What is Preeclampsia?

Preeclampsia is a serious pregnancy complication diagnosed if a woman is more than 20 weeks pregnant, has high blood pressure AND has protein in their urine. 

How is Preeclampsia Diagnosed?

Preeclampsia is diagnosed by having the following THREE conditions:

1. Being more than 20 weeks pregnant

2. Developing high blood pressure

Preeclampsia thresholds are >140/90, (severe hypertension is >160/110), measured in at least two readings at least 4 hours apart.  

For this reason, Pelvic Floored recommends that all pregnant women have their own at-home blood pressure monitor (like these from Amazon).  Begin checking your blood pressure each month in your 2nd trimester, then every other week in 3rd trimester, and finally weekly in the final 6 weeks.  General guidelines also recommend that you check blood pressure if you have any headaches.  If the blood pressure is above the above thresholds you should go to an Emergency Department immediately, to be evaluated for Preeclampsia. 

3.  Presence of protein in your urine.

Protein in your urine (fancy name "proteinuria") happens because of damage to the tiny blood vessels in the kidneys, due to the elevated blood pressure.  

If you are at elevated risk for preeclampsia, you can monitor your own urine at home with at-home test strips.  If you test positive for protein and you are >20 weeks pregnancy, contact your primary provider and if you can't get in touch, report to your nearest emergency room immediately. 

What are the symptoms of preeclampsia?

Besides the 3 items that result in the diagnosis of preeclampsia (>20 weeks pregnant, elevated blood pressure and presence of protein in your urine), there are many other symptoms of preeclampsia that result from multiple organ damage due to damage to small blood vessels in the body.  These symptoms can be: 

- Severe or persistent headache
- Blurry vision, seeing spots or other visual changes.
- Pain in your upper right abdomden, or stomach area
- Sudden, severe swelling in face, hands or feet
- Sudden weight gain or shortness of breath

Preeclampsia is very important to be aware of, as the high blood pressure can cause severe damage to multiple organs, especially the kidneys, liver and placenta, and can result in the death of mother and baby.   

Who is at greatest risk for Preeclampsia?

Preeclampsia occurs primarily in first pregnancies, and women who have had preeclampsia once are 7x more likely to develop it again (Duckitt, et al, 2016).  

Preeclampsia is more common in women who have a history of elevated blood pressure, kidney disease or obesity.  It is also more common in women over 40 years old, women pregnant with multiple babies (twins, triplets, etc), African American women and women with a family history of preeclampsia.  

Preeclampsia is also more common in women with migraines, diabetes, rheumatoid arthritis, lupus, scleroderma, urinary tract infections, gum disease, polycystic ovarian disease, multiple sclerosis, gestational diabetes and sickle cell disease (Clowse et al 2007; Conde-Agudelo et al 2008).

Finally, preeclampsia is more common in pregnancies that are the result of egg donation, in-vitro fertilization, and donor insemination.  

4 Things that REDUCE YOUR RISK of preeclampsia

Yes, there are certain things to DO reduce the risk of preeclampsia.

1. Low Dose Aspirin 

A 2017 study found that high risk women who took low dose aspirin after 12 weeks of pregnancy had reduced incidence of preeclampsia.  Therefore if you are at high risk, this is something to discuss with your primary medical provider. 

2. Exercise

Exercise is protective against developing preeclampsia.  And while the more intense the exercise, the more protection against developing preeclampsia, even gentle recreational exercise has preventative benefits against preeclampsia AND blood clots!

3. Calcium Supplementation

Hofmeyr, 2010, found that Calcium supplementation, especially in women with low calcium intake, can HALVE the risk of preeclampsia!!!  Additionally, it reduced risk of preterm birth, death or serious morbidity.  

4. Fiber Intake

Higher fiber intake, especially in early pregnancy, is associated with reduced risk of preeclampsia (Qiu, et al, 2008).  The highest quartile took in 21 grams of fiber a day, and those clients had significantly less risk of preeclampsia than the lowest quartile, who took in 11 grams of fiber a day.  Therefore if you are high risk, you should aim at an intake of at least 20 grams of fiber a day.

And 3 Things That DO NOT HELP in Preventing Preeclampsia

1. Rest

While in theory, this would reduce blood flow to the placenta, thereby reducing risk of small vessel damage, studies found no reduced incidence of preeclampsia in clients who were prescribed rest (Higgins, 2002), and in fact the bedrest increased risk of blood clots. 

2. Reducing Salt Intake

Duley et al, in 2010, assessed if reducing salt intake would be protective against preeclampsia, as this is a common medical recommendation to the general population for reducing elevated blood pressure.  Reducin salt intake, however, was not found to reduce risk of preeclampsia. 

3. Diuretics

While this was suggested in the past, believing it would reduce blood pressure, this has not been found to be the case, and in fact could dangerously lower a pregnant woman's blood volume, so should be avoided as prescription to the general population.  

Remember that Preeclampsia can Occur Postpartum as Well!

Hauspurg, et al 2021 found that preeclampsia can also occur POSTPARTUM!   It is most common in 7-10 days of delivery, but can happen at any time up to 6 months postpartum.  

This means that if you are high risk, you should continue to monitor your blood pressure in the 6 months postpartum, and if it is elevated, it requires immediate attention.  DO NOT let yourself be gaslit and told to "just relax."  

Thanks for Coming to My Cliff Notes on Preeclampsia :) 

I hope you enjoyed learning with me.  If this has helped you, please share it with a friend--especially a woman of color, you might just save her life, or the life of her baby.  

XOXO
Dr. Kelly 💋

 References: It's True!  You Can Look it Up!!

1. Bezerra Maia E Holanda Moura S, Marques Lopes L, Murthi P, da Silva Costa F. Prevention of preeclampsia. J Pregnancy. 2012;2012:435090. doi: 10.1155/2012/435090. Epub 2012 Dec 17. PMID: 23316362; PMCID: PMC3534321.
2. Clowse, M. E. B. (2007). Lupus activity in pregnancy. Rheumatic Disease Clinics of North America, 33,237.
3. Conde-Agudelo, A., Villar, J., & Lindheimer, M. (2008). Maternal infection and risk of preeclampsia: Systematic review and metaanalysis. American Journal of Obstetrics and Gynecology, 198(1), 7–22.
4. Duckitt, K., & Harrington, D. (2005). Risk factors for pre-eclampsia at antenatal booking: Systematic review of controlled studies. British Medical Journal,330(7491), 565. Retrieved December 30, 2016, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC554027/
5. Duley L, Henderson-Smart DJ, Meher S. Altered dietary salt for preventing pre-eclampsia, and its complications. Cochrane Database of Systematic Reviews. 2010;(4) doi: 10.1002/14651858.CD005548.CD005548
6. Hauspurg A, Jeyabalan A. Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy. Am J Obstet Gynecol. 2022 Feb;226(2S):S1211-S1221. doi: 10.1016/j.ajog.2020.10.027. Epub 2021 Jul 7. PMID: 35177218; PMCID: PMC8857508.
7. Hofmeyr GJ, Lawrie TA, Atallah ÁN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews. 2010;8 doi: 10.1002/14651858.CD001059.pub3.CD001059
8. Qiu C, Coughlin KB, Frederick IO, Sorensen TK, Williams MA. Dietary fiber intake in early pregnancy and risk of subsequent preeclampsia. Am J Hypertens. 2008 Aug;21(8):903-9. doi: 10.1038/ajh.2008.209. Epub 2008 Jul 17. Erratum in: Am J Hypertens. 2008 Oct;21(10):1169. PMID: 18636070.
9. Rosenberg, T. J., Garbers, S., Lipkind, H., & Chiasson, M. A. (2005). Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: Differences among 4 racial/ethnic groups. American Journal of Public Health, 95(9), 1545–1551.
10. U.S. Preventive Services Task Force. (2015). Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: Recommendation statement. American Family Physician,  91(5). Retrieved August 8, 2016, from http://www.aafp.org/afp/2015/0301/od1.html
11. Weissgerber TL, Wolfe LA, Davies GAL. The role of regular physical activity in preeclampsia prevention. Medicine & Science in Sports & Exercise. 2004;36(12):2024–2031. doi: 10.1249/01.mss.0000147627.35139.dc. 
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