The World Health Organization (WHO) places preeclampsia on the list of the main causes of maternal death (the one that occurs during pregnancy or shortly after delivery).
Fortunately, this condition can be avoided or treated, ensuring a healthier pregnancy for the woman and the baby.
Find out more about this fundamental subject in the article below and in case of doubts or suspicions, talk to the obstetrician who accompanies the pregnancy.
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What is preeclampsia?
Preeclampsia is called a pregnancy-specific hypertensive disease. It is characterized by increased blood pressure in pregnant women and loss of protein in the urine (proteinuria). If not treated correctly, it tends to evolve to more severe conditions (eclampsia), compromising pregnancy.
According to the Febrasgo protocol of 2019, currently, even if significant proteinuria is not observed, other conditions associated with elevated pressure should be analyzed.
Thus, pre-eclampsia can be considered if there is also involvement of other body systems or conditions such as:
- Thrombocytopenia;
- Liver dysfunction;
- Renal insufficiency;
- Acute pulmonary edema;
- Imminence of eclampsia or eclampsia);
- Signs of placental impairment (such as fetal growth restriction and / or dopplervelocimetric changes).
Preeclampsia is characterized by pressure changes that occur after the 20th week (or 5th month) of pregnancy and tends to end at the moment the baby is born. It can still be classified into early pre-eclampsia (before 34 weeks) and late pre-eclampsia (after 34 weeks).
In some cases, the disease may still accompany the mother even after delivery, requiring specific monitoring and treatment.
What are the types of gestational hypertension?
One of the most accepted ways of classifying hypertensive syndromes in pregnancy is by classifying them into 4 categories, which are:
- Chronic arterial hypertension: hypertension before 20 weeks;
- Gestational hypertension: hypertension without proteinuria and without other signs of attention;
- Pre-eclampsia: pressure increase after 20 weeks, with proteinuria or other indicative symptoms;
- Chronic arterial hypertension superimposed by pre-eclampsia: when there is hypertension before pregnancy, there is a worsening of the condition.
One of the ways to classify pre-eclampsia is by the intensity of the conditions, although some studies have pointed out that this is a form of classification that is no longer used:
Light
Mild preeclampsia is characterized by 2 episodes of blood pressure above, equal to or above 140/90, with intervals of at least 4 hours. When present, proteinuria should be equal to or greater than 300mg in 24 hours.
In general, it is not recommended to prescribe diuretics or medications, and there should be light rest and frequent monitoring of pressure.
Grave
In severe pre-eclampsia, 2 pictures of blood pressure equal to or above 160/110 are observed at 4-hour intervals. In addition, proteinuria appears at rates of 5g in 24 hours.
In these cases, there must be hospitalization for constant monitoring of the pregnant woman aiming at a strict control of blood pressure. In general, a high-protein diet is recommended , with no dramatic decrease in sodium.
What causes preeclampsia in pregnancy?
It is not yet known exactly what causes preeclampsia. However, factors such as being the first pregnancy, age of the pregnant woman (early adolescence or over 40 years) and history of the disease in close family members (mother, grandparents, sisters) may be related to the development of the condition.
Other risk factors for preeclampsia are:
- Obesity;
- Diabetes;
- History of high blood pressure prior to pregnancy;
- Kidney disease or complications (such as kidney failure or stone);
- Being pregnant with more than one baby (twins or triplets, for example);
- Getting pregnant with an interval less than 2 years or more than 10 years after the last pregnancy;
- Get pregnant by In Vitro Fertilization (IVF).
Some experts believe that the rise in blood pressure during pregnancy is caused by the poor development of the placental blood vessels.
This would cause small spasms in the veins and hinder the circulation of blood causing the heart to accelerate and put more pressure.
However, this thought is just speculation and has not yet been scientifically proven.
How to identify pre-eclampsia? Do you have symptoms?
The suspicion of pre-eclampsia can be raised by the pregnant woman herself when she has symptoms such as tiredness , headache , blurred vision, swelling, nausea. But the disease can only be diagnosed with a blood or urine test done after the 20th week of pregnancy.
Other symptoms of pre-eclampsia are excessive sweating on the feet or hands, decreased urine volume, weight gain and fluid retention.
Remembering that it is possible that pre-eclampsia does not show any signs or symptoms, which can make identification more difficult and time-consuming.
Therefore, it is extremely important that the pregnant woman does the correct medical monitoring during all stages of pregnancy.
The sooner it is diagnosed, the greater the chances of having an appropriate treatment, bringing more safety and comfort to the mother and baby.
Tests to diagnose preeclampsia
Although the symptoms can help to raise suspicions of pre-eclampsia, this disease can only be diagnosed correctly with the help of tests that must be evaluated and interpreted by a medical professional.
The main tests to identify preeclampsia are:
Blood or urine test
In this case, the blood test is used to assess the amount of protein present in the pregnant woman’s body.
The same thing is also true for the urine test that is done to check for proteinuria (one of the characteristics of pre-eclampsia).
Fetal ultrasound
Fetal ultrasound is used in the diagnosis of pre-eclampsia because it can allow the obstetrician to observe the dilation of the veins and notice how much pressure the heart is making to pump blood.
Biophysical profile
The biophysical profile test identifies the baby’s movements and breathing. In doing so, he assigns scores to assess fetal distress. If the grades are high it is an indication that something is wrong.
Pre-eclampsia: what are the risks for the baby and the mother?
Preeclampsia is a delicate disease that in more severe cases can cause the death of the pregnant woman, the baby, induce labor, cause abortions, convulsions and cardiovascular accidents (strokes), facilitate bleeding and bleeding and promote kidney failure and damage and liver.
In babies, pre-eclampsia can influence weight gain (which tends to be less than ideal) and the development and growth of organs and tissues.
But first of all, stay calm. It is possible that both the mother and the baby do not have any sequelae, if preeclampsia is diagnosed and treated correctly.
Care
As it is not known exactly what causes pre-eclampsia, there is still no scientifically proven way to prevent this condition.
Even so, some precautions can be taken to prevent or treat pre-eclampsia:
Before pregnancy
If you plan to become pregnant, treat some conditions (such as diabetes , high blood pressure and kidney problems) before conceiving.
Maintaining a healthy lifestyle with regular physical exercise, a diet rich in fruits and vegetables, and avoiding the frequent consumption of drugs or alcohol are important habits for all people, especially those who want to get pregnant.
During pregnancy
The pregnant woman must continue practicing physical exercises as recommended by the doctor.
Always do all the tests requested by the obstetrician and follow the medical guidelines.
After pregnancy
Follow medical recommendations regarding food and rest. If possible, get pregnant again at least 2 years from the date of delivery.
How to deal with?
The type of treatment for pre-eclampsia varies according to each case and only health professionals can indicate what is best for your pregnancy.
Generally, milder degrees are treated with daily monitoring of blood pressure and reduction of intense physical exercise.
The obstetrician may still recommend some medication (such as aspirin and ASA) to alleviate the symptoms of this disease.
The most serious cases, on the other hand, are treated with hospitalization and antihypertensive drugs administered intravenously (in the vein).
Diet: what to eat when there is a diagnosis of pre-eclampsia?
All recommendations must be given by healthcare professionals. No change in diet should be made on its own, especially since, in general, it is observed that a low-sodium diet does not bring such significant results to pre-eclampsia.
Food should prioritize calcium source products (such as soybeans, white beans , arugula, kale and broccoli). Since the supplementation of the nutrient is indicated only for pregnant women with diagnosed deficiency.
Potassium should also be consumed frequently. So foods like beets, sweet potatoes , spinach, kale and bananas .
The amount of salt should be reduced and processed foods (sausages, canned foods, ready-made spices, soft drinks and isotonic drinks) should also be avoided, as far as possible.
A healthy diet should also be maintained: consume 5 servings of fruit every day between large meals and avoid eating excess fats and sugars.
Second pregnancy: pre-eclampsia is repeated?
It is possible that pre-eclampsia may be repeated in later pregnancies. The chances are greater if the last pregnancy happened less than 2 years ago or more than 10 years ago. Therefore, anyone who has had this disease and is pregnant again should tell the obstetrician about this medical history.
However, there are several factors associated with the condition, which may or may not increase the chances of another episode occurring. Thus, women who have already suffered from pre-eclampsia in the first pregnancy should talk to health professionals, seeking individualized follow-up.
Preeclampsia is a serious disease that can lead pregnant women and babies to death. Therefore, it should be diagnosed and treated as soon as possible.
In case of doubts or suspicions, seek medical advice.
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