Question: prevention of preeclampsia I know that the jury is out on the exact causes of preeclampsia, but I am looking for some of the ways that the chances of acquiring it can be minimized.

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Preeclampsia and Eclampsia: Preeclampsia (pree-i-KLAMP-see-uh) and eclampsia (ih-KLAMP-see-uh) are pregnancy-related high blood pressure disorders. In preeclampsia, the mother’s high blood pressure reduces the blood supply to the fetus, which may get less oxygen and fewer nutrients. Eclampsia is when pregnant women with preeclampsia develop seizures or coma. NICHD and other agencies are working to understand what causes these conditions and how they can be prevented and better treated. Preeclampsia and eclampsia are part of the spectrum of high blood pressure, or hypertensive, disorders that can occur during pregnancy.At the mild end of the spectrum is gestational hypertension, which occurs when a woman who previously had normal blood pressure develops high blood pressure when she is more than 20 weeks pregnant and her blood pressure returns to normal within 12 weeks after delivery. This problem usually occurs without other symptoms. In many cases, gestational hypertension does not harm the mother or fetus. Severe gestational hypertension, however, may be associated with preterm birth and infants who are small for their age at birth.1 And about 15% to 25% of women with gestational hypertension go on to develop preeclampsia.2Preeclampsia is similar to gestational hypertension, because it also describes high blood pressure at or after 20 weeks of pregnancy in a woman whose blood pressure was normal before pregnancy. But preeclampsia can also include blood pressure at or greater than 140/90 mmHg, increased swelling, and protein in the urine.3 The condition can be serious and is a leading cause of preterm birth (before 37 weeks of pregnancy).4 If it is severe enough to affect brain function, causing seizures or coma, it is called eclampsia.One of the serious complications of hypertensive disorders in pregnancy is HELLP syndrome, a situation in which a pregnant woman with preeclampsia or eclampsia suffers damage to the liver and blood cells. The letters in the name HELLP stand for the following problems:- H - Hemolysis, in which oxygen-carrying red blood cells break down - EL - Elevated Liver enzymes, showing damage to the liver - LP - Low Platelet count, meaning that the cells responsible for stopping bleeding are low The causes of preeclampsia and eclampsia are not known. These disorders previously were believed to be caused by a toxin, called “toxemia,” in the blood, but health care providers now know that is not true. Nevertheless, preeclampsia is sometimes still referred to as “toxemia.”To learn more about preeclampsia and eclampsia, scientists are investigating many factors that could contribute to the development and progression of these diseases, including:- Placental abnormalities, such as insufficient blood flow - Genetic factors - Environmental exposures - Nutritional factors - Maternal immunology and autoimmune disorders - Cardiovascular and inflammatory changes - Hormonal imbalances - Risks During Pregnancy Preeclampsia during pregnancy is mild in 75% of cases.1 However, a woman can progress from mild to severe preeclampsia or to full eclampsia very quickly―even in a matter of days. Both preeclampsia and eclampsia can cause serious health problems for the mother and infant. Women with preeclampsia are at increased risk for damage to the kidneys, liver, brain, and other organ and blood systems. Preeclampsia may also affect the placenta. The condition could lead to a separation of the placenta from the uterus (referred to as placental abruption), preterm birth, and pregnancy loss or stillbirth. In some cases, preeclampsia can lead to organ failure or stroke. In severe cases, preeclampsia can develop into eclampsia, which includes seizures. Seizures in eclampsia may cause a woman to lose consciousness and twitch uncontrollably.2 If the fetus is not delivered, these conditions can cause the death of the mother and/or the fetus. Expecting mothers rarely die from preeclampsia in the developed world, but it is still a major cause of illness and death globally.3 According to the World Health Organization, preeclampsia and eclampsia cause 14% of maternal deaths each year, or about 50,000 to 75,000 women worldwide.4 - Risks After Pregnancy In “uncomplicated preeclampsia,” the mother’s high blood pressure and other symptoms usually go back to normal within 6 weeks of the infant’s birth. However, studies have shown that women who had preeclampsia are four times more likely to later develop hypertension (high blood pressure) and are twice as likely to later develop ischemic heart disease (reduced blood supply to the heart muscle, which can cause heart attacks), a blood clot in a vein, and stroke as are women who did not have preeclampsia.5 Less commonly, mothers who had preeclampsia could experience permanent damage to their organs, such as their kidneys and liver. They could also experience fluid in the lungs. In the days following birth, women with preeclampsia remain at increased risk for developing eclampsia and seizures.3,6 Preeclampsia may be related to problems with the placenta early in the pregnancy.1 Such problems pose risks to the fetus, including:- Lack of oxygen and nutrients, which can impair fetal growth - Preterm birth - Stillbirth if placental abruption (separation of the placenta from the uterine wall) leads to heavy bleeding in the mother - Death: According to the Preeclampsia Foundation , each year, about 10,500 infants in the United States and about half a million worldwide die due to preeclampsia.2 Stillbirths are more likely to occur when the mother has a more severe form of preeclampsia, including HELLP syndrome.Infants whose mothers had preeclampsia are also at increased risk for later problems, even if they were born at full term (39 weeks of pregnancy).3 Infants born preterm due to preeclampsia face a higher risk of some long-term health issues, mostly related to being born early, including learning disorders, cerebral palsy, epilepsy, deafness, and blindness. Infants born preterm may also have to be hospitalized for a long time after birth and may be smaller than infants born full term. Infants who experienced poor growth in the uterus may later be at higher risk of diabetes, congestive heart failure, and high blood pressure.4 The exact number of women who develop preeclampsia is not known. Some estimates suggest that preeclampsia affects 2% to 8% of all pregnancies globally and about 3.4% in the United States.1,2The condition is estimated to account for 10% to 15% of maternal deaths worldwide.1 Disorders related to high blood pressure are the second leading cause of stillbirths and early neonatal deaths in developing nations.3In addition, HELLP syndrome occurs in about 10% to 20% of all women with severe preeclampsia or eclampsia.4Although preeclampsia occurs primarily in first pregnancies, a woman who had preeclampsia in a previous pregnancy is seven times more likely to develop preeclampsia in a later pregnancy.5Other factors that can increase a woman's risk include:5- Chronic high blood pressure or kidney disease before pregnancy - High blood pressure or preeclampsia in an earlier pregnancy - Obesity. Overweight or obese women are also more likely to have preeclampsia in more than one pregnancy.6 - Age. Women older than 40 are at higher risk. - Multiple gestation (being pregnant with more than one fetus) - African American ethnicity. Also, among women who have had preeclampsia before, non-white women are more likely than white women to develop preeclampsia again in a later pregnancy.6 - Family history of preeclampsia. According to the World Health Organization, among women who have had preeclampsia, about 20% to 40% of their daughters and 11% to 37% of their sisters also will get the disorder.7Preeclampsia is also more common among women who have histories of certain health conditions, such as migraines,8 diabetes,9 rheumatoid arthritis,10 lupus,11 scleroderma,12 urinary tract infections,13 gum disease,14 polycystic ovary syndrome,15 multiple sclerosis, gestational diabetes, and sickle cell disease.16Preeclampsia is also more common in pregnancies resulting from egg donation, donor insemination, or in vitro fertilization.The U.S. Preventative Services Task Force recommends that women who are at high risk for preeclampsia take low-dose aspirin starting after 12 weeks of pregnancy to prevent preeclampsia.17 Women who are pregnant or who are thinking about getting pregnant should talk with their health care provider about preeclampsia risk and ways to reduce the risk. - Preeclampsia Possible symptoms of preeclampsia include: - High blood pressure - Too much protein in the urine - Swelling in a woman's face and hands (a woman's feet might swell too, but swollen feet are common during pregnancy and may not signal a problem) - Systemic problems, such as headache, blurred vision, and right upper quadrant abdominal pain - High blood pressure - Too much protein in the urine - Swelling in a woman's face and hands (a woman's feet might swell too, but swollen feet are common during pregnancy and may not signal a problem) - Systemic problems, such as headache, blurred vision, and right upper quadrant abdominal pain - Eclampsia The following symptoms are cause for immediate concern:1 - Seizures - Severe headache - Vision problems, such as temporary blindness - Abdominal pain, especially in the upper right area of the belly - Nausea and vomiting - Smaller urine output or not urinating very often - Seizures - Severe headache - Vision problems, such as temporary blindness - Abdominal pain, especially in the upper right area of the belly - Nausea and vomiting - Smaller urine output or not urinating very often - HELLP Syndrome HELLP syndrome can lead to serious complications, including liver failure and death.1 A pregnant woman with HELLP syndrome might bleed or bruise easily and/or experience abdominal pain, nausea or vomiting, headache, or extreme fatigue. Although most women who develop HELLP syndrome already have high blood pressure and preeclampsia, sometimes the syndrome is the first sign. In addition, HELLP syndrome can occur without a woman having either high blood pressure or protein in her urine. A health care provider will check a pregnant woman’s blood pressure and urine during each prenatal visit. If the blood pressure reading is considered high (140/90 or higher), especially after the 20th week of pregnancy, the health care provider will likely perform blood tests and more extensive lab tests to look for extra protein in the urine (called proteinuria) as well as other symptoms.The American College of Obstetricians and Gynecologists provides the following criteria for a diagnosis of gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome.Gestational hypertension is diagnosed if a pregnant woman has high blood pressure but no protein in the urine. Gestational hypertension occurs when women whose blood pressure levels were normal before pregnancy develop high blood pressure after 20 weeks of pregnancy. Gestational hypertension can progress into preeclampsia.1Mild preeclampsia is diagnosed when a pregnant woman has:2- Systolic blood pressure (top number) of 140 mmHg or higher or diastolic blood pressure (bottom number) of 90 mmHg or higher and either - Urine with 0.3 or more grams of protein in a 24-hour specimen (a collection of every drop of urine within 24 hours) or a protein-to-creatinine ratio greater than 0.3  or - Blood tests that show kidney or liver dysfunction - Fluid in the lungs and difficulty breathing - Visual impairmentsSevere preeclampsia occurs when a pregnant woman has any of the following:- Systolic blood pressure of 160 mmHg or higher or diastolic blood pressure of 110 mmHg or higher on two occasions at least 4 hours apart while the patient is on bed rest - Urine with 5 or more grams of protein in a 24-hour specimen or 3 or more grams of protein on 2 random urine samples collected at least 4 hours apart - Test results suggesting kidney or liver damage—for example, blood tests that reveal low numbers of platelets or high liver enzymes - Severe, unexplained stomach pain that does not respond to medication - Symptoms that include visual disturbances, difficulty breathing, or fluid buildup3Eclampsia occurs when women with preeclampsia develop seizures. The seizures can happen before or during labor or after the baby is delivered. HELLP syndrome is diagnosed when laboratory tests show hemolysis (burst red blood cells release hemoglobin into the blood plasma), elevated liver enzymes, and low platelets. There also may or may not be extra protein in the urine.4Some women may also be diagnosed with superimposed preeclampsia—a situation in which the woman develops preeclampsia on top of high blood pressure that was present before she got pregnant. Health care providers look for an increase in blood pressure and either protein in the urine, fluid buildup, or both for a diagnosis of superimposed preeclampsia.In addition to tests that might diagnose preeclampsia or similar problems, health care providers may do other tests to assess the health of the mother and fetus, including:- Blood tests to see how well the mother's liver and kidneys are working - Blood tests to check blood platelet levels to see how well the mother’s blood is clotting - Blood tests to count the total number of red blood cells in the mother’s blood - A maternal weight check - An ultrasound to assess the fetus’s size - A check of the fetus's heart rate - A physical exam to look for swelling in the mother’s face, hands, or legs as well as abdominal tenderness or an enlarged liver - Preeclampsia Treatment If the pregnancy is at 37 weeks or later, the health care provider will usually want to deliver the fetus to treat preeclampsia and avoid further complications. If the pregnancy is at less than 37 weeks, however, the woman and her health care provider may consider treatment options that give the fetus more time to develop, depending on how severe the condition is. A health care provider may consider the following options: - If the preeclampsia is mild, it may be possible to wait to deliver. To help prevent further complications, the health care provider may ask the woman to go on bed rest to try to lower blood pressure and increase the blood flow to the placenta. - Close monitoring of the woman and her fetus will be needed. Tests for the mother might include blood and urine tests to see if the preeclampsia is progressing, such as tests to assess platelet counts, liver enzymes, kidney function, and urinary protein levels. Tests for the fetus might include ultrasound, heart rate monitoring, assessment of fetal growth, and amniotic fluid assessment. - Anticonvulsive medication, such as magnesium sulfate, might be used to prevent a seizure. - In some cases, such as with severe preeclampsia, the woman will be admitted to the hospital so she can be monitored closely and continuously. Treatment in the hospital might include intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs. When a woman has severe preeclampsia and is at 34 weeks of pregnancy or later, the American College of Obstetricians and Gynecologists recommends delivery as soon as medically possible. If the pregnancy is at less than 34 weeks, health care providers will probably prescribe corticosteroids to help speed up the maturation of the fetal lungs before attempting delivery.2 Preterm delivery may be necessary, even if that means likely complications for the infant, because of the risk of severe maternal complications. The symptoms of preeclampsia usually go away within 6 weeks of delivery.3 - If the preeclampsia is mild, it may be possible to wait to deliver. To help prevent further complications, the health care provider may ask the woman to go on bed rest to try to lower blood pressure and increase the blood flow to the placenta. - Close monitoring of the woman and her fetus will be needed. Tests for the mother might include blood and urine tests to see if the preeclampsia is progressing, such as tests to assess platelet counts, liver enzymes, kidney function, and urinary protein levels. Tests for the fetus might include ultrasound, heart rate monitoring, assessment of fetal growth, and amniotic fluid assessment. - Anticonvulsive medication, such as magnesium sulfate, might be used to prevent a seizure. - In some cases, such as with severe preeclampsia, the woman will be admitted to the hospital so she can be monitored closely and continuously. Treatment in the hospital might include intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs. - Eclampsia Treatment Eclampsia—the onset of seizures in a woman with preeclampsia—is considered a medical emergency. Immediate treatment, usually in a hospital, is needed to stop the mother's seizures, treat blood pressure levels that are too high, and deliver the fetus. Magnesium sulfate (a type of mineral) may be given to treat active seizures and prevent future seizures. Antihypertensive medications may be given to lower the blood pressure. - HELLP Syndrome Treatment HELLP syndrome, a severe complication of preeclampsia and eclampsia, can lead to serious complications for the mother, including liver failure and death, as well as the fetus. The health care provider may consider the following treatments after a diagnosis of HELLP syndrome: - Delivery of the fetus - Hospitalization to provide intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs.4 - Delivery of the fetus - Hospitalization to provide intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs.4 - If I have high blood pressure, can I take steps to prevent problems like preeclampsia during pregnancy? If you currently have chronic hypertension (high blood pressure not due to pregnancy), you may be at higher-than-average risk for getting preeclampsia during pregnancy. Your risk is also higher if you had gestational hypertension (high blood pressure that occurs only during pregnancy) or preeclampsia with a previous pregnancy, if you are obese, or if you have other risk factors.1 Talk with your health care provider about how hypertension might affect your pregnancy and what you can do to lower your risk. Before You Get Pregnant - Visit your health care provider for a preconception visit to discuss what you can do to lower your risk. Your health care provider may recommend ways to control your blood pressure, if needed, by limiting your salt intake, exercising regularly, and losing weight if you are overweight. - If you take medication to control your blood pressure, ask your health care provider if you should change it. Some medications should not be used during pregnancy. Your health care provider may be able to recommend safer alternatives. While You Are Pregnant - Get regular prenatal care, including regular blood pressure checks, urine tests for protein, as well as regular weight checks. - Avoid alcohol and tobacco. - Talk with your health care provider about any drugs or supplements that you take or are thinking of taking, including vitamins and herbs. Follow your provider's recommendations about prescription and other medications. - If you are at very high risk of preeclampsia, your doctor may recommend that you start taking low-dose aspirin after at least 12 weeks of pregnancy.2 [top] - Visit your health care provider for a preconception visit to discuss what you can do to lower your risk. Your health care provider may recommend ways to control your blood pressure, if needed, by limiting your salt intake, exercising regularly, and losing weight if you are overweight. - If you take medication to control your blood pressure, ask your health care provider if you should change it. Some medications should not be used during pregnancy. Your health care provider may be able to recommend safer alternatives. - Get regular prenatal care, including regular blood pressure checks, urine tests for protein, as well as regular weight checks. - Avoid alcohol and tobacco. - Talk with your health care provider about any drugs or supplements that you take or are thinking of taking, including vitamins and herbs. Follow your provider's recommendations about prescription and other medications. - If you are at very high risk of preeclampsia, your doctor may recommend that you start taking low-dose aspirin after at least 12 weeks of pregnancy.2 - If I had preeclampsia with a previous pregnancy, will I have it again in later pregnancies? If you had preeclampsia during your first pregnancy, your risk of developing preeclampsia again is about 15%.3 Your risk is even higher if you delivered your first child before 28 weeks of pregnancy or if you are overweight or obese.3 Your risk of having preeclampsia again is also higher if you developed preeclampsia early in your previous pregnancy, if you developed chronic hypertension or diabetes after the first pregnancy, if you had in vitro fertilization, or if you are carrying more than one fetus. Having severe preeclampsia or HELLP syndrome during the first pregnancy also raises your risk. If you had HELLP syndrome during a pregnancy, you have about a 20% chance of getting some form of gestational hypertension again.4 [top]

Answer: Although preeclampsia occurs primarily in first pregnancies, a woman who had preeclampsia in a previous pregnancy is seven times more likely to develop preeclampsia in a later pregnancy. Other factors that can increase a woman's risk include chronic high blood pressure or kidney disease before pregnancy, obesity, age  over 40, being pregnant with more than one fetus, African American ethnicity, family history of preeclampsia. Preeclampsia is also more common among women who have histories of certain health conditions, such as migraines, diabetes, rheumatoid arthritis, lupus, scleroderma, urinary tract infections, gum disease, polycystic ovary syndrome, multiple sclerosis, gestational diabetes, and sickle cell disease. Preeclampsia is also more common in pregnancies resulting from egg donation, donor insemination, or in vitro fertilization. If you are at very high risk of preeclampsia, your doctor may recommend that you start taking low-dose aspirin after at least 12 weeks of pregnancy. Visit your health care provider for a preconception visit to discuss what you can do to lower your risk. Your health care provider may recommend ways to control your blood pressure, if needed, by limiting your salt intake, exercising regularly, and losing weight if you are overweight. If you take medication to control your blood pressure, ask your health care provider if you should change it. Some medications should not be used during pregnancy. Get regular prenatal care, including regular blood pressure checks, urine tests for protein, as well as regular weight checks. Avoid alcohol and tobacco. Talk with your health care provider about any drugs or supplements that you take or are thinking of taking, including vitamins and herbs. Follow your provider's recommendations about prescription and other medications.