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Pre-eclampsia

Updated: Sep 16

A disorder in which a pregnant person's blood pressure increases, or their pee contains too much protein. This can be very dangerous.


This article is pending medical review.

Contributors

Written by Julian Zeegers

Reviewed by Britte Megens and Sophie Oppelt

Edited by Juliëtte Gossens

 

A common parental complication is pre-eclampsia. It affects about 3-5% of

all pregnancies (1). Early-onset pre-eclampsia, which occurs at less than 34 weeks' gestation, is less common

pregnant person
© Shvets Productions

but poses a greater risk to both the carrier and baby compared to late-onset pre-eclampsia. Late-onset pre-eclampsia occurs when the disease starts at or after 34 weeks of gestation.


Below, we describe how pre-eclampsia is thought to develop, what the consequences for parent and baby are, and how it can be treated.


What we're covering


Development of pre-eclampsia

Consequences

Treatment



 

Development of Pre-eclampsia


Exactly how pre-eclampsia comes about is not entirely clear yet. However, scientists have recognized several different factors that may be at play. One characteristic of early-onset pre-eclampsia has been found to be the abnormal remodeling of spiral arteries (1). Spiral arteries are small arteries with a high resistance and low blood capacity that temporarily supply blood to the uterus during certain days of the menstrual cycle. During early pregnancy, special cells called the extravillous trophoblast cells invade the smooth muscle cells as well as the inner cell lining of the spiral arteries. By this complicated mechanism, the spiral arteries are remodeled to become low resistance and high capacity blood vessels - the opposite of what they are outside of pregnancy - in order to increase blood flow towards the fetus. If this occurs correctly, the developing fetus will obtain sufficient oxygen and nutrients to develop further. During early-onset pre-eclampsia, however, this rather difficult spiral artery remodeling process is impaired, resulting in growth restriction of the fetus. Due to this reason, early-onset pre-eclampsia is oftentimes more harmful than late-onset pre-eclampsia (2).


Consequences and Burden of Pre-eclampsia for Carrier and Baby


Immediate consequences of pre-eclampsia for carriers can include acute kidney or liver failure, pulmonary edema (fluid accumulation in the lungs), and bleeding events in the brain, among others. In addition to immediate consequences, pre-eclampsia (especially the early-onset type) has been associated with many other diseases later on in life. People who have suffered from pre-eclampsia have a greater risk of developing cardiovascular diseases later in life. Also, the onset of hypertension (high blood pressure) generally occurs sooner than in those who have had healthy pregnancies. Moreover, greater risks of developing thrombosis (obstruction of a blood vessel) and type II diabetes have been identified.


For the baby, a primary consequence of pre-eclampsia is fetal growth restriction, with a larger impact in early-onset pre-eclampsia compared to late-onset pre-eclampsia. Another important consequence for the baby includes fetal death, which occurs in around 5.2 per 1,000 pregnancies in carriers with pre-eclampsia compared to some 3.6 per 1,000 pregnancies for uncomplicated pregnancies. Furthermore, preterm birth is common for pre-eclamptic pregnancies, which increases mortality and disease risk. This includes a higher risk of respiratory distress syndrome and neurodevelopmental disorders, among others (1).


In addition to the physical burden pregnant people diagnosed with pre-eclampsia experience, there can be a major mental aspect as well: anxiety. Previous studies have shown that pre-eclamptic parents experience significantly more anxiety compared to healthy controls. Accordingly, obstetricians should be aware of this issue and recommend mental health care in addition to paying attention to the physical symptoms. Midwives are oftentimes the direct contact for pregnant people. They are supposed to be attentive to signs of mental health problems and, if necessary, refer them to treatment facilities. Several treatments that have shown to significantly reduce anxiety include cognitive-behavioural therapy, health education, and relaxation training (3). If you have experienced pre-eclampsia and you have been feeling anxious, ask your obstetrician, family medicine doctor, or general practitioner what your options for mental health care are. You are not alone!


Treatment of pre-eclampsia


Currently, the best treatment is to finalize the pregnancy and therefore deliver the placenta and baby timely. One important aspect, however, is the timing of delivery. When pre-eclampsia is diagnosed beyond 37 weeks (late-onset), it is oftentimes best to immediately deliver the baby to prevent complications for the prospective parent. However, if pre-eclampsia is diagnosed at an early stage of development, delivery of a healthy baby is more prone to fail due to an incomplete development of the lungs. This is a major dilemma for many prospective parents who go through pre-eclampsia, and for the doctors who are treating them. Prolonging the pregnancy allows the baby to develop more despite the oxygen- and nutrient-deprived circumstances in the uterus. However, the carrier will be at greater risk for diseases if the pregnancy is prolonged further (1).


Every pregnancy is different, and what is best in one case may not be what is best in another. Talk to your doctor and voice any concerns you may have, because your participation in your care is vital!

 

References

  1. Bokslag A, van Weissenbruch M, Mol BW, de Groot CJ. Preeclampsia; short and long-term consequences for mother and neonate. Early Hum Dev. 2016;102:47-50. DOI: 10.1016/j.earlhumdev.2016.09.007

  2. Albrecht ED, Pepe GJ. Regulation of Uterine Spiral Artery Remodeling: a Review. Reprod Sci. 2020;27(10):1932-42. DOI: 10.1007/s43032-020-00212-8

  3. Abazarnejad T, Ahmadi A, Nouhi E, Mirzaee M, Atghai M. Effectiveness of psycho-educational counseling on anxiety in preeclampsia. Trends Psychiatry Psychother. 2019;41(3):276-82. DOI: 10.1590/2237-6089-2017-0134


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