can Have a Lasting Impact
According to a 2019 article in Nature, preeclampsia doesn’t end with birth.
“Evidence is emerging of long-term increased risk of cardiovascular and kidney disease in women who have experienced pre-eclampsia; pre-eclampsia is also an important risk factor for neonatal respiratory distress syndrome and bronchopulmonary dysplasia,” Nature noted.
Another 2019 article, conducted in China and entitled Development of Postpartum Depression in Pregnant Women with Preeclampsia: A Retrospective Study, found a link between the illness and developing postpartum depression.
“The prevalence of PPD was 26.67% (24/90) in patients with PE, which was two times the prevalence in normal women (12.22%). Multiple logistic regression showed that women who had PE had nearly 3-fold increased odds of PPD compared to normal women and the risk of PPD increased with the aggravation of PE. Patients with severe PE had a more than 4-fold increased risk of screening positive for PPD. Conclusion. PE was independently associated with PPD. Furthermore, the risk of PPD seemed to increase with the aggravation of PE. Thus, additional prevention efforts and support methods should be provided for women with PE to reduce the incidence of PPD.”
Both these studies indicate that, if you end up with preeclampsia, you should be monitored for postpartum depression. The sooner you get on top of PPD, the sooner it will abate; treatments include therapy and often medication.
And, make sure you always list preeclampsia on your medical history, as it could be an underlying condition for later health problems. The more information your doctor has, the better and sooner you can get treatment.