Complications of preeclampsia for baby

Preeclampsia - Symptoms and causes

Overview

Preeclampsia is a complication of pregnancy. With preeclampsia, you might have high blood pressure, high levels of protein in urine that indicate kidney damage (proteinuria), or other signs of organ damage. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had previously been in the standard range.

Left untreated, preeclampsia can lead to serious — even fatal — complications for both the mother and baby.

Early delivery of the baby is often recommended. The timing of delivery depends on how severe the preeclampsia is and how many weeks pregnant you are. Before delivery, preeclampsia treatment includes careful monitoring and medications to lower blood pressure and manage complications.

Preeclampsia may develop after delivery of a baby, a condition known as postpartum preeclampsia.

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Symptoms

The defining feature of preeclampsia is high blood pressure, proteinuria, or other signs of damage to the kidneys or other organs. You may have no noticeable symptoms. The first signs of preeclampsia are often detected during routine prenatal visits with a health care provider.

Along with high blood pressure, preeclampsia signs and symptoms may include:

• Excess protein in urine (proteinuria) or other signs of kidney problems
• Decreased levels of platelets in blood (thrombocytopenia)
• Increased liver enzymes that indicate liver problems
• Severe headaches
• Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
• Shortness of breath, caused by fluid in the lungs
• Pain in the upper belly, usually under the ribs on the right side
• Nausea or vomiting

Weight gain and swelling (edema) are typical during healthy pregnancies. However, sudden weight gain or a sudden appearance of edema — particularly in your face and hands — may be a sign of preeclampsia.

When to see a doctor

Make sure you attend your prenatal visits so that your health care provider can monitor your blood pressure. Contact your provider immediately or go to an emergency room if you have severe headaches, blurred vision or other visual disturbances, severe belly pain, or severe shortness of breath.

Because headaches, nausea, and aches and pains are common pregnancy complaints, it's difficult to know when new symptoms are simply part of being pregnant and when they may indicate a serious problem — especially if it's your first pregnancy. If you're concerned about your symptoms, contact your doctor.

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Causes

The exact cause of preeclampsia likely involves several factors. Experts believe it begins in the placenta — the organ that nourishes the fetus throughout pregnancy. Early in a pregnancy, new blood vessels develop and evolve to supply oxygen and nutrients to the placenta.

In women with preeclampsia, these blood vessels don't seem to develop or work properly. Problems with how well blood circulates in the placenta may lead to the irregular regulation of blood pressure in the mother.

Other high blood pressure disorders during pregnancy

Preeclampsia is one high blood pressure (hypertension) disorder that can occur during pregnancy. Other disorders can happen, too:

• Gestational hypertension is high blood pressure that begins after 20 weeks without problems in the kidneys or other organs. Some women with gestational hypertension may develop preeclampsia.
• Chronic hypertension is high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy. High blood pressure that continues more than three months after a pregnancy also is called chronic hypertension.
• Chronic hypertension with superimposed preeclampsia occurs in women diagnosed with chronic high blood pressure before pregnancy, who then develop worsening high blood pressure and protein in the urine or other health complications during pregnancy.

Risk factors

Conditions that are linked to a higher risk of preeclampsia include:

• Preeclampsia in a previous pregnancy
• Being pregnant with more than one baby
• Chronic high blood pressure (hypertension)
• Type 1 or type 2 diabetes before pregnancy
• Kidney disease
• Autoimmune disorders
• Use of in vitro fertilization

Conditions that are associated with a moderate risk of developing preeclampsia include:

• First pregnancy with current partner
• Obesity
• Family history of preeclampsia
• Maternal age of 35 or older
• Complications in a previous pregnancy
• More than 10 years since previous pregnancy

Other risk factors

Several studies have shown a greater risk of preeclampsia among Black women compared with other women. There's also some evidence of an increased risk among indigenous women in North America.

A growing body of evidence suggests that these differences in risk may not necessarily be based on biology. A greater risk may be related to inequities in access to prenatal care and health care in general, as well as social inequities and chronic stressors that affect health and well-being.

Lower income also is associated with a greater risk of preeclampsia likely because of access to health care and social factors affecting health.

For the purposes of making decisions about prevention strategies, a Black woman or a woman with a low income has a moderately increased risk of developing preeclampsia.

Complications

Complications of preeclampsia may include:

• Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn't get enough blood, the baby may receive inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction.
• Preterm birth. Preeclampsia may lead to an unplanned preterm birth — delivery before 37 weeks. Also, planned preterm birth is a primary treatment for preeclampsia. A baby born prematurely has increased risk of breathing and feeding difficulties, vision or hearing problems, developmental delays, and cerebral palsy. Treatments before preterm delivery may decrease some risks.
• Placental abruption. Preeclampsia increases your risk of placental abruption. With this condition, the placenta separates from the inner wall of the uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both the mother and baby.

• HELLP syndrome. HELLP stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count. This severe form of preeclampsia affects several organ systems. HELLP syndrome is life-threatening to the mother and baby, and it may cause lifelong health problems for the mother.

  Signs and symptoms include nausea and vomiting, headache, upper right belly pain, and a general feeling of illness or being unwell. Sometimes, it develops suddenly, even before high blood pressure is detected. It also may develop without any symptoms.

• Eclampsia. Eclampsia is the onset of seizures or coma with signs or symptoms of preeclampsia. It is very difficult to predict whether a patient with preeclampsia will develop eclampsia. Eclampsia can happen without any previously observed signs or symptoms of preeclampsia.

  Signs and symptoms that may appear before seizures include severe headaches, vision problems, mental confusion or altered behaviors. But, there are often no symptoms or warning signs. Eclampsia may occur before, during or after delivery.

• Other organ damage. Preeclampsia may result in damage to the kidneys, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on how severe the preeclampsia is.
• Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease. The risk is even greater if you've had preeclampsia more than once or you've had a preterm delivery.

Prevention

Medication

The best clinical evidence for prevention of preeclampsia is the use of low-dose aspirin. Your primary care provider may recommend taking an 81-milligram aspirin tablet daily after 12 weeks of pregnancy if you have one high-risk factor for preeclampsia or more than one moderate-risk factor.

It's important that you talk with your provider before taking any medications, vitamins or supplements to make sure it's safe for you.

Lifestyle and healthy choices

Before you become pregnant, especially if you've had preeclampsia before, it's a good idea to be as healthy as you can be. Talk to your provider about managing any conditions that increase the risk of preeclampsia.

By Mayo Clinic Staff

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Preeclampsia | March of Dimes

Preeclampsia is a  pregnancy complication characterized primarily by high blood pressure , edema,and protein spillage in the urine-- occurring frequently  after the 20th week of pregnancy or after giving birth.

Most pregnant women with preeclampsia have healthy babies. But if not treated, it can cause serious problems, like premature birth and even death.

If you’re at risk for preeclampsia, your provider may want you take low-dose aspirin to help prevent it.

If you have blurred vision, swelling in your hands and face or severe headaches or belly pain, call your provider right away.

You can have preeclampsia and not know it, so go to all of your prenatal care visits, even if you’re feeling fine.

What is preeclampsia?

Preeclampsia is a serious blood pressure condition that can happen after the 20th week of pregnancy or after giving birth (called postpartum preeclampsia). It’s when a woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy.

Preeclampsia is a serious health problem for women around the world. It affects 2 to 8 percent of pregnancies worldwide (2 to 8 in 100). In the United States, it’s the cause of 15 percent (about 3 in 20) of premature births. Premature birth is birth that happens too early, before 37 weeks of pregnancy.

Most women with preeclampsia have healthy babies.  But if not treated, it can cause severe health problems for you and your baby.

Can taking low-dose aspirin help reduce your risk for preeclampsia and premature birth?

For some women, yes. If your provider thinks you’re at risk for preeclampsia, he may want you to take low-dose aspirin to help prevent it. Low-dose aspirin also is called baby aspirin or 81 mg (milligrams) aspirin. Talk to your provider to see if treatment with low-dose aspirin is right for you.

You can buy low-dose aspirin over-the-counter, or your provider can give you a prescription for it. A prescription is an order for medicine from your provider. If your provider wants you to take low-dose aspirin to help prevent preeclampsia, take it exactly as she tells you to. Don’t take more or take it more often than your provider says.

If you’re at high risk for preeclampsia, your provider may want you to start taking low-dose aspirin after 12 weeks of pregnancy. Or your provider may ask you to take low-dose aspirin if you have diabetes or high blood pressure. If your provider asks you to take low-dose aspirin, take it as recommended.

According to the American College of Obstetricians and Gynecologists (also called ACOG), daily low-dose aspirin use in pregnancy has a low risk of serious complications and its use is considered safe.

Are you at risk for preeclampsia?

We don’t know for sure what causes preeclampsia, but there are some things that may make you more likely than other women to have it. These are called risk factors. If you have even one risk factor for preeclampsia, tell your provider. 

You’re at high risk for preeclampsia If:

• You’ve had preeclampsia in a previous pregnancy. The earlier in pregnancy you had preeclampsia, the higher your risk is to have it again. You’re also at higher risk if you had preeclampsia along with other pregnancy complications.
• You’re pregnant with multiples (twins, triplets or more).
• You have high blood pressure, diabetes, kidney disease or an autoimmune disease like lupus or antiphospholipid syndrome. Diabetes is when your body has too much sugar in the blood. This can damage organs, like blood vessels, nerves, eyes and kidneys. An autoimmune disease is a health condition that happens when antibodies (cells in the body that fight off infections) attack healthy tissue by mistake.

Other risk factors for preeclampsia:

• You’ve never had a baby before, or it’s been more than 10 years since you had a baby.
• You’re obese. Obese means being very overweight with a body mass index (also called BMI) of 30 or higher. BMI is a measure of body fat based on your height and weight. To find out your BMI, go to www.cdc.gov/bmi.
• You have a family history of preeclampsia. This means that other people in your family, like your sister or mother, have had it.
• You had complications in a previous pregnancy, like having a baby with low birthweight. Low birthweight is when your baby is born weighing less than 5 pounds, 8 ounces.
• You had fertility treatment called in vitro fertilization (also called IVF) to help you get pregnant. 
• You’re older than 35.
• You’re African-American. African-American women are at higher risk for preeclampsia than other women.
• You have low socioeconomic status (also called SES). SES is a combination of things, like a person’s education level, job and income (how much money you make). A person with low SES may have little education, may not have a job that pays well and may have little income or savings.

What are the signs and symptoms of preeclampsia?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

Signs and symptoms of preeclampsia include:

• Changes in vision, like blurriness, flashing lights, seeing spots or being sensitive to light
• Headache that doesn’t go away
• Nausea (feeling sick to your stomach), vomiting or dizziness
• Pain in the upper right belly area or in the shoulder
• Sudden weight gain (2 to 5 pounds in a week)
• Swelling in the legs, hands or face
• Trouble breathing

Many of these signs and symptoms are common discomforts of pregnancy. If you have even one sign or symptom, call your provider right away.

How can preeclampsia affect you and your baby?

Without treatment, preeclampsia can cause serious health problems for you and your baby, even death. You may have preeclampsia and not know it, so be sure to go to all your prenatal care checkups, even if you’re feeling fine. If you have any sign or symptom of preeclampsia, tell your provider.

Health problems for women who have preeclampsia include:

• Kidney, liver and brain damage
• Problems with how your blood clots. A blood clot is a mass or clump of blood that forms when blood changes from a liquid to a solid. Your body normally makes blood clots to stop bleeding after a scrape or cut. Problems with blood clots can cause serious bleeding problems.
• Eclampsia. This is a rare and life-threatening condition. It’s when a pregnant woman has seizures or a coma after preeclampsia. A coma is when you’re unconscious for a long period of time and can't respond to voices, sounds or activity.
• Stroke. This is when the blood supply to the brain is interrupted or reduced. Stroke can happen when a blood clot blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open.

Pregnancy complications from preeclampsia include:

• Premature birth. Even with treatment, you may need to give birth early to help prevent serious health problems for you and your baby.
• Placental abruption. This is when the placenta separates from the wall of the uterus (womb) before birth. It can separate partially or completely. If you have placental abruption, your baby may not get enough oxygen and nutrients. Vaginal bleeding is the most common symptom of placental abruption after 20 weeks of pregnancy. If you have vaginal bleeding during pregnancy, tell your health care provider right away.
• Intrauterine growth restriction (also called IUGR). This is when a baby has poor growth in the womb. It can happen when mom has high blood pressure that narrows the blood vessels in the uterus and placenta. The placenta grows in the uterus and supplies your baby with food and oxygen through the umbilical cord. If your baby doesn’t get enough oxygen and nutrients in the womb, he may have IUGR.
• Low birthweight

Having preeclampsia increases your risk for postpartum hemorrhage (also called PPH). PPH is heavy bleeding after giving birth. It’s a rare condition, but if not treated, it can lead to shock and death. Shock is when your body’s organs don’t get enough blood flow. 

Having preeclampsia increases your risk for heart disease, diabetes and kidney disease later in life/

How is preeclampsia diagnosed?

To diagnose preeclampsia, your provider measures your blood pressure and tests your urine for protein at every prenatal visit. Additional lab work evaluating your blood count, clotting factors, liver and kidney function are also assessed.

Your provider may check your baby’s health with:

• Ultrasound. This is a prenatal test that uses sound waves and a computer screen to make a picture of your baby in the womb. Ultrasound checks that your baby is growing at a normal rate. It also lets your provider look at the placenta and the amount of fluid around your baby to make sure your pregnancy is healthy.
• Nonstress test. This test checks your baby’s heart rate.
• Biophysical profile. This test combines the nonstress test with an ultrasound.
• Doppler analysis . This is a sonographic test to evaluate the blood flow through the baby’s umbilical cord-- it can provide information as to how blood flow -- which carries oxygen- is getting to your baby

Treatment depends on how severe your preeclampsia is and how far along you are in your pregnancy. Even if you have mild preeclampsia, you need treatment to make sure it doesn’t get worse.

How is mild preeclampsia treated?

Most women with mild preeclampsia are delivered by 37 weeks of pregnancy . If you have mild preeclampsia before 37 weeks:

• Your provider checks your blood pressure and urine regularly. She may want you to stay in the hospital to monitor you closely. If you’re not in the hospital, your provider may want you to have checkups once or twice a week. She also may ask you to take your blood pressure at home.
• Your provider may ask you to do kick counts to track how often your baby moves. There are two ways to do kick counts: Every day, time how long it takes for your baby to move ten times. If it takes longer than 2 hours, tell your provider. Or three times a week, track the number of times your baby moves in 1 hour. If the number changes, tell your provider.
• If you’re at least 37 weeks pregnant and your condition is stable, your provider may recommend that you have your baby early. This may be safer for you and your baby than staying pregnant. Your provider may give you medicine or break your water (amniotic sac) to make labor start. This is called inducing labor.

How is severe preeclampsia treated?

If you have severe preeclampsia, you most likely stay in the hospital so your provider can closely monitor you and your baby. Your provider may treat you with medicines called antenatal corticosteroids (also called ACS). These medicines help speed up your baby’s lung development. You also may get medicine to control your blood pressure and medicine to prevent seizures (called magnesium sulfate).

If your condition gets worse, it may be safer for you and your baby to give birth early. Most babies of moms with severe preeclampsia before 34 weeks of pregnancy do better in the hospital than by staying in the womb. If you’re at least 34 weeks pregnant, your provider may recommend that you have your baby as soon as your condition is stable. Your provider may induce your labor, or you may have a c-section. If you’re not yet 34 weeks pregnant but you and your baby are stable, you may be able to wait to have your baby.

If you have severe preeclampsia and HELLP syndrome, you almost always need to give birth early. HELLP syndrome is a rare but life-threatening liver disorder. About 2 in 10 women (20 percent) with severe preeclampsia develop HELLP syndrome. You may need medicine to control your blood pressure and prevent seizures. Some women may need blood transfusions. A blood transfusion means you have new blood put into your body.

If you have preeclampsia, can you have a vaginal birth?

Yes. If you have preeclampsia, a vaginal birth may be better than a cesarean birth (also called c-section). A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. With vaginal birth, there's no stress from surgery. For most women with preeclampsia, it’s safe have an epidural to  manage labor pain as long as your blood clots normally. An epidural is pain medicine you get through a tube in your lower back that helps numb your lower body during labor. It's the most common kind of pain relief during labor.

What is postpartum preeclampsia?

Postpartum preeclampsia is a rare condition. It’s when you have preeclampsia after you’ve given birth. It most often happens within 48 hours (2 days) of having a baby, but it can develop up to 6 weeks after a baby’s birth. It’s just as dangerous as preeclampsia during pregnancy and needs immediate treatment. If not treated, it can cause life-threatening problems, including death.

Signs and symptoms of postpartum preeclampsia are like those of preeclampsia. It can be hard for you to know if you have signs and symptoms after pregnancy because you’re focused on caring for your baby. If you do have signs or symptoms, tell your provider right away.

We don’t know exactly what causes postpartum preeclampsia, but these may be possible risk factors:

• You had gestational hypertension or preeclampsia during pregnancy. Gestational hypertension is high blood pressure that starts after 20 weeks of pregnancy and goes away after you give birth.
• You’re obese.
• You had a c-section.

Complications from postpartum preeclampsia include these life-threatening conditions:

• HELLP syndrome
• Postpartum eclampsia (seizures). This can cause permanent damage to our brain, liver and kidneys. It also can cause coma.
• Pulmonary edema. This is when fluid fills the lungs.
• Stroke
• Thromboembolism. This is when a blood clot travels from another part of the body and blocks a blood vessel.

Your provider uses blood and urine tests to diagnose postpartum preeclampsia. Treatment can include magnesium sulfate to prevent seizures and medicine to help lower your blood pressure. Medicine to prevent seizures also is called anticonvulsive medicine. If you’re breastfeeding, talk to your provider to make sure these medicines are safe for your baby.

Reviewed October 2020

pre-eclampsia

Every mother-to-be wants her pregnancy to be a time of joyful anticipation. But the fear of preeclampsia can darken the joy.

What is preeclampsia?

Pre-eclampsia is a potentially life-threatening disease that occurs during pregnancy and affects multiple organ systems and is characterized by high maternal blood pressure and protein in the urine, or in the absence of the latter, dysfunction of other organ systems. This can affect both you and your unborn child. If the risk of preeclampsia is known in advance, it can be prevented. nine0003

How common is preeclampsia?

Most women have a normal pregnancy. At the same time, pre-eclampsia is a relatively common disease during pregnancy, which occurs in two out of a hundred women in Estonia.

When does preeclampsia occur?

Pre-eclampsia occurs after the 20th week of pregnancy or up to six weeks after delivery. Most often, preeclampsia occurs between the 32nd and 36th weeks of pregnancy. The earlier in pregnancy the disease occurs, the more severe its course, and the more dangerous it is for the mother and child. nine0003

What causes preeclampsia?

The exact causes of preeclampsia are unknown, but it is believed that they lie in the violation of the attachment of the developing placenta to the uterus, as a result of which there is no reliable connection between the circulatory systems of the mother and child. At the same time, a rapidly developing fetus requires oxygen and nutrients from the mother's circulatory system for its growth. If oxygen deficiency occurs in the developing placenta, toxic substances are released into the mother's circulatory system, which damage the lining of the mother's blood vessels. This is how a systemic lesion of the internal organs of the mother is formed. In order to save the lives of mother and child, the child must be born. If this happens at a very early stage of pregnancy, the baby is not yet ready for extrauterine life. nine0003

How will this affect me?

Mostly there is a mild form of the disease that occurs at the end of pregnancy and the prognosis for which is good. But sometimes pre-eclampsia can get worse very quickly and begin to threaten the lives of the mother and child. Preeclampsia also has a long-term effect on a woman's health, as it doubles the incidence of cardiovascular disease in the future. Most women with preeclampsia are hospitalized, and often their children have to be born prematurely. If the health of the mother or child is at risk, labor is induced or a caesarean section is performed. nine0003

How will this affect my child?

Most children remain healthy even when their mothers have severe preeclampsia. But sometimes preeclampsia can threaten the life and health of both the fetus and the newborn. Maternal preeclampsia doubles the risk of a surviving child suffering from cerebral palsy, that is, brain damage that results in delayed physical and sometimes mental development. In addition, surviving children are more likely to develop cardiovascular disease, obesity and diabetes in the future. In preeclampsia, there is not enough oxygen and nutrients for the growth of the fetus, and intrauterine growth retardation occurs. Since the only treatment for preeclampsia is childbirth, sometimes the pregnancy has to be terminated. Until the 34th week of pregnancy, the lungs of the fetus have not yet fully developed, and steroid injections are given to the pregnant woman to stimulate them. nine0003

How to recognize preeclampsia?

Unfortunately, in most women, the symptoms of the disease appear only at an advanced stage.

• Chronic headache not responding to painkillers
• Severe nausea and vomiting
• Visual disturbances, tinnitus
• Pain in the right hypochondrium
• Feeling short of breath, shortness of breath
• Infrequent urge to urinate (less than 500 ml per day)
• Edema of hands, face and eyelids
• Rapid weight gain (more than 1 kg per week)

If you experience any of the above symptoms, contact your obstetrician, gynecologist or hospital doctor on call.

Am I at risk?

Although all pregnant women can develop preeclampsia, some women are more at risk than others.

You are more at risk if

• this is your first pregnancy;
• you had preeclampsia during a previous pregnancy;
• your sister or mother had preeclampsia;
• Your body mass index is 35 kg/m ² or more;
• You are at least 40 years old;
• the time between births was more than 10 years;
• You are expecting twins;
• You have become pregnant in vitro; nine0084
• you have any medical problem, such as hypertension, kidney problems, lupus, diabetes;
• You developed diabetes during this pregnancy.

At what stage of pregnancy is screening performed?

Pre-eclampsia screening can be performed in all three trimesters.

• First trimester, 11–13 weeks ⁺⁶ weeks (as part of the OSCAR test)
• Second trimester, 19-21 weeks ⁺⁶ weeks (as part of fetal anatomy screening)
• Third trimester, 34-36 weeks (as part of fetal growth and condition study)

A three-stage screening test for preeclampsia can prevent it from occurring or move it to a later stage of pregnancy.

How reliable is screening for preeclampsia? nine0016