Preeclampsia

Preeclampsia is a dangerous combination of high blood pressure and too much protein in the urine that can happen in pregnant women after their 20th week of pregnancy. It can range from mild to severe, and often develops suddenly.

Preeclampsia affects 5 to 8% of pregnant women and their unborn children. It is the leading cause of maternal death worldwide. If not treated, preeclampsia can worsen into eclampsia, a condition that causes seizures and can be fatal. Unfortunately, preeclampsia increases the risk of fetal death. The sooner you develop preeclampsia during your pregnancy, the higher the risk.

The cure for preeclampsia is for the baby to be delivered. If it is too early for the baby to be delivered, your doctor will work with you to reduce symptoms and complications until you can deliver safely.

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Signs and Symptoms

• High blood pressure, at least twice within 7 days -- above 140/90, if your blood pressure was normal before pregnancy
• Severe headaches
• Sudden weight gain -- more than 2 to 5 pounds in a week
• Swelling of hands and feet -- this often happens in a healthy pregnancy, so it is not necessarily a sign of preeclampsia
• Blurred vision or sensitivity to light
• High levels of protein in your urine
• Pain in the upper right side of the abdomen
• Vaginal bleeding

What Causes It?

No one knows what causes preeclampsia. However, some women have a higher risk of developing it. Some research suggests preeclampsia may be an autoimmune disorder. Your risk may be greater if:

• This is your first pregnancy
• You are in your teens
• You are over 40
• You are carrying twins or multiples
• You are overweight
• You had preeclampsia before
• You have had high blood pressure, diabetes, or kidney disease
• You have a high percentage of body fat

What to Expect at Your Doctor's Office

If you have any symptoms of preeclampsia, you should see your doctor immediately. Women often find out they have preeclampsia during a routine prenatal checkup that includes a urine test and blood pressure check.

As you get closer to your delivery date, your doctor may do a nonstress test to check your baby's heart rate and make sure your baby is getting enough oxygen.

Treatment Options

If you have a mild case of preeclampsia, your doctor may recommend bed rest. You should lie on your left side, so the weight of the baby will not press against important blood vessels. Drink a lot of water to help you urinate and get rid of excess fluids.

Your doctor may want to monitor your blood pressure and urine every couple of days. The goal is to manage your symptoms until at least 36 weeks in your pregnancy, when the baby may be safely delivered.

If you have severe preeclampsia, it may not be possible to wait that long. Your doctor may admit you to the hospital, where you will receive drugs to induce labor, or have a Cesarean section (C-section).

Your doctor may prescribe the following drugs intravenously (IV):

• Magnesium sulfate or hydralazine, to reduce your blood pressure
• Calcium gluconate, if your blood pressure falls too low
• Furosemide, to help you urinate more
• Corticosteroids, for women at 22 to 34 weeks gestation, to help fetal lung development prior to birth

Complementary and Alternative Therapies

If you have preeclampsia, you should be under the care of an obstetrician. DO NOT try to self-treat preeclampsia with complementary and alternative therapies (CAM). If you want to use CAM therapies along with conventional medical treatment, your obstetrician should supervise all treatment. Some of the more common therapies are described below.

Nutrition and Supplements

Some supplements may help prevent preeclampsia. But they do not help once you have the condition. Others, intended to reduce symptoms once you have the condition, show mixed results in scientific studies. If you are pregnant, do not take anything without your obstetrician's approval. All supplements have side effects. And some may not be safe for women with certain medical conditions.

Preventing preeclampsia:

• Calcium. If you have low levels of calcium, or are at risk for high blood pressure, some studies show 2,000 mg of calcium per day may lower the risk of developing preeclampsia. Taking calcium does not seem to reduce the risk of developing preeclampsia in healthy women, and not all studies show the same result.
• Vitamin D. Some studies suggest that having low levels of vitamin D raise a pregnant woman's risk for preeclampsia. One preliminary study found that taking vitamin D supplements appeared to reduce the risk of preeclampsia. However, women in the study also consumed high levels of omega-3 fatty acids (found in fish oil). So researchers are not sure if it was vitamin D or the combination that reduced the risk.
• Folic acid and vitamin B6. May help prevent symptoms in women with a history of preeclampsia and high homocysteine levels. One study found a reduction in preeclampsia with supplementation of a multivitamin with folic acid.
• Vitamin C and vitamin E. May help reduce risk of preeclampsia. However, some studies have found no effect. Neither seems to help once you have the condition.
• Lycopene. More studies are needed to confirm results.
• Magnesium. Was shown to help reduce the risk in one study. But another study showed no effect.
• Coenzyme Q10 (CoQ10). In one study of women at high risk of preeclampsia, those who took CoQ10 were less likely to develop preeclampsia than those who took placebo. CoQ10 can increase the body's clotting ability, which may pose unique risks during pregnancy. Speak to your doctor.
• Low dose aspirin. Studies suggest that daily low dose aspirin is moderately effective at reducing the onset of preeclampsia and its complications among women at high risk for the disease. Talk to your doctor before beginning an aspirin regimen.

Treatments for preeclampsia:

These treatments require close supervision by a doctor.

• Studies show mixed results for l-arginine, an amino acid given either intravenously (IV) or by mouth. Your doctor should determine the dose. Some studies suggest that it may help when patients take it throughout pregnancy.
• Magnesium sulfate, given by injection, can help lower blood pressure.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, it is important to work with your doctor to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, and teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

Note: DO NOT use these herbs without your doctor's supervision. All herbs have side effects. And some may not be safe for pregnant women or women with certain medical conditions.

No studies have found any herbs effective for preeclampsia. Herbs that have traditionally been used to treat mild high blood pressure in pregnancy include:

• Hawthorn berries (Crataegus laevigata)
• Cramp bark (Viburnum opulus)
• Milk thistle (Silybum marianum)

Acupuncture

May help lower blood pressure and increase circulation.

Following Up

Your doctor will monitor you carefully for the first few days after you have delivered your baby. You may need to stay in the hospital for several days to weeks, depending on the severity of the preeclampsia. You should have checkups at least every 2 weeks for the first several months after leaving the hospital. Preeclampsia is a significant risk factor for long-term morbidity, such as chronic hypertension and hospitalizations later in life.

Special Considerations

If you wear rings, take them off as soon as symptoms begin. Swollen fingers can make it difficult or even impossible to remove rings, and they may begin to cut off circulation in your fingers.

Symptoms of preeclampsia can appear gradually and suddenly get worse, or you may not have any visible symptoms at all. The best way to prevent any complications from preeclampsia is to get regular prenatal care. Your doctor can provide immediate treatment.

Preeclampsia that happens early in your pregnancy, and preeclampsia that is severe, may increase your risk of heart disease. Your doctor may recommend more frequent screening for heart disease risk factors.

Supporting Research

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Belfort MA, Clark SL, Sibai B. Cerebral hemodynamics in preeclampsia: Cerebral perfusion and the rationale for an alternative to magnesium sulfate. Obstet Gynecol Surv. 2006;61(10):655-665.

Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007 Sep;92(9):3517-3522.

Bope ET, Kellerman RD, eds. Conn's Current Therapy 2014. 1st ed. Philadelphia, PA: Elsevier Saunders. 2013.

Cheng PJ, Huang SY, Su SY, Hsiao CH, Peng HH, Duan T. Prognostic value of cardiovascular disease risk factors measured in the first-trimester on the severity of preeclampsia. Medicine (Baltimore). 2016;95(5):e2653.

Ehrenberg HM, Mercer BM. Abbreviated postpartum magnesium sulfate therapy for women with mild preeclampsia: A randomized controlled trial. Obstet Gynecol. 2006;108(4):833-838.

Ferri FF. Ferri's Clinical Advisor 2014. 1st ed. St. Louis, MO: Elsevier Mosby; 2013.

Habek D, Bobic MV, Habek JC. Oncocytic therapy in management of preeclampsia. Arch Med Res. 2006;37(5):619-623.

Harmon QE, Huang L, Umbach DM, et al. Risk of fetal death with preeclampsia. Obstet Gynecol. 2015;125(3):628-35.

Haugen M, Brantsaeter AL, Trogstad L, et al. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology. 2009 Sep;20(5):720-726.

Hladunewich MA, Derby GC, Lafayette RA, Blouch KL, Druzin ML, Myers BD. Effect of L-arginine therapy on the glomerular injury of preeclampsia: A randomized controlled trial. Obstet Gynecol. 2006;107(4):886-895.

Mendola P, Mumford SL, Mannisto TI, Holston A, Reddy UM, Laughon SK. Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth. Epidemiology. 2015;26(1):17-26.

Mihu D, Sabau L, Costin N, Ciortea R, Malutan A, Mihu CM. Implications of maternal systemic oxidative stress in normal pregnancy and in pregnancy complicated by preeclampsia. J Matern Fetal Neonatal Med. 2012;25(7):944-951.

Mor O, Stavsky M, Yitshak-Sade M, et al. Early onset preeclampsia and cerebral palsy: a double hit model? Am J Obstet Gynecol. 2016;214(1):105.e1-9.

Nielsen LR, Muller C, Damm P, Mathiesen ER. Reduced prevalence of early preterm delivery in women with Type 1 diabetes and microalbuminuria -- possible effect of antihypertensive treatment during pregnancy. Diabet Med. 2006;23(4):426-431.

Pare E, Parry S, McElrath TF, Pucci D, Newton A, Lim KH. Clinical risk factors for preeclampsia in the 21st century. Obstet Gynecol. 2014;124(4):763-70.

Patrelli TS, Dall'asta A, Gizzo S, et al. Calcium supplementation and prevention of preeclampsia: a meta-analysis. J Matern Fetal Neonatal Med. 2012;25(12):2570-2574.

Podymow T, August P. Hypertension in pregnancy. Adv Chronic Kidney Dis. 2007;14(2):178-190.

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Weissgerber TL, Gandley RE, McGee PL, et al. Haptoglobin phenotype, preeclampsia risk and the efficacy of vitamin C and E supplementation to prevent preeclampsia in a racially diverse population. PLoS One. 2013;8(4):e60479.

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Review Date: 4/27/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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