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Preeclampsia

preeclampsia pregnant woman

What is preeclampsia?
Preeclampsia is high blood pressure induced by pregnancy. If not recognized and treated, the condition can progress to eclampsia, the occurrence of convulsions that can lead to coma and can be life threatening for both mother and child.

These convulsions of eclampsia, which result in temporary loss of consciousness, are indistinguishable from epileptic fits. Eclamptic fits usually occur as a late-stage complication of severe preeclampsia, but may sometimes arise without any evidence of preceding disturbances, and usually in the second half of the pregnancy.

What are the varieties of preeclampsia?
Although the terms are used differently, preeclampsia, toxemia, pregnancy induced hypertension (PIH), preeclamptic toxaemia (PET), and ephegesis gestosis all refer to similar hypertensive conditions of pregnancy. Toxemia is an older term based on a notion that the condition was due to poisons in the blood. PET is a label still used by physicians, especially in Britain. Ephegesis gestosis is generally synonymous with preeclampsia. PIH is a more recent term. The Preeclampsia Foundation uses the term "preeclampsia" as an umbrella term to cover all variants of hypertensive complications of pregnancy.

What are the causes of preeclampsia?
The final cause of preeclampsia is a disruption of normal blood vessel tone and circulation induced by the physiologic changes of pregnancy. Possible mechanisms include:

  • Insufficient blood flow to the uterus
  • Damage to the blood vessels
  • Injury to the lining of the blood vessels
  • A disruption in the hormones that maintain the blood vessels
  • Immune system dysfunction
  • Poor nutrition
  • Magnesium or calcium deficiency

Who is at risk of preeclampsia?
The greatest risk factor for preeclampsia is pregnancy. Others contributing factors include:

  • A history of preeclampsia. A personal history or family history of preeclampsia increases the risk.
  • First pregnancy. Your chances of developing preeclampsia are greater during your first pregnancy, your first pregnancy with a new partner, or your first pregnancy in 10 years or more
  • Age. Your risk of preeclampsia increases if less than 20 or greater than 35 years of age at the time of pregnancy.
  • Obesity. Having a pre-pregnancy body mass index (BMI) greater than 30 is a risk factor in and of itself.
  • Multiple pregnancy. Preeclampsia occurs more often in women carrying more than one baby.
  • History of certain conditions, such as chronic hypertension, diabetes, kidney disease or connective tissue disease, including rheumatoid arthritis or lupus can increase the risk.

What are the symptoms of preeclampsia?
The signs of preeclampsia are hypertension and the presence of excess protein in the urine (proteinuria) after 20 weeks of pregnancy. Other signs and symptoms can include:

  • Severe headaches
  • Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
  • Upper abdominal pain, usually under the ribs on the right side
  • Unexplained anxiety
  • Nausea or vomiting
  • Dizziness
  • Decreased urine output

How is it diagnosed?
Preeclampsia usually shows up during a routine prenatal checkup, another reason why regular prenatal care is essential.

A woman can be diagnosed with preeclampsia if she has an elevated blood pressure and proteinuria after 20 weeks gestation. Normal blood pressure readings for pregnant women are less than 130/85 millimeters of mercury (mm Hg). A blood pressure reading of 140/90 mm Hg or higher is considered elevated. However, a single high blood pressure reading does not diagnose preeclampsia. If you have one reading in the abnormal range - or a reading that is much higher than your normal blood pressure - your doctor will closely observe your readings and may request that you come in for additional blood pressure checks and urinary protein measurements.

If you do have preeclampsia, your doctor may request blood tests to determine how well your liver and kidneys are functioning and to see if your blood has the normal number of platelets. Your health care provider may also recommend close monitoring of your baby's development - usually by ultrasound. You may need a nonstress test (NST) or biophysical profile to assure your baby is getting sufficient oxygen and nutrients, especially as you near your due date. A nonstress test is just that - a noninvasive test that causes no harm to your baby. The test usually takes less than one half hour and requires no hospitalization. It is a simple procedure that looks at how often your baby moves and how much his or her heart rate increases with movement. A biophysical profile integrates an ultrasound with a nonstress test to provide more detail about your baby's lung function, tone, movement and the volume of amniotic fluid in your uterus.

What is the conventional treatment of preeclampsia?
The previous standard treatment for preeclampsia was Valium, a benzodiazepine, and phenytoin (Dilantin), an anti-convulsive drug, but a more recent clinical approach is to use magnesium sulfate. According to the Collaborative Eclampsia Trial (CLASP) published in The Lancet, June 1995, women on magnesium sulfate had:

  • 52% lower risk of recurrent seizures than those on diazepam;
  • Those who did have recurrent seizures had fewer than those on diazepam;
  • 26% lower risk of maternal death than those on diazepam;
  • Babies of mothers on magnesium fared better post-delivery and less likely to need special care;
  • Less likely to be ventilated or develop pneumonia or require intensive care than those on phenytoin;
  • 67% lower risk of recurrent seizures than those on phenytoin;
  • 50% lower risk of maternal death than those on phenytoin.

Nevertheless, magnesium sulfate, is not a benign drug and must be used by a skilled health provider with appropriate support facilities. Overdoses can and do happen. It is important to note that magnesium sulfate and Epsom salts are not the same. Ingesting Epsom salts, or magnesium vitamin supplements have not been shown to prevent maternal death due to eclamptic seizures.

What  therapies does Dr. Weil recommend for preeclampsia?
Since obesity is a contributing factor in some preeclampsia cases, it is important to maintain a healthy weight before and during pregnancy. With regard to nutrition and weight loss, Dr. Weil feels that what you eat is as important as how much you eat. A balanced diet should include the right mix of carbohydrates, fats and proteins to meet the body's nutritional needs, and the right number of calories to replace those lost in performing everyday activities. Here is the recommended breakdown: 50-60 percent of calories from carbohydrates, 30% from fat, 10-20 percent from protein (preferably whole soy or fish). Remember to buy organic foods whenever possible.

The Optimum Diet centers around variety, freshness, unprocessed foods and an abundance of fruits and vegetables. If you are not eating regularly, if your diet is not rich in fresh foods, and if you are unable to get plenty of fruits and vegetables, a multivitamin may help you fill in the gaps, but supplementing should not be used as an excuse for making poor choices. A daily intake of fiber is needed for proper intestinal function. Fiber fills you up, regulates blood sugar and can help reduce cholesterol levels. Good sources are fruits, vegetables, whole grains, seeds and nuts.

The glycemic index is a guide to how quickly foods raise blood sugar and cause increases in insulin production, resulting in conversion of calories to fat. The glycemic load uses the glycemic index to tell you how an average portion of a particular food will influence blood sugar and fat storage in the body. You can consume up to 40 percent of your daily calories as carbohydrate if you stick to foods that rank "low" to "moderate" on the glycemic load, such as lentils, carrots, wild rice and air-popped popcorn. Trans-fats are un-natural fat molecules created in the hydrogenation process. They are mostly found in animal fats and vegetable oils. TFAs (trans-fatty acids) are just as bad if not worse for the heart and arteries than saturated fats. They increase total cholesterol, raise "bad" LDL (low-density lipoprotein) and lower "good" HDL (high-density lipoprotein). Beyond that, TFAs may have adverse effects on cell membranes and the immune system, and may promote cancer and aging. These are often found in processed foods. Avoid: coconut oil, corn oil, cottonseed oil, anything hydrogenated or partially hydrogenated, lard, margarine, palm or palm kernel oil, safflower, sunflower or soybean oil, vegetable oil and vegetable shortening. Sources of "good fat" include almonds, cashews and omega-3 fats, found in fatty cold-water fish, fortified eggs, soy foods, flax, hemp seeds and walnuts. Extra-virgin olive oil, expeller-pressed canola oil, as well as walnut and hempseed oil are all good choices.

How can preeclampsia be prevented?
Early detection through simple screening measures and diligent prenatal care can predict or prevent many effects of preeclampsia.

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