Preeclampsia is a common condition affecting women in pregnancy. Occurring after 20 weeks of pregnancy, it is associated with new-onset high blood pressure (hypertension) and protein in the urine (proteinuria).
Additional signs include low levels of platelets, which help the blood clot, and abnormal kidney or liver function tests.
As the name suggests, preeclampsia is a precursor (or prodromal) syndrome for eclampsia: an obstetric medical emergency involving violent seizures and the potential for maternal mortality, especially in developing countries.
Almost 200 years since it was first documented, treatment for preeclampsia all but guarantees a safe, healthy delivery. Through careful monitoring and medications, doctors ensure mothers and babies complete labor safely, taking a proactive approach to the timing of the delivery.
Not all women are so lucky. In Sub-Saharan Africa, preeclampsia is one of the leading causes of poor perinatal outcomes, leading to intrauterine death, low birth weight, preterm delivery, and more. In this article, we’ll cover the key aspects of preeclampsia and how it affects the world’s most vulnerable mothers.
What Causes Preeclampsia?
Preeclampsia is a complex disorder usually emerging after the 20th week of pregnancy, presenting with high blood pressure and signs of damage to organ systems, often the kidneys.
While the exact causes remain unknown, several factors may contribute:
- Placental Issues: Anomalies in the development and function of the placenta can restrict blood flow, triggering preeclampsia
- Genetics: A family history of the condition increases risk
- Immune System Factors: Problems with the immune response might lead to preeclampsia
- Blood Vessel Damage: Prior vascular damage or high blood pressure can predispose to the disorder
Several risk factors increase the risk of developing preeclampsia. These include:
- First Pregnancy: It often affects first-time mothers
- Maternal Age: Women over 40 or under 20 are at higher risk
- Multiple Pregnancy: Twins or more heightens risk
- Obesity: A body mass index (BMI) over 30 raises the risk
- Medical History: Pre-existing conditions like diabetes, kidney disease, or lupus also increase susceptibility
- Interval Between Pregnancies: Long intervals (more than 10 years) between pregnancies can increase the risk
- Race: Black/African-American women are more likely to develop the condition
- Previous History of Preeclampsia: If you’ve had preeclampsia in a previous pregnancy, your risk increases in subsequent pregnancies
- Family History: Having a mother or sister who experienced preeclampsia increases the risk
- Chronic Hypertension: Women with high blood pressure before pregnancy are more likely to develop preeclampsia
- In Vitro Fertilization (IVF): Pregnancies resulting from IVF may have a higher risk of preeclampsia
- Autoimmune Disorders: Conditions like rheumatoid arthritis, lupus, or type 1 diabetes can raise the risk
- Polycystic Ovary Syndrome (PCOS): Women with PCOS have a higher incidence of preeclampsia
- Insufficient Vitamin D Levels: Some research suggests a link between low levels of vitamin D and an increased risk of preeclampsia
Taking a proactive approach to preeclampsia is sensible. However, taking low-dose aspirin during the first trimester can help to reduce the risk. Nonetheless, between 3% to 5% of all pregnancies are complicated by preeclampsia.
Symptoms of Preeclampsia
Unlike other medical obstetric conditions, preeclampsia is largely silent. Hypertension and proteinuria can go almost wholly unnoticed – that’s why doctors and nurses routinely measure expectant mothers’ blood pressure and urine protein levels after the 20th week.
Some symptoms you may notice include:
- Severe Headaches: Unusual, persistent headaches might indicate the condition
- Changes in Vision: Blurry vision, light sensitivity, or temporary vision loss are possible symptoms
- Upper Abdominal Pain: Typically, on the right side, under the ribs
- Nausea or Vomiting: These late-pregnancy symptoms can indicate preeclampsia
- Decreased Urine Output: Lower than normal urine levels may signal kidney damage
- Shortness of Breath: Caused by fluid in the lungs
- Sudden Weight Gain and Swelling (Edema): Particularly in the face and hands
Preeclampsia can be life threatening to the mother and child if left untreated. Potential complications include bleeding problems, placental abruption (separation of the placenta from the uterine wall), liver damage, kidney failure, and eclampsia. Eclampsia, in particular, results in severe seizures without treatment with anti-seizure medication.
Preeclampsia and Sub-Saharan Africa
Identifying and treating preeclampsia in advanced healthcare systems is cheap, efficient, and reliable. It requires little more than a quick checkup and careful monitoring. However, women in Sub-Saharan Africa are at the mercy of this silent menace in the absence of affordable medical services.
According to a 2023 analysis in Tropical Doctor, of the pregnant women attending a clinic, 7% had symptoms of preeclampsia, and 59.8% of those were severe at admission.
As the authors wrote: “Significant adverse maternal outcomes were eclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, and placental abruption, and significant adverse perinatal outcomes were intrauterine fetal death, preterm delivery, low birth weight (LBW), neonatal asphyxia and early neonatal death.”
The WHO has prioritized the treatment of preeclampsia as essential to meeting its Sustainable Development Goals (SDGs). For the cost of basic training, a blood pressure monitor, and urine dipsticks, thousands of women could be screened and cared for.
Thereby preventing severe admissions and deleterious outcomes for babies. Doing so could significantly reduce the maternal mortality rate – it’s just a matter of will.
Written by: Emmanuel J. Osemota
References:
https://www.afro.who.int/health-topics/maternal-health
https://www.who.int/publications/i/item/9789241548335
https://pubmed.ncbi.nlm.nih.gov/35918836/
https://www.bmj.com/content/366/bmj.l2381
https://www.thelancet.com/clinical/diseases/pre-eclampsia
