Preeclampsia: How to protect yourself and your baby from this fatal condition

Mums-to-be, as part of taking care of your body throughout pregnancy, you should also be wary of some conditions that may put your health and your baby's health at risk.

One of the pregnancy complications to watch out for is preeclampsia. Learn about its symptoms, causes and tips for prevention here.

What is preeclampsia?

Preeclampsia is a pregnancy condition categorised by high blood pressure and increased protein in the urine. It is a multi-system disorder (failure of more than one bodily system). In severe cases, preeclampsia can affect the liver and kidneys.

High blood pressure in pregnancy is defined as blood pressure higher than 140/90 mmHg (millimetres of mercury) on two readings, more than four hours apart.

The Singapore College of Obstetricians and Gynaecologists defines two types of preeclampsia:

Preeclampsia, where the expecting mother is at least 20 weeks pregnant, has a blood pressure reading exceeding 140/90 mmHg and protein in the urine exceeding 0.3g/24hr.

Severe Preeclampsia where the blood pressure reading exceeds 160/110 mmHg or the protein in the urine exceeds 3g/24hr, or there are symptoms of impending eclampsia (seizures in a woman diagnosed with preeclampsia, in the absence of other causes).

What causes preeclampsia?

What is the main cause of preeclampsia?

Like many other pregnancy-related complications, the exact cause of preeclampsia remains at large. There are, however, a few contributing factors.

Placental dysfunction

The placenta plays a crucial role in supporting the developing foetus by facilitating the exchange of oxygen and nutrients between mother and baby. In cases of preeclampsia, the placenta may not function optimally, resulting in reduced blood flow to the foetus.

To compensate for this, the mother's body works harder to enhance blood supply to the baby. This increased stress on the mother's body can lead to elevated blood pressure levels, one of the hallmarks of preeclampsia.

Damaged blood vessels

During early pregnancy, new blood vessels form to supply blood to the placenta. If these vessels become damaged or fail to develop correctly, it can restrict blood flow to the placenta, potentially triggering preeclampsia. The exact reasons behind blood vessel dysfunction are not yet fully understood, but researchers continue to investigate this aspect.

Autoimmune conditions

Certain autoimmune diseases, such as lupus, have been linked to an increased risk of preeclampsia. Lupus is an inflammatory disease in which the body's immune system mistakenly attacks its own tissues and organs.

Since autoimmune diseases can affect various bodily systems, including the kidneys, heart, and lungs, they may contribute to the development of preeclampsia. The precise mechanisms underlying this association are still being explored.

Renal impairment

Renal impairment, or impaired kidney function, can also be a contributing factor to preeclampsia. When the kidneys fail to effectively filter waste products from the blood, it can disrupt the body's delicate balance.

Pre-existing renal problems before pregnancy can increase the risk of developing preeclampsia. It is important for women with known kidney issues to receive appropriate prenatal care to closely monitor their health and manage potential risks.

Preeclampsia symptoms

How do you know if you have preeclampsia?

If you ever wondered why every pregnancy check-up is accompanied by a urine and blood pressure test, it is related to two of the key indicators of preeclampsia: an increase in blood pressure and protein in the urine. Below are other preeclampsia symptoms explained:

• Increase in blood pressure. When your blood pressure reading is equivalent to or exceeds 140/90 mmHg. The reading must be taken at least twice with a minimum interval of four hours.
• Increase in urine protein. Traces of excess protein in your urine or any other signs of kidney-related problems may also be harbingers of preeclampsia.
• Severe headaches. Pregnancy and headaches go hand in hand, and most women experience headaches at some point in their pregnancy. But severe and persistent headaches should be taken seriously, especially when they are a part of preeclampsia symptoms. They might indicate an underlying cause.
• Changes in vision. Blurred vision, seeing double and increased light sensitivity are all examples of changes in vision. Contact your doctor right away if you experience this during pregnancy.
• Unexplained abdominal pain. Abdominal pain is common during pregnancy but caution must always be exercised and no pain should be ignored. Pain in the upper abdomen is particularly characteristic of preeclampsia.
• Swelling. While swelling is common in pregnancy due to water retention, swelling that increases rapidly (oedema) in the hands, feet and face is definitely a warning sign that something is not right. The swelling may also be accompanied by sudden and rapid weight gain.

When do preeclampsia symptoms show up?

Preeclampsia usually occurs after 20 weeks into the pregnancy. However, according to WebMD, the symptoms often begin after 34 weeks.

In a few cases, symptoms develop after birth, usually within 48 hours of delivery (the condition is known as postpartum preeclampsia), but such a situation is much less common.

Signs of preeclampsia – when to call the doctor

Singapore obstetrician and gynaecologist specialist Dr Regina Zuzarte-Ng, Gynae MD Women's Clinic (Clementi), advises expecting mothers to always be on the lookout for changes in their bodies and how they feel.

Never ignore the above-mentioned preeclampsia symptoms, especially headaches, upper abdominal pain and visual disturbances.

While many of these preeclampsia symptoms may seem harmless and synonymous with the usual pregnancy symptoms, you do not want to throw caution to the wind. If you are unsure, your doctor is just a call away.

Risk factors of preeclampsia

Dr Regina states that preeclampsia affects approximately five per cent of all pregnancies. Women are most susceptible to preeclampsia when they:

• Have pre-existing high blood pressure or hypertension prior to getting pregnant
• Have experienced preeclampsia in a previous pregnancy
• Are expecting their first child
• Are over the age of 35
• Are below the age of 18
• Are obese
• Are expecting multiples
• Have diabetes

She cautions that the possibility of preeclampsia is not limited to these factors. Women with none of these conditions may also be at risk and should always exercise caution and monitor themselves closely throughout their pregnancy.

A study done on the cases of severe preeclampsia in Singapore reveals that the incidence of severe preeclampsia is 29.3 per 10,000 deliveries. 43 per cent of these cases had maternal complications.

Complications of preeclampsia

The answer is yes. Most women who have preeclampsia deliver healthy babies. However, if not treated right away, it can cause severe health problems for you and your baby.

Low birth weight and premature birth

That said, the complications that can arise out of preeclampsia are definitely not to be taken lightly.

"Reduced blood flow to the placenta in preeclampsia leads to reduced supply of oxygen and nutrients to the foetus and therefore problems such as low birth weight and poor growth may arise.

There may also be a need to deliver the baby early to protect the mother's health, and the baby may suffer from the effects of prematurity," said Dr Tan Kok Hian, head and senior consultant, Perinatal Audit and Epidemiology Unit, Division of Obstetrics and Gynaecology at KK Women's and Children's Hospital (KKH).

Dr Regina also warns that preeclampsia is a serious problem that can lead to maternal death. Complications women may experience are:

• Eclampsia: A severe complication is caused when preeclampsia worsens and affects the brain. It causes seizures and may be followed by coma or even death.
• Damage to other organs: Preeclampsia is a multi-system disorder that can affect the kidneys, and cause liver failure, stroke and seizures.
• HELLP syndrome: Hemolysis — breaking down of red blood cells, EL — elevated liver enzymes, LP — low platelet count. A life-threatening complication is usually considered to be a variant of preeclampsia. An estimated 15 per cent of women with preeclampsia develop this syndrome.
• Concealed haemorrhage: Preeclampsia can cause massive internal bleeding that can lead to death. Ringing in the ears, extreme weakness and visual disturbances are indications that the bleeding has advanced to a more serious stage.
• Placental abruption: The risk of placental abruption (partial or complete separation of the placenta from the uterus prior to delivery) increases with preeclampsia. If the abruption is small and goes unnoticed, the baby may be deprived of oxygen and nutrients and have growth problems, be born prematurely or be stillborn. Placental abruption can cause severe bleeding that is dangerous to you and your baby.
• Reduced thyroid function: Hypothyroidism (a condition in which the thyroid gland produces insufficient hormones). Women with preeclampsia are at increased risk of experiencing this during the last lap of their pregnancy and again later in life (as much as 20 years after giving birth). Hypothyroidism can lead to overall weakness and increase the risk of cardiovascular disease.

Tests to determine preeclampsia

Having preeclampsia symptoms is not enough to determine whether or not you have the condition.

When you go in for a routine check-up, a blood pressure reading that is equivalent to or above 140/90 mmHg warrants concern. Additional readings in the abnormal range after four hours may confirm preeclampsia.

Your doctor is likely to perform these additional tests on you.

• Blood tests: Your blood needs to be checked for several reasons including the state of your liver and kidneys. Your blood count needs to be monitored as preeclampsia can cause low platelets (the cells that help the blood clot) to occur.
• Urine tests: You may require urine protein collection tests to be done over a 24-hour period to check for excessive protein loss in the urine. This will help to determine the severity of preeclampsia.
• Ultrasounds: Your baby's growth needs to be closely monitored as preeclampsia can cause growth retardation. Ultrasound images will allow your gynaecologist to keep track of your baby's weight and the amount of amniotic fluid (fluid surrounding the foetus) you have.
• Cardiotocography (CTG) scan: This is usually done in the third trimester to monitor the foetal heartbeat and the contractions of the uterus. The scan helps to monitor any signs of foetal distress.

Preeclampsia treatment

The only actual cure for preeclampsia is delivery, stated Dr Regina. If you are diagnosed with preeclampsia any time after 36 weeks into your pregnancy, you would be asked to deliver immediately.

If preeclampsia symptoms occur earlier in the pregnancy and you are diagnosed with the condition, you will be prescribed medication to control the blood pressure until you reach 36 weeks.

• Oral blood pressure medication: Methyldopa and Nifedipine are prescribed to control blood pressure. This is provided it is not severe preeclampsia. These medications can have possible side effects like palpitation (rapid or irregular heartbeat) and giddiness.
• Intravenous medication: In the case of severe preeclampsia, drugs like magnesium sulphate and labetabol will be given through drips.
• Corticosteroids: If you are diagnosed with HELLP syndrome or severe preeclampsia, corticosteroid medication can help the liver and platelets to better function. In doing so, there is a better chance to bring your pregnancy closer to full term.
• Steroid jabs: If you are delivering before full term, you may be given steroid jabs to strengthen your baby's lungs.
• Aspirin: Especially for women who have had preeclampsia in a previous pregnancy, aspirin can be prescribed as it helps to improve blood flow to the placenta. Aspirin can be taken from the end of the first trimester until 34 weeks into the pregnancy.

Hospitalisation

In the case of severe preeclampsia, you may need to be hospitalised to facilitate regular tests to ensure that you and your baby are fine. Your amniotic fluid also needs to be watched closely as low amniotic fluid signals poor blood supply to your baby.

Hellen Lie, founder and creative director of a design and planning company, shares the shock and horror she faced when she was diagnosed with preeclampsia 30 weeks into her pregnancy.

She said: "In a single day, my pregnancy life was turned upside down."

Her case was categorised as severe preeclampsia due to high levels of protein in her urine. Hellen had to be warded for the rest of her pregnancy.

Hospitalisation, especially for prolonged periods, is definitely a cause for concern in Singapore, taking into consideration the cost.

Hellen's gynaecologist warned her of the possibility of a preterm baby who would need to ward in the NICU. The expenses would cost her no less than $50,000, and eventually, Hellen decided to move to KKH.

Delivery

If you need to deliver early, your gynaecologist may either induce labour or perform a c-section immediately. You will continue to be monitored closely even after delivery for there is a chance that your blood pressure may spike anywhere between 24 and 48 hours after delivery.

Your blood pressure is expected to return to normal 12 weeks after delivery.

How to prevent preeclampsia

The human body works in ways that no one quite understands. Though it is not possible to completely prevent preeclampsia from occurring, you can definitely lower your risks by understanding the risk factors and making some simple changes to your lifestyle.

Dr Regina emphasises the importance of ensuring that you are in the best possible health prior to conceiving. If you have any pre-existing medical conditions, it is best to consult a doctor to sort them out and work towards maintaining a healthy body weight.

Senior medical consultant Abdul Majid provides the following tips to maintain healthy blood pressure and body weight prior to getting pregnant.

Avoid unnecessary stress

As obvious as this sounds, Majid says that many Singaporeans get caught in the rat race and impose too much stress on themselves.

He emphasises how this relates to the alarming increase in high blood pressure and stroke cases occurring in those ranging from 25 to 35 years of age.

"Especially if you're planning to have a baby, you must learn to relax. Don't bite off more than you can chew!" he adds.

Limit salt intake and have a balanced diet

We all love tasty food but take salt in moderation as it is the leading cause of high blood pressure. Your body only needs 500mg of salt a day. He adds: "And that includes all the salt from fast food and processed food."

He encourages adding food like oatmeal, celery, blueberries, papaya, yoghurt, carrots, salmon and spinach to maintain healthy blood pressure.

Steer clear of alcohol and cigarettes

If you are planning to have a baby, you might as well start working on these from the beginning. Alcohol and cigarettes are not only a no-no in pregnancy they also have detrimental effects on your blood pressure.

A safe amount of alcohol is a drink a day for women who are not expecting. No amount of smoking is safe and Majid strongly advocates abstinence.

Exercise

Majid says that exercise is the biggest favour you can do for yourself.

Along with the plethora of benefits that exercise has to offer, it stimulates your body to release nitric acid which aids in opening up your blood vessels, in turn reducing blood pressure.

Brisk walking and swimming are his personal favourites. Do remember to check with your physician before embarking on any new exercise programme though.

That seems like a lot to digest but as in the case of any other medical condition, it all boils down to understanding the situation and making an informed choice when the situation calls for it.

And, of course, it is an absolute must to take the best possible care of yourself.

Don't worry mum-to-be, being diagnosed with preeclampsia is certainly not the end of the world. Dr Regina reassures that she has dealt with preeclampsia cases in her practice and that both mum and baby made it through well and fine!

ALSO READ: What is gestational diabetes and how does it affect pregnancy?

This article was first published in theAsianparent.