How dangerous is preeclampsia?

Contents

Preeclampsia (toxemia; pregnancy-induced hypertension)

  • What is Preeclampsia (Toxemia, Pregnancy-induced hypertension)
  • Statistics on Preeclampsia (Toxemia, Pregnancy-induced hypertension)
  • Risk Factors for Preeclampsia (Toxemia, Pregnancy-induced hypertension)
  • Progression of Preeclampsia (Toxemia, Pregnancy-induced hypertension)
  • Symptoms of Preeclampsia (Toxemia, Pregnancy-induced hypertension)
  • Clinical Examination of Preeclampsia (Toxemia, Pregnancy-induced hypertension)
  • How is Preeclampsia (Toxemia, Pregnancy-induced hypertension) Diagnosed?
  • Prognosis of Preeclampsia (Toxemia, Pregnancy-induced hypertension)
  • How is Preeclampsia (Toxemia, Pregnancy-induced hypertension) Treated?
  • Preeclampsia (Toxemia, Pregnancy-induced hypertension) References

What is Preeclampsia (Toxemia, Pregnancy-induced hypertension)

Preeclampsia is a pregnancy induced disease associated with elevated blood pressure and protein in the urine which presents in the second half of pregnancy.

Statistics on Preeclampsia (Toxemia, Pregnancy-induced hypertension)

In developing countries pre-eclampsia affects 3.4% of all pregnancies. Amongst women with pre-eclampsia the more serious condition, eclampsia develops in 2.3%. The risk of developing pre-eclampsia increased almost seven-fold from 1980-2003. This was mainly because of increased rates of smoking and obesity but also because the methods for diagnosing and recording pre-eclampsia improved.
An Australian study reported 4.2% of pregnant women developed pre-eclampsia and 27 per 100,000 pregnancies ended in the death of the mother following complication of pre-eclampsia. Of all pregnancies which ended in induced labour, pre-eclampsia was the reason for induction in 9%.
Preeclampsia usually occurs in late pregnancy. In one study of women with pregnancy hypertension, about half had pre-eclampsia and one in two cases of hypertension occurred within 3 days of delivery. All the pregnant women developed hypertension in the second or third trimester (15-40 weeks pregnancy). In a minority of cases (5%) hypertension started after child birth. On average the women had normal blood pressure again 5-6 weeks after delivery, however one in five women still had high blood pressure six months after their pregnancy.

Risk Factors for Preeclampsia (Toxemia, Pregnancy-induced hypertension)

  • Increased risk is associated with first pregnancies
  • Extremes of age – Very young mothers or advanced maternal age;
  • Multiple pregnancy-twins.
  • New sexual partner
  • Previous history or family history of the disease
  • Obese women
  • Women with a past history of diabetes, hypertension, or kidney disease.

The exact cause of preeclampsia is yet to be identified. Numerous theories of possible causes include: genetic, dietary, vascular (blood vessel), and autoimmune factors. No particular factor however, has been conclusively linked to the disorder. It has been described as a disease originating from the placenta but with widespread effects both for the mother and baby.

Progression of Preeclampsia (Toxemia, Pregnancy-induced hypertension)

Preeclampsia refers to the combination of puffiness/swollen feet, high blood pressure and protein in the urine occurring after the 20th week of pregnancy and often occurs in first-time mothers. The disease can range from mild to severe in the way it presents. A very high blood pressure signifies severe disease. If severe and not treated, its complications can affect the kidneys, liver, clotting system, brain of the mother or cause growth restrictions in the fetus. This can pose a risk to the health of the mother and baby.
Mild Preeclampsia
Mildly raised blood pressure after 20th week with proteinuria but no effects on the brain.
Moderate-Severe Preeclampsia
Highly raised blood pressure with proteinuria and effects on the brain. The effects of preeclampsia on the brain include headache, dizziness, tinnitus, altered mental status, visual changes, and seizures. The visual changes may result from spasm of the blood vessels, insufficient blood supply, and hemorrhage in the visual centre of the brain, or from retinal detachment. Preeclampsia may also occur in women with pre-existing hypertension (superimposed preeclampsia), and in this situation the prognosis is poorer for mother and baby.

How is Preeclampsia (Toxemia, Pregnancy-induced hypertension) Diagnosed?

Diagnosis is made when blood pressure is higher than 140/90 and significant protein in the urine. Tests that may be performed include:

  • Blood tests: to check for abnormal liver function tests, low platelets counts or red blood cell count
  • Proteinuria (protein noted in urine)
  • Ultrasound

Prognosis of Preeclampsia (Toxemia, Pregnancy-induced hypertension)

Does it occur in subsequent pregnancies?
This is the most common question pregnant women ask. Yes, it does and recurrence rate is estimated to vary from 5% to 25%. The Australasian society for the study of hypertension in pregnancy recommends low-dose aspirin early in pregnancy if previous one was preeclamptic. Remember it is always advisable to check with your doctor. Outcome in mild cases is good for both mother and baby but severe disease may be associated with serious complications. Maternal deaths caused by preeclampsia are rare in Western countries. However, in less developed nations, mortality rate is considerably increased. Prognosis for the baby is dependent on the associated effects of preeclampsia on the growing fetus – low birth weight, IUGR, prematurity and so on.
What happens if I develop eclampsia?
Uncomplicated eclampsia usually does not result in permanent neurological deficit.
What is the effect on long term health?
Previously, it was said to have no greater cardiovascular risk than a normal pregnancy. However results of two large studies have shown an associated increase in cardiovascular risk of women in the study. Based on those findings, it is recommended that all women who have had preeclampsia in pregnancy should have their cardiovascular risk assessed regularly and should maintain a healthy lifestyle.

How is Preeclampsia (Toxemia, Pregnancy-induced hypertension) Treated?

The only known cure for preeclampsia is delivery. However, if the baby is still considered to be pre-term, treatment aims to control the disease and delay/prevent development of complications from the disease using medications. Labour is induced as soon as the foetus has a good chance of survival outside of the womb.
In moderate to severe cases patients are usually hospitalized while mild ones are managed on an outpatient basis; with careful monitoring of blood pressure, urine checks for protein, and ultrasound to measure the baby’s growth. Provided everything progresses smoothly, attempts are made to manage the condition till week 34-36 of pregnancy at which delivery can be performed with less complications of prematurity.
Drugs used in the treatment of this disease:

Trade Names

Generic Names

Action

Adalat, Nifecard, Aldomet Nifedipine, Methyldopa Lowers blood pressure
Magnesium Sulphate Injection 49.3% Magnesium Sulphate Prevent seizures in sever cases
Celestone, Cortate Betamethasone, Deexamethasone Improve lung maturity of baby

Preeclampsia (Toxemia, Pregnancy-induced hypertension) References

  1. Abalos E, Duley L, Steyn DW, Henderson-Smart DJ. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy (Review). The Cochrane library 2007; 3.
  2. Brown MA. Preeclampisa: a lifelong disorder. MJA 2003; 179 (4): 182-184
  3. Dolea C, AbouZahr C. 2003. Global burden of hypertensive disorders in pregnancy in the year 2000. Evidence and Information for Policy- World Health Organisation. (cited 24 June 2015). Available from:
  4. Anath CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis. BMJ. 2013.; 347.
  5. Duley L, Gulmezoglu AM, Henderson-Smart DJ. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia (Review). The Cochrane library 2007; 3: 6-14.
  6. Roberts CL, Ford JB, et al. Hypertensive disorders in pregnancy- a population based study. Med J Aust. 2005; 182(7): 332-5. Full Text: Full Text
  7. Impey L. Obstetrics and Gynecology. 2nd ed. USA: Blackwell; 2006.
  8. Australian Institute of Health and Welfare and University of New South Wales. Australian Mothers and Babies 2012. 2014. (cited 24 June 2015). Available from:
  9. Podymow T, August P. Postpartum course of gestational hypertension and pre-eclampsia. Hypertens Preg. 2010; 29(3): 294-300. (cited 24 June 2015). Abstract available from:
  10. Norwitz ER Repke JT. Acute complications of Preclampsia. Clinical Obstetrics and Gynecology 2002; 45 Suppl 2: 308-29
  11. King Edward Memorial Hospital for Women. KEMH Clinical Guidelines: Complications of pregnancy- Hypertension in Pregnancy. 2015. (cited June 24 2015). Available from:
  12. National Health and Medical Research Council. Report on Maternal Deaths in Australia 1994-96. 2001. Available from: http://www.nhmrc.gov.au/publications/synopses/withdrawn/wh32.pdf

What is my risk of developing pre-eclampsia, HELLP syndrome or eclampsia again in a future pregnancy?

If you had pre-eclampsia in your first pregnancy:

  • You have somewhere between a 1 in 2 and a 1 in 8 chance of developing gestational hypertension next time you are pregnant.
  • You have about a 1 in 6 chance of developing pre-eclampsia next time you are pregnant.
  • If you had severe pre-eclampsia, HELLP syndrome or eclampsia that meant that your baby had to be delivered before 34 weeks, you have about a 1 in 4 chance of developing pre-eclampsia next time you are pregnant.
  • If you had severe pre-eclampsia, HELLP syndrome or eclampsia that meant that your baby had to be delivered before 28 weeks, you have about a 1 in 2 chance of developing pre-eclampsia next time you are pregnant.

Being obese is a risk factor for pre-eclampsia (see above). If you have had pre-eclampsia in a previous pregnancy and you are planning for another pregnancy but you are overweight or obese, you should try to lose weight before you become pregnant again. This may help to reduce your chance of developing pre-eclampsia in your next pregnancy. See the separate leaflet called Weight Loss (Weight Reduction).

Could pre-eclampsia, HELLP syndrome or eclampsia have any effects on my future health?

Some research has shown that women who develop these conditions may have a slightly higher chance of developing high blood pressure (hypertension) and have a higher chance of having a heart attack or stroke in the future. However, the overall risk of developing these problems is still low. Therefore, you may wish to look at ways in which you may be able to reduce your risk of these complications by making changes to your lifestyle. These can include avoiding some combined hormonal contraceptive pills in the future, and keeping to a healthy weight, exercising regularly, eating a healthy, balanced diet and not smoking. See the separate leaflet called Cardiovascular Disease (Atheroma).

If you have had pre-eclampsia, HELLP syndrome or eclampsia during your pregnancy, it is important that your blood pressure be checked several times after you leave hospital after you have given birth. This will usually be done by a midwife who visits you at home. Your blood pressure will also be checked and your urine checked for protein, at your six- to eight-week check, to make sure that things have returned to normal.

Poor Pregnancy Outcomes Linked To Increased Uric Acid

Reporting in the Oct. 27 online issue of Hypertension, a journal published by the American Heart Association, researchers note that the greatest risk of high blood pressure during pregnancy accompanies preeclampsia, a devastating disorder that affects some 5 percent of first pregnancies and is traditionally diagnosed by increased blood pressure and the presence of protein in the urine. The only effective treatment is immediate delivery, which, if too early, can pose risks to the fetus.

In developed countries where prenatal care is routine, preeclampsia accounts for about 15 percent of premature deliveries a year. Worldwide, in settings without good prenatal care, preeclampsia increases the risk of fetal death five-fold and kills 50,000 women a year, researchers said. For clinicians, treating preeclampsia is a delicate balance of fetal and maternal risk from the disease and fetal development-associated risk because of premature delivery.

“We used a research database to ask whether inclusion of uric acid levels in the diagnosis of preeclampsia would help us to evaluate risk for complications among patients,” said James M. Roberts, M.D., professor and vice chair of research in the department of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine and the study’s first author. “We focused primarily on fetal outcomes such as gestational age at delivery and birth weight, but also looked at markers of maternal disease, including severely elevated blood pressure during labor.”

Records for 972 pregnant women who were recruited between 1997 and 2002 as part of an ongoing preeclampsia study at the Magee-Womens Hospital of the University of Pittsburgh Medical Center were reviewed and the women were divided into eight groups:

  • 431 women had normal levels of uric acid and blood pressure and no evidence of protein in their urine
  • 48 women had classic preeclampsia including high blood pressure and protein in their urine but normal uric acid
  • 141 women had preeclampsia and elevated levels of uric acid in their blood
  • 52 women had high blood pressure and elevated levels of uric acid but no protein in their urine
  • 184 women had only increased uric acid levels
  • 83 women had only high blood pressure
  • 21 women had only protein in their urine
  • 12 women had protein in their urine and elevated levels of uric acid but normal blood pressure

Analysis of the data revealed that the women with both preeclampsia and elevated uric acid levels had a nearly seven-fold increased risk of premature delivery and delivered nearly four weeks earlier than preeclamptic women whose uric acid levels were normal. Most of these deliveries were induced to prevent more severe maternal illness and infants tended to be smaller at birth, even adjusted for gestational age, Dr. Roberts said.

One of the more interesting findings was that for women with high blood pressure and no protein in their urine but who did have increased uric acid, the risk of early delivery or reduced fetal growth was at least as likely as in women with classic signs of preeclampsia but normal uric acid. Also, women with high blood pressure who lacked urine protein and had normal uric acid had no increased risk for babies.

“Irrespective of protein levels, women with high blood pressure had a higher incidence of being delivered early as uric acid increased,” said Dr. Roberts, who also is director of the university-affiliated Magee-Womens Research Institute. “For every one-unit increase in uric acid, the odds of preterm birth increased 2.3 times.”

While results of the National Institutes of Health-funded study seem to suggest that uric acid measures could have a utility for predicting risk of adverse outcomes, further prospective testing is necessary to confirm the findings and determine cost-effectiveness of its use to improve outcomes, Dr. Roberts said.

FAQs

Some of our experts have weighed in on this topic in our Ask the Experts section of this website.

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What is the long-term impact of preeclampsia?

Women who have had preeclampsia have three to four times the risk of high blood pressure and double the risk for heart disease and stroke. They also have an increased risk of developing diabetes. For women who had preeclampsia and delivered preterm, had low-birthweight babies, or suffered from severe preeclampsia more than once, the risk of heart disease can be even higher. While still unknown whether the risk is caused by preeclampsia or if the woman was already predisposed, these risks first emerge in the years following a complicated pregnancy. Although this may seem daunting, ample research shows that there are many ways for women to protect their heart health and that of their families!

This research does not mean you will definitely develop heart problems if you had preeclampsia, but for some women pregnancy can serve as an early warning sign for future heart disease. This kind of “heads up” gives you an opportunity to make changes now for a healthier tomorrow – and reap the benefits today, too! Read more here.

Some studies suggest, babies born from preeclamptic pregnancies have a higher risk of developing hypertension, coronary artery disease, and other chronic illnesses in adult life. These risks are especially true among babies who were delivered at term.

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The Dangers of Preeclampsia

Headaches and blurry vision during pregnancy could be innocuous sensations, or signs of preeclampsia, a condition related to elevated blood pressure that develops after week 20 of pregnancy.

Preeclampsia Defined

“Preeclampsia is when you have high blood pressure plus protein in your urine,” explains high- risk obstetrician-gynecologist Susan Lashley, MD, assistant clinical professor in the division of maternal and fetal medicine at the University of Virginia in Charlottesville.

Also called toxemia of pregnancy, developing high blood pressure or hypertension during pregnancy is very dangerous to both mother and child.

Types and Symptoms of Preeclampsia

Dr. Lashley describes the two types of preeclampsia:

  • Mild preeclampsia: The only symptoms are high blood pressure levels and protein in the urine.
  • Severe preeclampsia: Besides the above symptoms, patients could have headaches, nausea, vomiting, and seizures.

Other symptoms of preeclampsia are sensitivity to light and abdominal pain.

These can all be signs of other conditions in pregnancy, so it is important to contact your doctor if you experience them. Your doctor will also check for preeclampsia during prenatal care visits by testing your blood pressure and analyzing your urine.

Statistics and Causes of Preeclampsia

High blood pressure appears in about 5 percent to 10 percent of pregnancies, although severe preeclampsia is much less common. “We don’t really know what causes preeclampsia,” says Dr. Lashley. “We think it is related to the placenta, which is why delivering the baby and placenta is the only ‘cure.’”

Risk Factors for Preeclampsia

Certain factors increase your risk for preeclampsia during pregnancy:

  • Being over 40 years old
  • Being younger than 20 years old
  • Carrying twins or other multiples
  • Having high blood pressure when not pregnant
  • Having a previous diagnosis of preeclampsia
  • Being obese prior to conception
  • Having other chronic conditions, such as diabetes, kidney disease, lupus, or rheumatoid arthritis

Risks of Preeclampsia

If not addressed, preeclampsia can:

  • Damage the placenta, which feeds and supports the baby
  • Damage the mother’s kidneys, liver, and brain
  • Lead to seizures — this dangerous stage is called eclampsia
  • Cause a low birth weight
  • Cause a pre-term birth

Preeclampsia can even be fatal for both mom and baby in some cases.

Guarding Against Preeclampsia

There is no sure way to prevent preeclampsia. As always, maintaining a healthy weight, eating a nutritious diet, and getting regular prenatal care will help reduce the risk of complications and ensure that conditions like preeclampsia are caught early enough to be managed.

If you have high blood pressure before becoming pregnant, make sure that it is under control by exercising, cutting back on salt, and taking your prescribed medications.

Managing Preeclampsia

“If women are at term, we deliver the baby,” says Lashley. “If they are pre-term, we try to hang on as long as possible because you want a more developed baby.”

If you are diagnosed with preeclampsia before your baby can be delivered safely, you will be closely monitored at home or possibly in the hospital. You may be given medication to control your blood pressure and prevent seizure. Your doctor may decide that an early delivery is necessary, in which case medication may be given to try to help your baby’s lungs mature before delivery.

Symptoms of preeclampsia most often go away within six weeks of delivery. However, some women will still have high blood pressure at their six-week check-up and will be diagnosed with hypertension (high blood pressure), says Lashley.

Even though it is hard to predict who will develop preeclampsia, becoming educated about the symptoms and sticking to your scheduled prenatal care appointments will give you the very best chance for a healthy pregnancy and delivery.

What is Preeclampsia?

Preeclampsia is one of the most common birth complications in the United States. In fact, 1 out every 20 women develop it. Preeclampsia occurs when there is a rise in blood pressure during pregnancy, and is often marked by signs of damage to organs. It generally starts around the 20th week of pregnancy. Preeclampsia should be treated seriously, as even a slight rise in blood pressure may lead to life-threatening conditions.

Preeclampsia Symptoms

There are a number of symptoms associated with preeclampsia,yet in some instances, it will develop without the mother noticing any symptoms at all. Consequently, it’s imperative to monitor blood pressure throughout pregnancy. Mayo Clinic suggests that blood pressure that’s 140/90 or higher is abnormal.

Symptoms and signs to look out for include:

  • Breath shortness
  • Edema (swelling in the hands and face)
  • Nausea, sometimes accompanied with vomiting
  • Poor liver function
  • Excessive protein in the urine
  • Pain below the rib cage
  • Severe headaches
  • Blurry vision

Risk Factors Associated with Preeclampsia

There are quite a few risk factors that heightens a pregnant woman’s risk of developing preeclampsia, including:

  • Maternal age of 40 or older
  • Previous pregnancies with preeclampsia
  • Maternal obesity
  • Carrying more than one infant
  • A pregnancy with a different partner than previous pregnancies
  • Smoking
  • Diabetes
  • Lupus

Preeclampsia Complications

When preeclampsia occurs, both mother and infant are at risk for serious health complications, including:

  • Placental abruption
  • Eclampsia (preeclampsia accompanied with seizures)
  • HELLP (hemolysis elevated liver enzymes)
  • Poor blood flow to the placenta, which can result in oxygen deprivation at birth
  • Increased risk of developing heart and blood vessel diseases

Is There a Cure for Preeclampsia?

There is not currently a cure for preeclampsia aside from delivery. If you have preeclampsia, the best treatment is usually relegated to a lack of strenuous activity, often bed rest. Medications, such as antihypertensives, corticosteroids and anticonvulsants may also be prescribed.

In severe cases of preeclampsia, the mother will often be scheduled for a Cesarean section (c-section). Mothers who are diagnosed with preeclampsia towards the end of pregnancy, when the infant is viable, may have induced labor if a C-section is not necessary. This is so that the child stays as healthy as possible and doesn’t go into fetal distress. If labor isn’t treated carefully, the child can develop physical and neurological problems, and may have special needs well into childhood.

How is Preeclampsia Related to Cerebral Palsy?

There is still much about cerebral palsy that doctors don’t quite understand. However, studies indicate that mothers who have preeclampsia are more likely to have children with cerebral palsy if the infant is born prematurely. In some cases, preeclampsia causes mothers to go into labor early, delivering babies that are born at 37 weeks or earlier.

Doctors don’t quite know if preeclampsia causes cerebral palsy, but research suggests that mothers who deliver babies between the gestational ages of 32 and 36 weeks are almost five times more likely to have babies who develop cerebral palsy.

Preventative Tips

Although there isn’t a cure yet for preeclampsia, there are few preventative tips that can help mothers control the risk of developing it, including taking a daily low-dose aspirin and taking calcium supplements daily. In addition, it’s always a good idea to limit salt intake during pregnancy and to eat as healthy as possible. However, before taking any medications and vitamins, always consult your physician beforehand.

Preeclampsia

What is preeclampsia?

Preeclampsia is a condition unique to pregnancy that complicates up to 8 percent of all deliveries worldwide. It is characterized by high blood pressure (hypertension) and high levels of protein in the urine (proteinuria) in the mother. Preeclampsia typically occurs in first time mothers and in the later part of pregnancy (after 20 weeks gestation). It can also affect other organs in the body and can be dangerous for both the mother and her baby. Because of these risks, preeclampsia needs to be treated by a healthcare provider.

What are some of the risks with preeclampsia?

Risks of preeclampsia can include:

  • Seizures in the mother
  • Stroke or bleeding in the brain
  • Temporary kidney failure
  • Liver problems
  • Blood clotting problems
  • Placental abruption: The placenta pulls away from the wall of the uterus, causing distress to the baby and bleeding in the mother
  • Poor growth of the baby
  • Premature (early) delivery of the baby
  • A cesarean delivery

What is HELLP syndrome?

HELLP syndrome is a severe form of preeclampsia that develops in 4 to 12 percent of cases. The name stands for:

HELLP syndrome can be present without many of the typical signs of preeclampsia, including high blood pressure (hypertension) and proteinuria (protein in the urine), and in some cases the diagnosis can be missed or delayed.

Common symptoms of HELLP syndrome can include:

  • Fatigue
  • Nausea
  • Vomiting
  • Right side or mid abdominal pain

Diagnosis is usually made with blood tests. Delivery is generally necessary in order to treat HELLP syndrome and for the abnormalities to correct themselves. Complications associated with HELLP syndrome include rupture of the liver, massive bleeding, stroke and seizures.

What is eclampsia?

Eclampsia is a life-threatening complication that develops in approximately 1 percent of women with preeclampsia and results in seizures or coma. Warning signs to watch for can include:

  • Severe headaches
  • Blurred or double vision
  • Seeing spots
  • Abdominal pain

These patients often will have overactive reflexes. Treatment is based on preventing further seizure activity and generally involves use of magnesium sulfate given intravenously (directly into the vein) for at least 24 to 48 hours. High blood pressure must be treated aggressively in these patients. Generally, once the mother’s condition has been stabilized the baby is delivered. If the baby is extremely premature (less than 32 weeks), delivery may be delayed for 24 to 48 hours so that steroids may be given to the mother. These steroids help the baby’s lungs mature and prevent other complications related to premature birth. In some cases, eclampsia can occur following a seemingly normal delivery, even after the patient has gone home from the hospital.

What causes preeclampsia?

Preeclampsia is thought to arise from a problem with the health of the placenta (the organ that develops in the uterus during pregnancy and is responsible for providing oxygen and nutrients to the baby). It is thought that the blood supply to the placenta is decreased in preeclampsia, and this can lead to problems with both the mother and baby.

Who is at higher risk of developing preeclampsia?

A woman is more likely to develop preeclampsia if she:

  • Is expecting her first child
  • Is under age 20 or over age 40
  • Has a history of chronic hypertension
  • Has had preeclampsia during past pregnancies
  • Has a family history of preeclampsia or chronic hypertension
  • Is overweight
  • Has an immune system disorder, such as lupus or rheumatoid arthritis
  • Has kidney disease
  • Is expecting multiple babies
  • Had in vitro fertilization
  • Is African American

What symptoms may patients with preeclampsia experience?

Symptoms patients with preeclampsia may have include:

  • Headaches
  • Blurry vision
  • Dark spots appearing in their vision
  • Right side abdominal pain
  • Swelling in their hands and face
  • Increased weight gain

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Complications


Pre-eclampsia

Problems affecting the mother

Fits (eclampsia)

Eclampsia describes a type of convulsion or fit (involuntary contraction of the muscles) that pregnant women can experience, usually from week 20 of the pregnancy or immediately after the birth.

Eclampsia is quite rare in the UK, with an estimated 1 case for every 4,000 pregnancies.

During an eclamptic fit, the mother’s arms, legs, neck or jaw will twitch involuntarily in repetitive, jerky movements.

She may lose consciousness and may wet herself. The fits usually last less than a minute.

While most women make a full recovery after having eclampsia, there’s a small risk of permanent disability or brain damage if the fits are severe.

Of those who have eclampsia, around 1 in 50 will die from the condition. Unborn babies can suffocate during a seizure and 1 in 14 may die.

Research has found that a medication called magnesium sulfate can halve the risk of eclampsia and reduce the risk of the mother dying.

It’s now widely used to treat eclampsia after it’s occurred and treat women who may be at risk of developing it.

HELLP syndrome

HELLP syndrome is a rare liver and blood clotting disorder that can affect pregnant women.

It’s most likely to occur immediately after the baby is delivered, but can appear any time after 20 weeks of pregnancy, and in rare cases before 20 weeks.

The letters in the name HELLP stand for each part of the condition:

  • “H” is for haemolysis – this is where the red blood cells in the blood break down
  • “EL” is for elevated liver enzymes (proteins) – a high number of enzymes in the liver is a sign of liver damage
  • “LP” is for low platelet count – platelets are substances in the blood that help it clot

HELLP syndrome is potentially as dangerous as eclampsia, and is slightly more common.

The only way to treat the condition is to deliver the baby as soon as possible.

Once the mother is in hospital and receiving treatment, it’s possible for her to make a full recovery.

Stroke

The blood supply to the brain can be disturbed as a result of high blood pressure. This is known as a cerebral haemorrhage, or stroke.

If the brain doesn’t get enough oxygen and nutrients from the blood, brain cells will start to die, causing brain damage and possibly death.

Organ problems

  • pulmonary oedema – where fluid builds up in and around the lungs. This stops the lungs working properly by preventing them absorbing oxygen.
  • kidney failure – when the kidneys can’t filter waste products from the blood. This causes toxins and fluids to build up in the body.
  • liver failure – disruption to the functions of the liver. The liver has many functions, including digesting proteins and fats, producing bile and removing toxins. Any damage that disrupts these functions could be fatal.

Blood clotting disorder

The mother’s blood clotting system can break down. This is known medically as disseminated intravascular coagulation.

This can either result in too much bleeding because there aren’t enough proteins in the blood to make it clot, or blood clots developing throughout the body because the proteins that control blood clotting become abnormally active.

These blood clots can reduce or block blood flow through the blood vessels and possibly damage the organs.

But the New Jersey committee doesn’t interview the relatives of the deceased, nor does it assess whether a death was preventable. Moreover, like every other state that conducts such reviews, New Jersey “de-identifies” the records — strips them of any information that might point to an individual hospital or a particular woman. Otherwise, the medical community and lawmakers would refuse to go along. The goal is to “improve care for patients in general,” said Joseph Apuzzio, a professor of obstetrics and gynecology at Rutgers-New Jersey Medical School who heads the committee. This requires a process that is “nonjudgmental” and “not punitive,” he said. “That’s the best way to get a free discussion of all of the health care providers who are in the room.”

Yet the result of de-identification, as Larry soon realized, is that the review is of little use in assigning responsibility for individual deaths, or evaluating whether some hospitals, doctors or nurses are more prone to error than others. To Larry, this seemed like a critical oversight — or perhaps, willful denial. In a preventable death or other medical error, he said, sometimes the who and the where are as important as the why. “Unless someone points the finger specifically,” he said, “I think the actual cause is lost.”

Someone eventually steered Larry toward the New Jersey Department of Health’s licensing and inspection division, which oversees hospital and nursing home safety. He filed a complaint against Monmouth Medical Center in 2012.

The DOH examined Lauren’s records, interviewed her caregivers and scrutinized Monmouth’s policies and practices. In December 2012 it issued a report that backed up everything Larry had seen firsthand. “There is no record in the medical record that the Registered Nurse notified of the elevated blood pressures of patient prior to delivery,” investigators found. And: “There is no evidence in the medical record of further evaluation and surveillance of patient from prior to delivery.” And: “There was no evidence in the medical record that the elevated blood pressures were addressed by until after the Code Stroke was called.”

The report faulted the hospital. “The facility is not in compliance” with New Jersey hospital licensing standards, it concluded. “The facility failed to ensure that recommended obstetrics guidelines are adhered to by staff.”

To address these criticisms, Monmouth Medical Center had implemented a plan of correction, also contained in the report. The plan called for a mandatory educational program for all labor and delivery nurses about preeclampsia and HELLP syndrome; staff training in Advance Life Support Obstetrics and Critical Care Obstetrics; and more training on the use of evidence-based methods to assess patients and improve communications between caregivers.

Some of the changes were strikingly basic: “Staff nurses were educated regarding the necessity of reviewing, when available, or obtaining the patients prenatal records. Education identified that they must make a comparison of the prenatal blood pressure against the initial admission blood pressure.” And: “Repeat vital signs will be obtained every 4 hours at a minimum.”

An important part of the plan of correction involved Vaclavik, though neither he nor the nurses were identified by name. The head of Monmouth’s OB-GYN department provided “professional remediation for the identified physician,” the Department of Health report said. In addition, there was “monitoring of 100% of records for physician of record per month x 3 months.” The monitoring focused on “compliance of timely physician intervention for elevated blood pressures/pain assessment and management.”

The department chairman, Robert Graebe, found Vaclavik’s charts to be 100 percent compliant, Vaclavik said in the deposition. Graebe was asked in a March 2017 deposition if Vaclavik was in good standing at the hospital at the time of Lauren’s treatment. “Was and is,” Graebe replied.

In a separate note, the Department of Health told Larry that it forwarded his complaint to the Board of Medical Examiners and the New Jersey Board of Nursing. Neither agency has taken disciplinary action, according to their websites.

Larry’s copy of the DOH report arrived in the mail. He was gratified by the findings but dismayed that they weren’t publicly posted. That meant hardly anyone would see them.

A few months after the DOH weighed in, he sued Monmouth, Vaclavik and five nurses in Monmouth County Superior Court in Freehold, New Jersey. For a medical malpractice lawsuit to go forward in New Jersey, an expert must certify that it has merit. Larry’s passed muster with an OB-GYN. But beyond the taking of depositions, there’s been little action in the case.

As the maternal death rate has mounted around the U.S., a small cadre of reformers has mobilized. Some of the earliest and most important work has come in California, where more babies are born than in any other state — 500,000 a year, one-eighth of the U.S. total.

Modeled on the U.K. process, the California Maternal Quality Care Collaborative is informed by the experiences of founder Elliott Main, a professor of obstetrics and gynecology at Stanford and the University of California-San Francisco, who for many years ran the OB-GYN department at a San Francisco hospital. “One of my saddest moments as an obstetrician was a woman with severe preeclampsia that we thought we had done everything correct, who still had a major stroke and we could not save her,” he said recently. That loss has weighed on him for 20 years. “When you’ve had a maternal death, you remember it for the rest of your life. All the details.”

Launched a decade ago, CMQCC aims to reduce not only mortality, but also life-threatening complications and racial disparities in obstetric care. It began by analyzing maternal deaths in the state over several years; in almost every case, it discovered, there was “at least some chance to alter the outcome.” The most preventable deaths were from hemorrhage (70 percent) and preeclampsia (60 percent).

Seven Causes Account For Most Pregnancy-Related Deaths

Seven Causes Account For Most Pregnancy-Related Deaths 7.6%8.9%9.5%9.5%11.4%12.7%12.7%Preeclampsia & EclampsiaMental Health ConditionsEmbolismInfectionCardiomyopathyCardiovascular & Coronary ConditionsHemorrhage Source: “Report from Maternal Mortality Review Committees: A View Into Their Critical Role,” February 2017

Main and his colleagues then began creating a series of “toolkits” to help doctors and nurses improve their handling of emergencies. The first one, targeting obstetric bleeding, recommended things like “hemorrhage carts” for storing medications and supplies, crisis protocols for massive transfusions, and regular training and drills. Instead of the common practice of “eye-balling” blood loss, which often leads to underestimating the seriousness of a hemorrhage and delaying treatment, nurses learned to collect and weigh postpartum blood to get precise measurements. Hospitals that adopted the toolkit saw a 21 percent decrease in near deaths from maternal bleeding in the first year; hospitals that didn’t use the protocol had a 1.2 percent reduction. By 2013, according to Main, maternal deaths in California fell to around 7 per 100,000 births, similar to the numbers in Canada, France and the Netherlands — a dramatic counter to the trends in other parts of the U.S.

“Prevention isn’t a magic pill,” Main said. “It’s actually teamwork a structured, organized, standardized approach” to care.

CMQCC’s preeclampsia toolkit, launched in 2014, emphasized the kind of practices that might have saved Lauren Bloomstein: careful monitoring of blood pressure and early and aggressive treatment with magnesium sulfate and anti-hypertensive medications. Data on its effectiveness hasn’t been published.

The collaborative’s work has inspired ACOG and advocates in a few states to create their own initiatives. Much of the funding has come from a 10-year, $500 million maternal health initiative by Merck, the pharmaceutical giant. Originally intended to focus on less developed countries, Merck for Mothers decided it couldn’t ignore the growing problem in the U.S. The U.S. maternal mortality rate is “unacceptable,” said Executive Director Mary-Ann Etiebet. Making pregnancy and childbirth safer “will not only save women’s lives but will improve and strengthen our health systems … for all.”

But the really hard work is only beginning. According to the Institute of Medicine, it takes an average of 17 years for a new medical protocol to be widely adopted. Even in California, half of the 250 hospitals that deliver babies still aren’t using the toolkits, said Main, who largely blames inertia.

In New York state, some hospitals have questioned the need for what they call “cookbook medicine,” said Columbia’s Mary D’Alton. Her response: “Variability is the enemy of safety. Rather than have 10 different approaches to obstetric hemorrhage or treatment of hypertension, choose one or two and make it consistent. … When we do things in a standardized way, we have better outcomes.”

One big hurdle: training. Another: money. Smaller providers, in particular, may not see the point. “It’s very hard to get a hospital to provide resources to change something that they don’t see as a problem,” ACOG’s Barbara Levy said. “If they haven’t had a maternal death because they only deliver 500 babies a year, how many years is it going to be before they see a severe problem? It may be 10 years.”

In New Jersey, providers don’t need as much convincing, thanks to a recent project to reduce postpartum blood loss led by the Association of Women’s Health, Obstetric and Neonatal Nurses. A number of hospitals saw improvements; at one, the average length of a hemorrhage-related ICU stay plunged from 8 days to 1.5 days. But only 31 of the state’s 52 birthing hospitals participated in the effort, in part — perhaps — because nurses led it, said Robyn D’Oria, executive director of the Central Jersey Family Health Consortium and a member of the state’s maternal mortality committee. “I remember having a conversation with a hospital that I would describe as progressive and she said to me, ‘I cannot get past some of the physicians not wanting to buy into this.’”

So New Jersey hospitals are about to try again, this time adopting mini-toolkits created by the ACOG-led Alliance for Innovation on Maternal Health for hemorrhage and preeclampsia. “We’re at the very beginning” of a rollout that is likely to take at least two years, D’Oria said. Among those helping to create momentum has been Ryan Hansen, the husband of the teacher who died at Monmouth Medical Center a few months before Lauren Bloomstein.

Still, as hospitals begin to revamp, mothers in the state continue to perish. One was Ashley Heaney Butler. A Rutgers University graduate, she lived in Bayville, where she decorated the walls of her house with anchors, reflecting her passion for the ocean. She worked for the state Division of Vocational Rehabilitation Services as a counselor, and served as president of the New Jersey Rehabilitation Association. Her husband Joseph was a firefighter. She gave birth at Monmouth last September to a healthy boy and died a couple of weeks later at the age of 31, never leaving the hospital. It turned out that she had developed an infection late in her pregnancy, possibly related to a prior gastric bypass surgery. She was under the care of several doctors, including Vaclavik.

Hailey Anne Bloomstein, now 5 years old, has her mother’s brown hair and green eyes. (Bryan Anselm for ProPublica)

The death of a new mother is not like any other sudden death. It blasts a hole in the universe. “When you take that one death and what that does, not only to the husband, but to the family and to the community, the impact that it has in the hospital, on the staff, on everybody that’s cared for her, on all the people who knew them, it has ripple effects for generations to come,” Robyn D’Oria said.

Jackie Ennis felt Lauren’s loss as an absence of phone calls. She and Lauren had been closer than many sisters, talking several times a day. Sometimes Lauren called just to say she was really tired and would talk later; she’d even called Ennis from Hawaii on her honeymoon. The night Lauren died, Ennis knew something was wrong because she hadn’t heard from her best friend. “It took me a really long time not to get the phone calls,” she said. “I still have trouble with that.”

During Lauren’s pregnancy, Frankie Hedges had thought of herself as Hailey’s other grandmother. She and Lauren had made a lot of plans. Lauren’s death meant the loss of their shared dreams for an entire extended family. “I just feel she didn’t get what she deserved,” Hedges said.

Vaclavik’s obstetric practice is “larger” than in 2011, and he continues to have admitting privileges at Monmouth and two other hospitals, he said in his deposition. “I will never forget” Lauren’s death, he said. “… I probably suffer some post-traumatic stress from this.”

Hailey is five years old, with Lauren’s brown hair and clear green eyes. She feels her mother’s presence everywhere, thanks to Larry and his new wife Carolyn, whom he married in 2014. They met when she was a surgical tech at one of the hospitals he worked at after Lauren died. Photos and drawings of Lauren occupy the mantle of their home in Holmdel, the bookcase in the dining room and the walls of the upstairs hallway. Larry and Carolyn and their other family members talk about Lauren freely, and even Larry’s younger daughter, 2-year-old Aria, calls her “Mommy Lauren.” On birthdays and holidays, Larry takes the girls to the cemetery. He designed the gravestone — his handprint and Lauren’s reaching away from each other, newborn Hailey’s linking them forever. Larry has done his best to keep Lauren’s extended family together — Ennis and Hedges and their families are included in every important celebration.

Larry still has the video of Lauren and Hailey on his phone. “By far the hardest thing for me to accept is from Lauren’s perspective,” he said one recent evening, hitting the play button and seeing her alive once more. “I can’t, I literally can’t accept it. The amount of pain she must have experienced in that exact moment when she finally had this little girl. … I can accept the amount of pain I have been dealt,” he went on, watching Lauren stroke Hailey’s cheek. “But is the one thing I just can’t accept. I can’t understand, I can’t fathom it.”

Update, July 28, 2017: This story has been updated to indicate that the State Board of Medical Examiners declined to discipline ob/gyn John Vaclavik for his care of Lauren Bloomstein.

Do you know someone who died or nearly died in childbirth? Please tell us your story. If you want to reach out to us directly, email us at .

Nina Martin covers gender and sexuality for ProPublica. She has been a reporter and editor specializing in women’s, legal and health issues for more than 30 years.

Renee Montagne is an NPR special correspondent. She’s reported and hosted for NPR since the mid-1980s.

Research editor Derek Kravitz and engagement reporter Adriana Gallardo at ProPublica and researcher Bo Erickson at NPR contributed to this story.

Production by Jillian Kumagai and Hannah Birch.

Tova Leigh

I can’t see a white light, but I know I am about to die.

It’s Friday night. I am lying in a hospital bed in the intensive care unit after giving birth to my twins, at 35 weeks and 3 days. My blood pressure is 240 over 120, and my whole body is shaking. I have lost control of my muscles, and I can’t speak when the doctor asks me if I can hear him. Three other doctors rush into the room and stick a second IV in my other arm. I am now being pumped with drugs in a desperate attempt to reduce my blood pressure, which is out of control. I can’t see a white light, but I know I am about to die.

Rewind eight months. My husband and I were trying to get pregnant. We had a beautiful 1 ½-year-old daughter, and we wanted her to have a brother or sister. I took a pregnancy test, and it was positive. We did 10 more (as you do), and when we finally had our first scan, the technician said: “Congratulations are due,” and then added, “How many congratulations would you like?”

We both replied almost in unison: “One!”

“Well, it’s two as far as I can tell,” he said.

I burst into manic laughter, and my husband just stood there in total shock. After a few moments of silence, he said very matter of factly, “I need to get a second job.”

I won’t bore you with details of the pregnancy, but let’s just say that having twins inside you is no piece of cake. I was massive at week 12, I had morning (afternoon and evening) sickness till week 26, and I could not for the life of me find two names I liked!

But the big blow came when I went in for a routine checkup at 28 weeks. I was running late for the appointment, so when I finally sat down and had my blood pressure taken, I was not surprised it measured high. The nurse asked me to wait for a few minutes so she could check again. Annoyed and thinking she was just being fussy, I agreed and waited to be called back in.

The second time she measured, it was even worse. She looked at me, and I could see she was worried. “Is your eyesight blurry?” she asked. You immediately know it’s not a great sign when someone asks you that. She made a phone call, and I was asked to give a urine sample. After the results came back, I heard the word “preeclampsia” for the very first time.

If you don’t know what preeclampsia is, it basically means that your inner organs might fail, and your blood pressure is so high it can even cause a stroke. In short, it’s a life-threatening condition (for mother and baby) that sometimes occurs during pregnancy.

I was admitted to the hospital that same day and spent the next two months there. Each day, experts came into my room and told me how I was most likely going to deliver in the next 24 hours. Of course, at 28 weeks, this was not what I wanted to hear. I knew that if that did happen the twins who were tiny at that point would need an immense amount of care and have to spend the first few months of their lives in the NICU.

Being a big believer in mind over matter, I decided to focus my whole being on positive thoughts. I asked lovely ladies on social media groups to share only good stories with me. I read a lot about the condition because I wanted to understand what my body was doing and to understand my options.

I drank a lot of water, reassuring myself that it was cleansing my body—a theory I made up and which was not based on any facts. I thought of my babies and how they were growing inside me, and I visualized myself lasting till week 35. That was the goal I set for myself. I knew that if I made it to 35 weeks the babies would be fine.

All this time, my eldest daughter Ella, who had just turned 2, was at home without her mother. This was the hardest part. I could take being in a hospital forever knowing that I was doing it for my unborn babies. I could stand the horrid food, the boredom, the fear, the lack of privacy, the constant noise, the daily blood tests, the medication, the whole shebang! The one thing that totally broke me was being away from Ella. In my lowest moments, I found myself wishing the babies would just come already so I could get back to her.

But against the odds, and I do mean that, I somehow lasted for nearly two months. During this time, I met so many brave ladies. It’s actually amazing to see how strong women are. I see new moms squeezing their breasts so hard, till they nearly bleed, just to get a few drops of milk they can give to their premature babies down in intensive care. And moms to babies who are smaller than mine were going to be were keeping positive and sitting by their babies while holding their tiny, tiny hands. I met so many incredible people during this time and heard many inspiring stories, and although this was by far the hardest challenge I had ever experienced, it was also one of the most eye-opening and strength-building experiences that would change me forever.

And so, at 35 weeks, I said to the doctors, “That’s it. Get them out.” My C-section was booked, and I was so excited to finally meet them!

When I first saw the twins, I started to cry. They were so small. I did not expect them to be so tiny, especially after all the hard work I put into carrying them for as long as possible. Dani weighed exactly 4 lbs. 6 oz., and Arielle was not even that. At 4 lbs. 3 oz., she was honestly the ugliest baby I had ever seen, but I loved her with all my heart. I loved them both, and I was so relieved the ordeal is over.

That night as I lay in intensive care, I woke up to a feeling something was not right. I called the nurse and asked her to check my blood pressure. The machine confirmed that my blood pressure was already alarmingly high, but what was more concerning was that it was racing higher by the minute. My husband who was asleep on a hospital chair by my bed, woke up, and was surprised by all the commotion in our room.

Within minutes, I was surrounded by doctors and a lot of noise. I knew exactly what was happening because I had read about it. I was about to enter the world of eclampsia, which is a condition in which one or more convulsions occur, often followed by coma and sometimes death. Just then, the shakes started. I had d lost control. My whole body was jumping on the bed, and I was scared. I thought to myself: This is it.

Looking at my husband, I could tell he had no clue what was going on, and that is when I began to really panic. I mean, how the hell was I going to leave my three girls with this guy who couldn’t even tell I was about to die?!

So I decided not to.

I closed my eyes and imagined I was on the beach drinking a cocktail. I had a piña colada, followed by a margarita, and it was lush. I could hear the doctor ask, “Are you OK? Can you hear me?” but at that point, I was in Paris eating lovely cheeses I had missed eating during my pregnancy. My body was still shaking and more drugs were being pumped into my veins, but now I was at home with my girls. I could see them all so clearly. Their faces, their eyes, their hair, I could smell them, and I knew that everything was going to be OK. I found myself smiling, and at that point, I figured the whole room must have thought I had lost my mind.

The doctor kept pressing the blood pressure machine’s button every few seconds, and it seemed like no one in the room was breathing—except me of course. I was having a great time snowboarding in white powder screaming “woo hoo!” at the top of my lungs.

Just then my blood pressure started coming down. My body settled, and I opened my eyes. I was not dead.

All I could think of was how lucky and blessed I was to have so many dedicated people around me. This included my darling husband who looked like shit right then, as he finally realized how close he was to losing me and having to raise three kids all by himself.

It was the longest night of my life, and although the worst was seemingly behind me, I knew that the real challenge had yet to come. A few days later, I was allowed to go home with my babies, and life in the fast lane of parenthood (to three kids) began.

From that point on, I decided that humor shall be my secret weapon and positive thinking my shield.

Preeclampsia

Preeclampsia: Symptoms, Risks, Treatment, and Prevention

Preeclampsia is a condition that occurs only during pregnancy. Some symptoms may include high blood pressure and protein in the urine, occurring after week 20 of pregnancy. Preeclampsia is often precluded by gestational hypertension. While high blood pressure during pregnancy does not necessarily indicate preeclampsia, it may be a sign of another problem. The condition affects at least 5-8% of pregnancies.

Who is at risk for preeclampsia?

  • A first-time mom
  • Previous experience with gestational hypertension or preeclampsia
  • Women whose sisters and mothers had preeclampsia
  • Women carrying multiple babies
  • Women younger than 20 years and older than age 40
  • Women who had high blood pressure or kidney disease prior to pregnancy
  • Women who are obese or have a BMI of 30 or greater

What are the symptoms?

Mild preeclampsia: high blood pressure, water retention, and protein in the urine.

Severe preeclampsia: headaches, blurred vision, inability to tolerate bright light, fatigue, nausea/vomiting, urinating small amounts, pain in the upper right abdomen, shortness of breath, and tendency to bruise easily. Contact your doctor immediately if you experience blurred vision, severe headaches, abdominal pain, and/or urinating very infrequently.

How do I know if I have preeclampsia?

At each prenatal checkup, your healthcare provider will check your blood pressure, urine levels, and may order blood tests which may show if you have preeclampsia. Your physician may also perform other tests that include: checking kidney and blood-clotting functions; ultrasound scan to check your baby’s growth; and Doppler scan to measure the efficiency of blood flow to the placenta.

How is it treated?

Treatment depends on how close you are to your due date. If you are close to your due date, and the baby is developed enough, your health care provider will probably want to deliver your baby as soon as possible.

If you have a mild case and your baby has not reached full development, your doctor will probably recommend you do the following:

  • Rest, lying on your left side to take the weight of the baby off your major blood vessels.
  • Increase prenatal checkups.
  • Consume less salt
  • Drink at least 8 glasses of water a day
  • Change your diet to include more protein

If you have a severe case, your doctor may try to treat you with blood pressure medication until you are far enough along to deliver safely, along with possibly bed rest, dietary changes, and supplements.

How can preeclampsia affect the mother?

If preeclampsia is not treated quickly and properly, it can lead to serious complications for the mother such as liver or renal failure and future cardiovascular issues.

It may also lead to the following life-threatening conditions:

  • Eclampsia– This is a severe form of preeclampsia that leads to seizures in the mother.
  • HELLP Syndrome (hemolysis, elevated liver enzymes, and low platelet count)- This is a condition usually occurring late in pregnancy that affects the breakdown of red blood cells, how the blood clots, and liver function for the pregnant woman.

How does preeclampsia affect my baby?

Preeclampsia can prevent the placenta from getting enough blood. If the placenta doesn’t get enough blood, your baby gets less oxygen and food. This can result in low birth weight. Most women still can deliver a healthy baby if preeclampsia is detected early and treated with regular prenatal care.

How can I prevent preeclampsia:

Currently, there is no sure way to prevent preeclampsia. Some contributing factors to high blood pressure can be controlled and some can’t. Follow your doctor’s instruction about diet and exercise.

  • Use little or no added salt in your meals.
  • Drink 6-8 glasses of water a day.
  • Don’t eat a lot of fried foods and junk food.
  • Get enough rest.
  • Exercise regularly.
  • Elevate your feet several times during the day.
  • Avoid drinking alcohol.
  • Avoid beverages containing caffeine.
  • Your doctor may suggest you take the prescribed medicine and additional supplements.

Compiled using information from the following sources:

1. Medscape; Hypertension and Pregnancy

2. Preeclampsia Foundation

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