Prenatal Monitoring and Care
What You Should Know About Preeclampsia: Q&A with Eleni Tsigas of the Preeclampsia Foundation
Eleni Tsigas is Executive Director of the Preeclampsia Foundation and has previously served the organization in a variety of volunteer capacities, including on its Board of Directors. Tsigas came to the Preeclampsia Foundation after her own pregnancies were seriously affected by preeclampsia. Since the death of her daughter due to preeclampsia complications, she has become a tireless advocate for others who suffer from the sometimes devastating impact of this condition. The Preeclampsia Foundation is a 501 (c)(3) nonprofit organization established in 2000. The Foundation’s mission is to reduce maternal and infant death and other adverse outcomes due to preeclampsia by providing patient support and education, raising public awareness, catalyzing research and improving healthcare practices.
Q. What is preeclampsia?
A. Preeclampsia is a rapidly-progressing condition affecting childbearing women, marked by high blood pressure and protein the urine. Preeclampsia is often silent, showing up unexpectedly during a routine blood pressure check and urine test. Preeclampsia affects at least 5 to 8 percent of all pregnancies and accounts for 18 percent of US maternal deaths each year. Together, preeclampsia and one of its severe complications, eclampsia, account for 76,000 maternal deaths per year around the world. In the US, preeclampsia accounts for approximately 15 percent of all premature births.
Q. What are the symptoms?
A. Swelling of the face and hands, sudden weight gain, headaches and changes in vision are important symptoms, though some women with rapidly advancing disease report few symptoms. Many signs and symptoms of preeclampsia mirror other “normal” effects of pregnancy on a woman’s body.
Q. When does preeclampsia occur?
A. Preeclampsia can appear any time during pregnancy, delivery, and up to six weeks postpartum. It most frequently occurs in the third trimester and resolves within 48 hours of delivery. Preeclampsia can develop gradually or come on quite suddenly, even flaring up in a matter of hours, though some clinical signs may have been present for weeks undetected.
Q. Why does it occur?
A. The cause of preeclampsia is still unknown. There are a number of theories, as well as several risk factors that can increase one’s chance of getting it. Among them are: insufficient blood flow to the uterus; disruption of the balance of the hormones that maintain the diameter of blood vessels; damage to the lining of the blood vessels that regulates their diameter; preexisting maternal conditions like diabetes, lupus, sickle cell disorder, hyperthyroidism, etc.; obesity, diabetes and insulin resistance; and genetic tendencies.
Q. Why is preeclampsia dangerous?
A. Preeclampsia can cause a woman’s blood pressure to rise and puts her at risk of stroke or impaired kidney function, impaired liver function, blood clotting problems, pulmonary edema (fluid on the lungs), seizures and, in severe forms, maternal and infant death. Because preeclampsia affects the blood flow and placenta, babies can be smaller and are often born prematurely. Eclampsia, one of the most serious complications of severe preeclampsia, can cause seizures that result in coma, brain damage and possibly maternal or infant death.
Q. How does preeclampsia affect the baby?
A. Preeclampsia is the leading known cause of preterm birth in the United States. It is also associated with Intrauterine Growth Restriction (IUGR), in which reduced blood flow to the placenta restricts the supply of food to the baby and can result in starvation. As a result, babies affected by IUGR may be smaller for their gestational age. Because with preeclampsia the placenta becomes compromised and the baby’s body begins to restrict blood flow to the limbs, kidney and stomach in an effort to preserve the vital supply to the brain and heart, the baby may develop acidosis, causing the baby to lose consciousness and stop moving, requiring an emergency delivery. Infant death is one of the most devastating consequences of preeclampsia. Infants who survive preeclampsia but are born prematurely may sometimes face ongoing life challenges, such as learning disabilities, cerebral palsy, epilepsy, blindness and deafness. Recent studies suggest that babies born to preeclamptic mothers have an increased risk of stroke and diabetes later in life.
Q. Who is most at risk?
A. Preeclampsia is most common in first-time pregnancies. If you have had preeclampsia with your first pregnancy, you are more likely to experience it in subsequent pregnancies. Other significant risk factors include a history of chronic high blood pressure, diabetes or kidney disorder; family history of the preeclampsia; women with greater than a Body Mass Index (BMI) of 30, and multiple gestation (twins, triplets, or more); mother over age 40 or under 18 years of age; polycystic ovarian syndrome; and lupus or another autoimmune disorders such as MS or rheumatoid arthritis. It’s also important to know that preeclampsia can strike women who have none of these risk factors.
Q. How is it diagnosed and treated?
A. Preeclampsia can manifest in a very short time. A woman can have a normal prenatal appointment in the morning and be gravely ill in the afternoon. The best practice is to encourage a woman to err on the side of caution and contact her care provider immediately if she has any symptoms. Prompt treatment saves lives and early diagnosis through simple screening measures and good prenatal care can predict or delay many effects of the condition. The standard course of treatment is magnesium sulfate, a simple salt that has shown in clinical trials to prevent eclamptic seizures. However, magnesium sulfate must be prescribed by a skilled healthcare provider, because overdoses can occur. For women whose preeclampsia occurs early in the pregnancy, the impact is more profound. Time off work, bed rest, medication and even hospitalization may be prescribed to keep blood pressure under control. Unfortunately the only “cure” for preeclampsia begins with delivery of the baby and placenta. In cases where the blood pressure cannot be managed with medication and treatment, and the mother’s or baby’s health is at risk, the mother may be given steroids to aid the maturation of the infant’s lungs and the baby will be delivered before term.
Q. What is your organizational focus now?
A. Our primary initiatives right now are education and awareness. It’s important to engage all healthcare providers in the process of patient education, including nurses, midwives and even doulas. We emphasize that expectant mothers should receive frequent reminders about the signs and symptoms of preeclampsia, starting at 20 weeks of pregnancy. We encourage providers to share this message in a reassuring manner, but one that conveys the seriousness of the condition and the need to report any concerns immediately. Because preeclampsia sometimes strikes suddenly and acutely, vigilance is required. Helping a woman to understand the potential impact on her baby, as well as on her own health, is the key to early diagnosis and prompt care.
Q. What can partners in maternal-child health do?
A. We invite partners to help us raise awareness of preeclampsia as a relatively common occurrence by sharing our educational materials with childbearing women – including our information-packed website that also provides peer-to-peer support across a wide range of related issues. Care providers can join us in informing all pregnant women about potential risks, signs and symptoms, and what action they can take to help ensure a healthy pregnancy and a healthy baby.
For more information about preeclampsia, visit the Preeclampsia Foundation website at www.preeclampsia.org