Pre-eclampsia

Although the exact cause of pre-eclampsia remains unclear, several factors have been identified that increase a woman’s likelihood of developing the condition. These include:

High-risk factors

• Previous history of pre-eclampsia
• Chronic kidney disease
• Long-standing high blood pressure
• Diabetes mellitus
• Systemic Lupus Erythematosus (SLE)
• Sickle cell disease
• Vascular disorders
• Obesity (BMI of 30 kg/m² or higher)
• Use of assisted reproductive technologies
• Carrying more than one baby (e.g., twins or triplets)
• Presence of multiple moderate-risk factors

Moderate-risk factors

• Being pregnant for the first time
• Maternal age over 40
• Previous placental abruption
• History of stillbirth
• Previous baby with growth restriction

Less common risk factors

• Family history of pre-eclampsia
• Trisomy 13 (a genetic condition that causes developmental and physical challenges)
• Conditions like gum infections, urinary tract infections, or Helicobacter pylori infections

Detecting pre-eclampsia early is critical, especially since the condition may not initially show clear signs. Diagnosis involves the following steps:

Physical assessment and medical history

Doctors examine the patient for signs like elevated blood pressure (above 140/90 mmHg) and swelling. A detailed medical history helps in identifying any pre-existing conditions or risk factors, guiding diagnosis and management.

Urine testing

Protein levels in the urine are checked using a dipstick — a chemically treated strip that changes color in the presence of protein. A positive result often requires further laboratory analysis.

Blood investigations

• Placental Growth Factor (PIGF): This test is considered highly reliable in assessing and predicting pre-eclampsia. It evaluates the concentration of a specific placental protein.
• Soluble fms-like tyrosine kinase-1 (sFlt-1): Elevated levels of this protein are often found in pre-eclampsia.
• Kidney Function Tests (KFT): To assess any impact on kidney performance or pre-existing kidney problems.
• Liver Function Tests (LFT): Liver issues are relatively common in affected pregnancies.
• Platelet count: A drop in platelet count (thrombocytopenia) is frequently observed and can interfere with blood clotting.

Imaging and monitoring

• Fetal ultrasound: Provides insight into fetal growth and overall well-being, although it doesn’t diagnose pre-eclampsia directly.
• Nonstress Test (NST): Measures fetal heart rate in response to movement, helping to evaluate if the fetus is under stress.
• Cardiotocography (CTG): Simultaneously records the baby’s heartbeat and the mother’s uterine contractions to assess fetal health.

While it's not always possible to prevent pre-eclampsia, several strategies can reduce the likelihood of developing it:

Maintain optimal blood sugar and blood pressure levels

• During pregnancy, blood sugar should ideally range from 60–99 mg/dL before meals and 100–129 mg/dL afterward. Blood pressure is best kept near 120/80 mmHg, though personal targets may differ.

Achieve appropriate pregnancy weight gain

• Women who are overweight may aim for a weight gain between 7 to 11.5 kg. Those with a normal BMI can aim for 11.5 to 15.8 kg during pregnancy.

Eat a balanced and nutritious diet

• Focus on foods rich in nutrients — whole grains, fruits, vegetables, dairy, legumes, and nuts. Reduce intake of salt, sugar, caffeine, and processed items.

Prioritize sleep

• Poor-quality sleep can lead to increased stress and elevate the risk of pregnancy-related complications, including pre-eclampsia.

Engage in gentle exercise

• Activities like walking, prenatal yoga, stretching, and swimming can improve circulation and support heart health. Always discuss the safety of physical activity with a healthcare provider.

Manage stress effectively

• Techniques such as meditation, breathing exercises, soft music, and time spent outdoors may help lower stress levels, which is crucial for reducing pre-eclampsia risk.

Medication

• For individuals with one high-risk or multiple moderate-risk factors, low-dose aspirin after 12 weeks of pregnancy is often recommended. Always consult a doctor before starting any medication during pregnancy.

Specialists to Consult

Healthcare providers involved in diagnosing and managing pre-eclampsia include:

• Obstetricians and gynecologists: These specialists manage pregnancy, childbirth, and disorders of the female reproductive system.
• Perinatologists: Also known as maternal-fetal medicine specialists, they handle high-risk pregnancies and related complications.

Delivering the baby is the only definitive way to resolve pre-eclampsia. The timing of delivery depends on gestational age and the severity of the condition.

• If the pregnancy has reached 37 weeks or more, labor may be induced or a cesarean may be performed.
• If delivery isn’t immediately safe, the mother will be closely observed. Monitoring may include:
• Blood pressure readings
• Urine protein levels
• Blood tests (especially liver and kidney function)
• Fetal heart rate
• Ultrasound to assess fetal growth and amniotic fluid
• Placental blood flow assessments

In such cases, the goal is to extend the pregnancy as safely as possible, giving the baby more time to mature.

Management options include:

Bed rest: This may be advised at home or in a hospital, typically with the mother lying on her left side to promote circulation.

Antihypertensive medications: These include

• Labetalol
• Nifedipine
• Hydralazine

Steroids for fetal lung development:

• Betamethasone
• Dexamethasone

Anti-seizure medication:

• Intravenous magnesium sulfate is used to prevent eclampsia (seizures caused by pre-eclampsia)

Post-Delivery Care

Pre-eclampsia usually subsides shortly after childbirth, but some complications may arise in the days that follow.

• Continuous monitoring of the mother’s blood pressure is essential, and medications may need to be continued temporarily.
• If the baby is born prematurely, neonatal intensive care may be necessary.
• After discharge, regular follow-ups are important to monitor and manage the mother’s blood pressure until it stabilizes.

While many instances of pre-eclampsia resolve soon after childbirth without causing serious harm, some cases can lead to severe complications if not promptly diagnosed and treated. These complications may impact both the mother and the baby.

Complications in the Mother

HELLP Syndrome: This is a serious condition represented by the acronym HELLP, which includes:

• Hemolysis – the destruction of red blood cells before their normal lifespan ends
• Elevated liver enzymes – indicating liver stress or damage
• Low platelet count – reducing the blood’s ability to clot properly

Stroke: Excessively high blood pressure may disrupt blood flow to the brain, potentially resulting in a stroke.

Seizures (Eclampsia): In rare situations, pre-eclampsia can progress to eclampsia, a condition marked by seizures. During such episodes, the mother may experience rhythmic, uncontrollable movements in her arms, legs, jaw, or neck.

Organ Complications:

• Kidney failure
• Liver dysfunction
• Cardiac events such as a heart attack
• Acute respiratory distress
• Problems related to blood clotting
• Vision disturbances and eye-related issues

Complications in the Baby

• Restricted fetal growth
• Premature detachment of the placenta (placental abruption)
• Early birth
• Low birth weight
• Stillbirth
• Breathing problems after delivery