At a routine 36-week prenatal exam, Jessie Ha’s blood pressure measured 120/80.
These numbers were on the high side for her. She has an autoimmune disease that normally causes her blood pressure to run low. But the 35-year-old disability advocate was not overly worried. Nor was her doctor. They chalked it up to normal pre-birth jitters, since Jessie was scheduled for an induction later that week.
In retrospect, her doctor may have been too blasé. Spikes in blood pressure during pregnancy are not to be taken lightly. They can signal preeclampsia—a serious pregnancy complication involving high blood pressure. And women with autoimmune diseases, like Jessie, are at elevated risk for preeclampsia.
On the other hand, stress, anxiety, or lack of sleep can also temporarily raise blood pressure, and Jessie’s was not above 140/90, the typical threshold considered high.
The next morning, when Jessie awoke and looked in the mirror, she discovered that the middle of her face “was missing”. She had a gaping black hole in the center of her visual field. It was if her chin met her forehead. From years of working with people with traumatic brain injuries, she knew something was wrong and rushed to the ER.
By the time she arrived, her blood pressure had climbed to 250/160–dangerously high. Her doctors rapidly induced labor (Her blood platelets were low, so her doctors felt an induction was safer than an emergency C-section.)
Within a few hours, she gave birth to a healthy baby girl, and her blood pressure dropped back to normal.
What is Preeclampsia?
Worldwide, preeclampsia affects 2-8% of all pregnancies. This serious pregnancy complication is characterized by high blood pressure and signs of damage to other organ systems, such as the liver and kidneys.
Despite being one of the most common serious pregnancy disorders, preeclampsia remains poorly understood. No one knows exactly what causes it, although problems with the placenta likely play a role.
Preeclampsia is responsible for 10-15% of all maternal deaths globally. In the developed world, the rate of maternal death is much lower, but complications—like the need to induce labor early—remain common.
Fortunately, many of the negative outcomes are avoidable given early detection and treatment.
Myths and Misunderstandings about Preeclampsia
Myths and misunderstandings about preeclampsia can impede early detection. So we wanted to draw your attention to the four of the most common ones:
MISUNDERSTANDING #1: Protein in your urine is required for diagnosis.
Preeclampsia can be diagnosed in the presence of sustained high blood pressure and ANY of the following symptoms:
- Protein in the urine
- Fluid in the lungs
- Trouble with the kidney or liver
- Signs of organ damage
- Decreased blood platelets
- Signs of brain trouble (blurred vision, spots, severe headaches that don’t respond to treatment, or as Jessie experienced, partial loss of vision)
Until 2013, high blood pressure and protein in the urine were both required for a preeclampsia diagnosis. That year, the American College of Obstetricians and Gynecologists updated their diagnostic criteria to remove protein in the urine as a requirement, noting that the presence of protein in a woman’s urine is not predictive of ongoing organ damage or of how quickly preeclampsia progresses.
“Many patients with preeclampsia don’t have enough proteinuria to meet the [old] criteria, so their diagnosis and treatment is delayed,”
– James N. Martin, Jr., MD, past president of the ACOG and member of the Preeclampsia Foundation Medical Advisory Board.
Not all providers have updated their approach to diagnosing preeclampsia. In the last month of two of my own pregnancies, I also experienced high blood pressure. One was before 2013, the other after. Yet, both times my care team told me I did not have preeclampsia because I did not have any protein in my urine.
Looking back, I now wonder whether I didn’t have preeclampsia. My doctors did not test my blood for the other indicators, like low platelets and elevated liver enzymes.
MISUNDERSTANDING #2: Delivery cures preeclampsia.
Numerous respected health websites and scientific articles continue to describe delivery as a cure for preeclampsia. While preeclampsia does sometimes resolve following delivery, and doctors may induce labor early as a critical treatment, it is not a cure. Women should continue to be monitored until their symptoms have resolved.
Preeclampsia can also start after birth (and up to 6 weeks postpartum). This condition is rare but just as dangerous as the pregnancy kind, especially since it can easily go undetected.
Many women head home after delivery unaware that preeclampsia can occur within days or weeks of giving birth.
Hospitals frequently discharge mom and baby after only 48 hours. They send mom home with instructions that focus on routine practical matters–caring for vaginal tears and newborn care and feeding. Thus, many women remain unaware that preeclampsia can occur within days or weeks of giving birth. Without knowing what symptoms to watch out for, they can easily confuse early symptoms of postpartum preeclampsia with normal post-birth fatigue.
Of all the misconceptions, that birth is a cure is perhaps the most deadly. According to ProPublica, the vast majority of maternal deaths from preeclampsia occur after delivery, mostly from stroke.
SYMPTOMS OF PREECLAMPSIA:
- Rapid weight gain (2 or more pounds in a week)
- Sudden severe swelling in your face, hands, or ankles
- Abdominal pain
- Severe headaches that do not respond to tylenol
- Change in reflexes
- Not peeing as much as usual
- Excessive vomiting and nausea
- Vision changes, such as blurred vision, flashing lights, or seeing spots
- None—your blood pressure can be high without you knowing it
MISUNDERSTANDING #3: Preeclampsia is often “mild”
While most women with preeclampsia will deliver a health baby and have a full recovery, there is no such thing as “mild” preeclampsia, according to the Preeclampsia Foundation.
The National Institutes of Health and other respected sources are guilty of perpetuating this misconception, making statements about most cases of preeclampsia being mild.
There is no such thing as “mild” preeclampsia.
All women with preeclampsia need careful monitoring and aggressive treatment.
However, this description is about the eventual outcomes. It is not a diagnosis. Outcomes are usually good, yes, but whether preeclampsia takes mild or severe course cannot be predicted in advance.
“Diagnosing a woman’s condition as “mild preeclampsia” is not helpful because it is a progressive disease, progressing at different rates in different women. Appropriate care requires frequent re-evaluation for severe features of the disease”
In other words, all women with preeclampsia need careful monitoring and aggressive treatment.
MISUNDERSTANDING #4: We don’t need a cure because preeclampsia can be managed.
Worldwide, preeclampsia accounts for about 15% of all maternal deaths. It is also responsible for 12-25% of all cases of fetal growth restriction and 15-20% of preterm labor.
While the burden of disease is worse in developing countries, even in the U.S., preeclampsia remains a leading cause of maternal mortality, preterm birth, and other pregnancy-related complications. After pregnancy, women who had preeclampsia face elevated risks for later hypertension, stroke, and cardiovascular disease.
“Preterm preeclampsia is a stronger risk factor than smoking for the development of stroke and other cardiovascular diseases in women.”
– Basky Thilaganathan Professor and Director of Fetal Medicine at St George’s Hospital, UK, in a recent editorial.
More than better management, which is desperately needed, we need prevention.
Fortunately, preeclampsia is finally getting the attention it deserves. A study in California that tracked maternal deaths between 2003-2005 found that 60% of deaths from preeclampsia could have been prevented with proper care. And a new collaboration between the CDC Foundation, the Centers for Disease Control and Prevention (CDC) and the Association of Maternal and Child Health Programs (AMCHP) is creating a national database to investigate maternal deaths. In 2006, the NIH was funding only 40 research projects on preeclampsia. By 2013, it was funding over 180 such projects.
But even better than early detection and management, we need prevention. Obviously, detection and management are critical, but we also need a way to stop preeclampsia before it wreaks havoc on mom and baby.