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Preeclampsia


Preeclampsia is a dangerous combination of high blood pressure, fluid retention, and high levels of protein in the urine of women after their 20th week of pregnancy. Sometimes called toxemia or pregnancy-induced hypertension, it affects about one in 20 pregnant women and their unborn children. If not treated, preeclampsia can worsen into eclampsia, a potentially fatal condition that involves seizures and coma. The cure for preeclampsia is delivery of the baby by induced labor or cesarean section. Treatments seek to control the condition until the baby can be delivered safely.


Signs and Symptoms

Preeclampsia:

Eclampsia:


What Causes It?

Nobody knows what causes preeclampsia. However, certain women have a higher risk of developing it in pregnancy. They include women in their first pregnancy; teenagers, and women over 40 who are pregnant. Others at high risk are women carrying multiple fetuses, women who had preeclampsia with a previous pregnancy, women who are obese, and women who have had high blood pressure, diabetes, or kidney disease.


What to Expect at Your Provider's Office

You may or may not experience any symptoms of preeclampsia. See your doctor immediately if you do. Preeclampsia is often found during a routine pre-natal checkup that includes a urine test and blood pressure check. As you get closer to your delivery date, your doctor may do a non-stress test that checks your baby's heart rate to make sure your baby is getting enough oxygen.


Treatment Options

If you have a mild case of preeclampsia, your health care provider may recommend that you rest in bed. You should lie on your left side, to prevent the weight of your uterus from pressing against important blood vessels. You should drink a lot of water to help you urinate and get rid of excess fluids. Your health care provider will want to monitor your blood pressure and urine every couple of days. The goal is to manage the condition in order to reach 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, and your health care provider may admit you to the hospital, where you will receive drugs to induce labor or a cesarean section.

Your practitioner may prescribe the following drugs, which are given intravenously.

In severe cases, medications to lower your blood pressure may be prescribed. Corticosteroids are sometimes given to help the baby's lungs develop faster in advance of an early delivery.

Complementary and Alternative Therapies

If you have preeclampsia, you should be under the care of an obstetrician. Complementary and alternative therapies can be used with medical treatment. Some of the more common ones are described below.

Nutrition and Supplements

Some supplements appear to help prevent preeclampsia but do not help once you have the condition. Others, intended to lessen the severity once you have the condition, show mixed results in scientific studies. Note: None of these supplements should be taken during pregnancy without a doctor's supervision.

Preventing preeclampsia: If you are deficient in calcium or at risk for hypertension, some studies show 2,000 mg per day to lower the risk of developing preeclampsia. It does not seem to reduce risk of developing the condition in healthy women, and not all studies show the same result.

Treatments for preeclampsia: These treatments require close medical supervision:

Herbs

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

Note: These herbs should be used during pregnancy only under a doctor's supervision. Do not self-treat.

Herbs that can be used to treat mild hypertension in pregnancy include the following:

Use equal parts of each in a tincture, 20 drops three to four times a day.

Acupuncture

May be helpful in lowering blood pressure and generally increasing circulation.


Following Up

Your health care provider will monitor you carefully for the first few days after you have delivered your child. Your health care provider may keep you in the hospital for several days to weeks after you have delivered your baby, 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.


Special Considerations

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

The symptoms of preeclampsia can appear gradually and suddenly get worse. See your health care provider regularly for checkups during your pregnancy, which you should do regardless of your risk of preeclampsia. Your health care provider can recognize the early signs of preeclampsia and get treatment for you immediately.


Supporting Research

Berkow R, ed. Merck Manual of Diagnosis and Therapy. 16th edition. Rahway, NJ: The Merck Publishing Group; 1992.

Berkow R, Beers MH, Fletcher AJ, eds. Merck Manual, Home Edition. Rahway, NJ: Merck & Co; 1997.

Bucher HC, Guyatt GH, Cook RJ, et al. Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia; a meta-analysis of randomized controlled trials. JAMA . 1996;275:1113-7.

Chappell LC, Seed PT, Briley AL, et al. Effects of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial. Lancet . 1999;354:810-6.

Gulmezoglu AM, Hofmeyr GJ, Oosthuisen MM. Antioxidants in the treatment of severe pre-eclampsia: an explanatory randomised controlled trial. Br J Obstet Gynaecol . 1997;104:689-96.

Klonoff-Cohen HS, Cross JL, Pieper CF. Job stress and preeclampsia. Epidemiol. 1996;7:245-249.

Larson DE, ed. Mayo Clinic Family Health Book. 2nd ed. New York, NY: William Morrow and Company; 1996.

Leeda M, Riyazi N, de Vries JI, et al. Effects of folic acid and vitamin B6 supplementation on women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction. Am J Obstet Gynecol. 1998;179:135-9.

Ritchie LD, King JC. Dietary calcium and pregnancy-induced hypertension: is there a relation? Am J Clin Nutr. 2000;71(5 Suppl):1371-4S [review].

Scalzo R. Naturopathic Handbook of Herbal Formulas. Durango, Colo: 2nd ed. Kivaki Press; 1994.

Staff AC, Berge L, Haugen G, et al. Dietary supplementation with L-arginine or placebo in women with pre-eclampsia. Acta Obstet Gynecol Scand . 2004;83:103-7.


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