What to expect when you're expecting (208 page)

Rapid heartbeat

Scant urine output

Abnormal kidney function

Exaggerated reflex reactions

The Reasons Behind Preeclampsia

No one knows for sure what causes preeclampsia, though there are a number of theories:

A genetic link. Researchers hypothesize that the genetic makeup of the fetus could be one of the factors that predisposes a pregnancy to preeclampsia. So, if your mother or your spouse’s mother had preeclampsia during their pregnancies with either of you, you are somewhat more likely to have preeclampsia during your pregnancies.

A blood vessel defect. It has been suggested that this defect causes the blood vessels in some women to constrict during pregnancy instead of widen (as usually happens). As a result of this vessel defect, theorize researchers, there is a drop in the blood supply to organs like the kidney and liver, leading to preeclampsia. The fact that women who experience preeclampsia during pregnancy are at an increased risk later in life of having some sort of cardiovascular condition also seems to indicate that the condition may be the result of a predisposition in some women to high blood pressure.

Gum disease. Pregnant women with severe gum disease are more than twice as likely to also have preeclampsia compared to women with healthy gums. Experts theorize that the infection causing the periodontal disease may travel to the placenta or produce chemicals that can cause preeclampsia. Still, it is not known if periodontal disease causes preeclampsia or if it is just associated with it.

An immune response to a foreign intruder: the baby. This theory implies that the woman’s body becomes “allergic” to the baby and placenta. This “allergy” causes a reaction in the mother’s body that can damage her blood and blood vessels. The more similar the father’s and mother’s genetic markers, the more likely this immune response will occur.

What can you and your practitioner do?
Regular prenatal care is the best way to catch preeclampsia in its early stages (your practitioner might be tipped off by protein in your urine and a rise in your blood pressure, or the symptoms just listed). Being alert to any such symptoms (and alerting your practitioner if you notice them) also helps, particularly if you had a history of hypertension before pregnancy.

If you’re diagnosed with preeclampsia, your treatment will probably include bed rest at home and careful blood pressure and fetal monitoring (though more pronounced cases may require hospital bed rest). With severe preeclampsia, the treatment is usually more aggressive and includes delivery within three days of diagnosis. Intravenous magnesium sulfate is begun promptly because it almost always prevents progression to eclampsia.

Though treatments are available to control preeclampsia for short periods of time, there is no cure except for delivery of your baby, which will likely be recommended as soon as the baby is physically mature enough or after medications are given to speed lung maturity. The good news is that 97 percent of women with preeclampsia recover completely, with a speedy return to normal blood pressure, after delivery.

On the research horizon: Scientists are developing simple blood and urine tests that can predict which moms-to-be are likely to develop this complication. They’ve found that women who eventually develop preeclampsia show high levels of a substance called soluble FH-1 in the blood and urine. Another substance called endoglin may also prove to predict the condition. Ideally, the research will lead to much earlier detection of preeclampsia.

Can it be prevented?
Research has suggested that for women at risk for preeclampsia, aspirin or other anticlotting drugs during pregnancy may reduce the risk, though the benefits of this medically induced therapy need to be weighed against its theoretical risks. Some research has suggested that good nutrition, which ensures adequate intakes of antioxidants, magnesium, vitamins (especially D), and minerals, may reduce the risk of preeclampsia, as may proper dental care.

You’ll Want to Know …

Fortunately, in women who are receiving regular medical care, preeclampsia is almost invariably caught early on and managed successfully. With appropriate and prompt medical care, a woman with preeclampsia near term has virtually the same excellent chance of having a positive pregnancy outcome as a woman with normal blood pressure.

What is it?
HELLP syndrome is a combination of conditions that can affect a pregnant woman, either by itself or in conjunction with preeclampsia, almost always in the last trimester. The acronym stands for hemolysis (H), in which red blood cells are destroyed too soon, causing a low red-cell count; elevated liver enzymes (EL), which indicates that the liver is functioning poorly and is unable to process toxins in the body efficiently; and low platelet count (LP), which makes it difficult for the blood to form clots.

When HELLP develops, it can threaten both a mother’s life and that of her baby. Women who aren’t diagnosed and treated quickly run about a 1 in 4 chance of suffering serious complications, primarily in the form of extensive liver damage or stroke.

How common is it?
HELLP syndrome occurs in fewer than 1 in 10 preeclamptic or eclamptic pregnancies and fewer than 1 in 500 pregnancies.

Women who develop preeclampsia or eclampsia are at risk, as are women who have had HELLP in a previous pregnancy.

What are the signs and symptoms?
The symptoms of HELLP are very vague, consisting of (in the third trimester):

Nausea