What do 19 Kids & Counting’s Michelle Duggar, Keeping Up with the Kardashians’ Kim Kardashian, former First Lady Laura Bush, and singer Mariah Carey all have in common? Each of these women experienced preeclampsia during one or more pregnancies. Chances are good that you’ve heard of preeclampsia, at least enough to know it’s a pregnancy complication that can have serious consequences for moms and/or babies. Maybe you even know that preeclampsia is the number one cause of maternal death among black women, who die at dramatically higher rates compared to their white and Hispanic counterparts (whose own rates of maternal death are already unacceptably high) [1]. But what is preeclampsia, and why is it a problem? Who gets it, and is it preventable?
What is preeclampsia?
According to the Preeclampsia Foundation, preeclampsia, also known as toxemia of pregnancy, “is persistent high blood pressure that develops during pregnancy or the postpartum period and is often associated with high levels of protein in the urine OR the new development of decreased blood platelets, trouble with the kidneys or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances.”
Diagnosis of preeclampsia
While a diagnosis of preeclampsia used to require detection of protein in the urine (proteinuria, which your healthcare provider checks for at every prenatal visit when they put the dipstick in your urine sample), the American College of Obstetricians and Gynecologists now recognizes that women can have signs of organ damage, such as kidney or liver injury or failure, even without proteinuria. What’s more, proteinuria doesn’t tell you how severe your preeclampsia is.
Preeclampsia also used to be described as mild preeclampsia or severe preeclampsia. It’s now diagnosed as “preeclampsia without severe features,” “preeclampsia with severe features” (including signs of HELLP syndrome, described here), or “eclampsia” (meaning that seizures and/or coma are occurring), based on your blood pressure numbers and any symptoms you may be experiencing.
Typically, preeclampsia is diagnosed after the 20th week of pregnancy, particularly in the last trimester.
Preeclampsia symptoms
Preeclampsia symptoms include “headaches, abdominal pain, shortness of breath or burning behind the sternum, nausea and vomiting, confusion, heightened state of anxiety, and/or visual disturbances such as oversensitivity to light, blurred vision, or seeing flashing spots or auras.”
How often does preeclampsia occur?
As Natural Womanhood has previously reported, preeclampsia impacts 3-6% of all pregnancies (estimates vary, Cleveland Clinic suggests up to 8%), but women who utilize assisted reproductive technologies (ART) like in vitro fertilization (IVF) with programmed-cycle frozen embryo transfer (FET) have double or triple the rates of preeclampsia vs. women who conceived via modified-natural or natural IVF cycles [2][3][4]. Additionally, women who undergo IVF with donor sperm and/or eggs have up to seven times higher rates compared to women who conceived naturally [5].
Preeclampsia causes
Researchers don’t know exactly what causes preeclampsia, but it’s clear that there’s always a problem with the way the placenta (baby’s nutritional and oxygen lifeline) develops, and that issues with the placenta appear to dis-regulate the mom’s blood pressure consequently. There’s also some evidence that maternal immune system issues and inflammation play a role in developing preeclampsia by causing improper implantation of the placenta in the uterine wall during the first trimester [6][7].
Who gets preeclampsia?
There are many risk factors for preeclampsia, according to the Mayo Clinic, Cleveland Clinic, and the Preeclampsia Foundation, including being a first-time mom, being pregnant for the first time, being under 20 years old or over age 35, expecting multiple babies (more likely to occur in women who have undergone ART procedures), being African American, having had preeclampsia in a previous pregnancy (~20% chance of developing preeclampsia again, according to Harvard Medical School), undergoing IVF, history of preeclampsia in a close family member like a sister or mom, personal history of high blood pressure and/or diabetes, obesity, and some autoimmune conditions like lupus or rheumatoid arthritis.
Why is preeclampsia a problem?
Short-term problems
For mom, preeclampsia can lead to eclampsia (full-blown seizures or coma), HELLP syndrome (a life-threatening complication), liver, lung, heart, kidney, or eye damage, and/or stroke. For baby, preeclampsia can lead to intrauterine growth restriction (IUGR), leading to low birth weight (meaning that your baby doesn’t grow properly due to insufficient oxygen and nutrients because of placental problems), and/or preterm birth. Preeclampsia is also the leading cause of preterm birth (more on the risks of preterm birth below). Placental abruption, the premature separation of the placenta from the uterine wall before labor starts, can be fatal for you and/or your baby due to the hemorrhaging it causes (i.e., excessive, uncontrolled bleeding).
Long-term problems
A recently released study found that children born to mothers who had preeclampsia during their pregnancy or postpartum period were more likely to develop heart disease and/or suffer a stroke down the road [8]. Mothers who have had preeclampsia are themselves at increased risk for developing heart disease and/or high blood pressure later on.
How do you treat preeclampsia?
The number one way to treat preeclampsia is to deliver the baby. If you are not yet full-term, risks of continuing the pregnancy are weighed against the risks of delivering baby early, since preterm birth can lead to heart, lung, and brain issues for the baby, as well as trouble regulating temperature and blood sugar, anemia, jaundice, and infection as well as long-term difficulties like cerebral palsy and vision and hearing issues, and increased risk of sudden infant death syndrome (SIDS). If doctors are trying to buy time for your baby to grow, they will give you medications to control your blood pressure, steroids to mature your baby’s lungs, and potentially antiseizure medication to decrease your likelihood of seizures.
How do you prevent preeclampsia?
Semen?
Potentially, regular sex with a long term male partner can play a role in preventing preeclampsia. Sound crazy? As Natural Womanhood’s Cassie Moriarty previously covered, “research has found that seminal fluid from a recurring male partner might play a crucial role in building up immunological tolerance in a woman—a tolerance that is necessary for carrying a healthy pregnancy.” Importantly, “we do know that semen contains protective and immune-tolerance inducing substances, such as antimicrobial peptides (AMPs)” and transforming growth factor B, which all impact mom’s immune system and play a role in her tolerance of her genetically “foreign” baby.
Moriarty writes, “there is reason to believe that the link between lower incidence of preeclampsia in women who carry pregnancies with partners to whose semen they have been repeatedly exposed, is due to her body’s ‘familiarity’ to the proteins and microbes found in a specific partner’s semen” and potentially contributes to “improved immune tolerance during a future pregnancy with that partner.”
Harvard Health Publishing’s article on preeclampsia supports the semen theory, noting that risk factors for developing preeclampsia include “Having a male partner with whom you were sexually active for only a short length of time prior to becoming pregnant (this may be due to a change in the way a woman’s immune system reacts to genes from the father after repeated exposure to his semen).”
Nutrition
The late Marilyn Shannon, author of Fertility, Cycles, and Nutrition, was a committed advocate of following the Brewer Diet (best described as a nutrition guide rather than a diet plan, since weight loss is not a goal) to prevent preeclampsia. A key component of the Brewer Diet is high protein intake, significantly higher than the recommended daily allowance (RDA). Registered dietitian Lily Nichols, author of Real Food in Pregnancy (summarized here) notes that “the RDA is set at a bare minimum level and it’s likely that optimal protein intake is much higher than the RDA.” In early pregnancy, moms may need around 80 grams of protein per day, and by late pregnancy, moms may actually need closer to 100 grams of protein per day.
Nichols observes, “sufficient protein intake is needed to support the many vascular changes that occur in pregnancy” and since “your body is tasked with handling about 50% increased blood volume and your entire vascular system has to adapt as a result,” then “sufficient protein intake, especially from amino acids found in collagen-rich foods, is key.” (Vascular, of course, means “blood vessel;” recall from above that preeclampsia is characterized by blood vessel problems in the placenta, that in turn cause blood pressure problems for mom.)
Recent research supports the idea that nutrition plays a not insignificant role in development of preeclampsia. Science Daily reported that a study published in peer-reviewed medical journal JAMA Network Open found reduced rates of preeclampsia in women who followed a Mediterranean-style diet, which prioritizes consumption of healthy fats, fruits, veggies, and whole grains [9]. Corresponding study author Dr. Natalie Bello commented, “This multicenter, population-based study validates that a healthier eating pattern is associated with a lower risk of adverse pregnancy outcomes, the most exciting being a 28% lower risk for preeclampsia.”
Medication
There is no preeclampsia prevention-specific drug one can take, but if you’re deemed to be at high-risk for developing preeclampsia, taking a baby aspirin (81 mg) can decrease your risk by about 15%, according to Harvard Medical School and the Mayo Clinic.
The best medicine is prevention
When you know your personal risk factors for, and the symptoms of, preeclampsia, you know what to watch out for. If you should experience any concerning symptoms, be sure to bring them to your provider’s attention (and read this for tips on what to do if your provider doesn’t take your concerns seriously). Since ‘an ounce of prevention is worth a pound of cure,’ be sure to prioritize optimizing your pregnancy diet, attending all your prenatal checkups (when preeclampsia symptoms are most often detected), managing your stress with prayer, meditation, etc., and moving your body in some sort of gentle exercise each day.
References:
[1] MacDorman MF, Thoma M, Declercq E, and Howell EA. Racial and ethnic disparities in maternal mortality in the United States using enhanced vital records, 2016-2017. American Journal of Public Health DOI: 10.2105/AJPH.2021.306375 (2021). [2] Ananth C, Keyes K, Wapner R. “Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis.” BMJ, (2013);347:f6564. doi: https://doi.org/10.1136/bmj.f6564 [3] European Society of Human Reproduction and Embryology. “Embryo freezing for IVF appears linked to blood pressure problems in pregnancy.” ScienceDaily. ScienceDaily, 30 June 2021. <www.sciencedaily.com/releases/2021/06/210630115355.htm>. [4] von Versen-Höynck F, et al. “Increased Preeclampsia Risk and Reduced Aortic Compliance With In Vitro Fertilization Cycles in the Absence of a Corpus Luteum.” Hypertension, vol. 73, issue 3 (2019). Pp: 640-49. https://doi.org/10.1161/HYPERTENSIONAHA.118.12043 [5] Masoudian P, et al. “Oocyte donation pregnancies and the risk of preeclampsia or gestational hypertension: a systematic review and metaanalysis.” Am J Obstet Gynecol. (2016) vol 214, no. 3: pp. 328-39. doi: 10.1016/j.ajog.2015.11.020. Epub 2015 Nov 25. PMID: 26627731. [6] Medical College of Georgia at Augusta University. “Mother’s immune cells appear to exacerbate complications of preeclampsia.” ScienceDaily. ScienceDaily, 19 July 2022. <www.sciencedaily.com/releases/2022/07/220719091130.htm>. [7] Xia Y, Kellems RE. “Is preeclampsia an autoimmune disease?” Clin Immunol, vol. 133, no.1 (2009):pp. 1-12. doi: 10.1016/j.clim.2009.05.004. Epub 2009 Jun 5. PMID: 19501024; PMCID: PMC3380609. [8] Yang F, et al. “Association of Maternal Preeclampsia With Offspring Risks of Ischemic Heart Disease and Stroke in Nordic Countries.” JAMA Netw Open, vol. 5, no. 11 (2022): e2242064. doi:10.1001/jamanetworkopen.2022.42064 [9] Nour Makarem, et al. “Association of a Mediterranean Diet Pattern With Adverse Pregnancy Outcomes Among US Women.” JAMA Network Open, 2022; 5 (12): e2248165 DOI: 10.1001/jamanetworkopen.2022.48165Additional Reading:
