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Preeclampsia, a Different Cause of High Blood Pressure in Pregnancy

Preeclampsia is a complication of pregnancy in which high blood pressure occurs along with organ damage that manifests commonly as abnormal presence of protein in the urine. Preeclampsia presents anytime after 20 weeks of gestation  in women with previously normal blood pressure before pregnancy. Preeclampsia can progress to eclampsia, where high blood pressure causes convulsions.

Approximately 10% of pregnant mothers in Africa develop preeclampsia. Annie is among them.

Annie is a 38-year-old lady pregnant with her first child. At 12 weeks gestation, she started attending prenatal clinic at the local mission hospital in Mukuru.  At 36+ weeks gestation, Annie noticed swelling of the legs and feet after a shower. She dismissed it with the assumption it was because of the long walk home and standing in the bank hall for hours during the day. The following morning, a severe headache woke her up, plus swollen hands, feet and legs. Annie has had an otherwise smooth pregnancy. It is the first time experiencing such symptoms.

After a conversation with her husband, they agreed on a prenatal clinic check-up where the doctor carried out a physical examination plus urine and blood tests, and diagnosed preeclampsia.

Symptoms of Preeclampsia

The symptoms may manifest slowly or suddenly and vary from person to person. Preeclampsia can even develop without symptoms, in which case it is identified during blood pressure checks and urine tests.

Symptoms are linked to damage to the kidneys, liver, brain, or other organs and may include:

  • High blood pressure – exceeding 140/90mmHg in two different times of the day.
  • A urine test will reveal protein in the urine known as proteinuria
  • Loss of vision, or blurry vision or photosensitivity
  • Swelling (edema) of the feet, legs, hands or face. This is common in normal pregnancy so does not reliably indicate preeclampsia
  • Severe headache
  • Dizziness
  • Nausea and vomiting
  • Abdominal pains on the upper right side (around the liver)
  • Reduced urine output in 24 hours
  • Shortness of breath – if the lung has fluid

What causes preeclampsia

The definite cause of preeclampsia is unknown; however, research has tied it to abnormal development of the blood vessels that supply the placenta, which the fetus relies on for growth and development.

Blacks have a higher risk of preeclampsia than other races, suggesting genetics plays a role.  Other risk factors of developing preeclampsia include:

  • Prior history of preeclampsia or eclampsia
  • Having hypertension before pregnancy or chronic hypertension
  • First pregnancy
  • New paternity. This means pregnancy with a new partner.
  • Extreme ages – very young or older mothers over 35 years.
  • Obesity
  • Multiple pregnancies
  • In vitro fertilization

Preeclampsia differs from other high blood pressure disorders in pregnancy such as chronic  hypertension and gestational hypertension. One major difference is that preeclampsia is associated with new onset of protein in urine and other signs indicative of organ damage.

Can preeclampsia harm you or your baby?

Prompt medical intervention of preeclampsia reduces the chances of the mother or baby developing complications. However, if untreated, preeclampsia has severe or even fatal complications.

Some of the complications of preeclampsia to the baby are preterm birth, fetal growth restriction, or death.

Complications to the mother include eclampsia, HELLP syndrome in which there are liver and blood abnormalities, placenta abruption (detachment of the placenta from the uterus before labor/delivery), and multi-organ damage.

Prevention and Treatment

The cure for preeclampsia is delivering the baby to avoid complications. Anti-hypertensives and other medications prescribed by the doctor may help reduce the high blood pressure.

Blood pressure monitoring in prenatal clinic offers a chance of detecting and managing preeclampsia early. Unlike other forms of high blood pressure, the risk of preeclampsia cannot be lowered by eating less salt, exercise, or reducing caloric intake.

After delivery, the mother’s blood pressure may return to normal and symptoms may disappear, but for some, blood pressure remains high and the woman continues to need blood pressure medication. All in all, monitoring post-partum is crucial.