I Was Just Diagnosed With Preeclampsia: Now What?
The condition, which is defined as a serious and sometimes fatal disorder of pregnancy classified by higher-than-normal blood pressure, swelling, and inflammation in the body, and in some cases, protein in the urine, can indeed be a frightening prospect to face as you near your due date.
And while you may be somewhat familiar with the term preeclampsia, thanks to some recent high-profile celebrities who had the pregnancy disorder, you probably don't know what happens after the diagnosis. We talked to experts to help you get familiar with what a preeclampsia diagnosis really means.
Complications of Preeclampsia
Beyond dangerously high blood pressure and high levels of protein in the urine (a sign of kidney problems), preeclampsia is associated with several other complications if left untreated, including:
- A low birth weight baby (under 5.5 pounds)
- Placental abruption (the placenta separates from the uterus)
- Abnormal liver function tests
- Preterm delivery (delivering before 37 weeks)
- Kidney failure
- Transient (not permanent) loss of vision
- Rupture of the liver
- Maternal and/or fetal death (rare)
The only cure for preeclampsia is to deliver the baby, but your doctor will develop a treatment plan that takes your specific case into account. Here's what you can expect:
Strict health monitoring.
Not only will your blood pressure be carefully monitored to ensure that it's not going too high, but you'll likely have more rigorous testing of your urine and blood done, too. Doctors will check your urine for rising protein levels (preeclampsia causes protein from your cells to spill over into your urine) and perform lab work to give them a more accurate picture of how preeclampsia is affecting your kidneys, liver, and other organs.
Your baby will also be carefully monitored, with non-stress testing (NSTs) and more frequent ultrasounds to measure amniotic fluid levels and markers for fetal well-being, like heart rate and breathing.
Preeclampsia can cause a host of symptoms during pregnancy. In addition to causing extreme swelling, preeclampsia can cause vision changes (you might see "floaters" or flashes of light), abdominal pain and tenderness, severe headaches, general malaise, and nausea and vomiting. (The symptoms of preeclampsia point to damage going on below the surface, and are important to get checked out.)
Although the only real "cure" for preeclampsia is delivering your baby, the disorder may be managed with antihyptertensive medications to lower your blood pressure. In many cases, you'll need to continue taking these after delivery as well, as the high blood pressure caused by the preeclampsia can last up to a year postbirth.
Other preventive measures include a daily dose of baby aspirin, which studies have shown may help prevent preeclampsia from worsening. Once you're in labor, your doctor may also give you magnesium sulfate, a smooth muscle relaxant that's infused through an IV, as a preventive measure to ward off seizures.
And if you're delivering before 37 weeks, doctors may prescribe special steroids for your baby to help with respiratory function, as his lungs may not be fully developed.
Possible hospitalization and induction.
Although the majority of preeclampsia cases occur after 37 weeks of pregnancy, the disorder can happen as early as after 20 weeks, says Lisa Valle, D.O., an ob-gyn hospitalist at Saint John's Health Center in Santa Monica, California. If your preeclampsia becomes severe enough, you may need to be hospitalized so doctors can monitor your condition more carefully.
All preeclampsia cases are treated on an individual basis, but if the condition occurs early enough in your pregnancy and is severe enough to endanger your life, your healthcare team will consider if an induction is in both your and your baby's best interest.
"The delivery plan has to be strategized," says Abdulla Al-Khan, M.D., director of the Division of Maternal-Fetal Medicine & Surgery at Hackensack University Medical Center in New Jersey. If you're at (or past) the 37-week point, immediate delivery is preferred, Dr. Al-Khan says. If you're under 34 weeks (and especially under 32 weeks without severe features) you may be "admitted, monitored, and watched carefully on a daily basis to see if we can bide time to avoid premature labor," he says.
Risks down the road.
Unfortunately, once you've had preeclampsia with one pregnancy, you're at an increased risk of developing the condition again. There can also be other long-lasting effects of the disease.
"We've said for many years that delivery is the cure," says Maurice Druzin, M.D., professor of obstetrics, gynecology, and maternal fetal medicine at Lucile Packard Children's Hospital Stanford, in Palo Alto, CA. Dr. Druzin tells Parents: "The true statement is, delivery is the most important intervention toward curing the disease of preeclampsia. If you don't deliver, it's not going to get better. However, the profound effects of preeclampsia on all organ systems may take up to six weeks after delivery to completely resolve."
In fact, Dr. Druzin points out that in most cases, the disease resolves itself after childbirth. But for some women, the residual high blood pressure can take up to two years to go away, says Ellen W. Seely, M.D., professor of medicine at Harvard Medical School and director of clinical research in the endocrinology, diabetes, and hypertension division at Brigham and Women's Hospital in Boston. For others, like me, the effects are even longer lasting.
"We've seen cases of patients who get better, but still have residual hypertension," says Dr. Druzin. "Those patients do not have preeclampsia, which only occurs in pregnancy and for up to six weeks postpartum. The correct diagnosis would be chronic hypertension."
Regardless of the possible causes, having preeclampsia can have a lasting effect on your health. "Over the past 10 years or so, we have [had] an increasing amount of data that show women who have had preeclampsia are at increased risk for hypertension, heart disease, and stroke," Dr. Seely says. There is also data indicating that preeclampsia increases future risk for Type 2 diabetes, she says.
In fact, the condition doubles your risk of stroke and quadruples your risk of high blood pressure later in the life, according to the American Heart Association, making it all the more important that women who have preeclampsia are carefully monitored by their primary care providers. But experts say that many women and some clinicians don't know about the long-term health risks that can come from what many consider to be a temporary condition.
"We found that women are often not aware that their history of preeclampsia gives them an increased likelihood of developing future high blood pressure, heart disease, and stroke," says Dr. Seely. "Unless they're aware, they're not going to think they're a candidate to adopt lifestyle modifications. A lot of health providers are also not aware of the association, so women aren't given the information or the tools by which they could decrease their risk."
Life After a Preeclampsia Diagnosis
If you've had preeclampsia, let your primary care provider know and get regular checkups to monitor your blood pressure, cholesterol, and blood sugar. Although Dr. Seely notes that more research is needed to find out whether women who have had preeclampsia require more individualized treatments, it doesn't hurt to adopt the same healthy behaviors as would anyone trying to lower her cardiovascular disease risk:
- Get to or maintain a healthy weight
- Exercise regularly
- Stop smoking
- Follow a healthy diet, such as the DASH diet, which has been clinically proven to lower blood pressure