Pre-Eclampsia
What is Pre-Eclampsia?
Pre-eclampsia is an illness arising only in pregnancy, which can affect the mother, her unborn child or, most commonly, both. It can develop at any time in the second half of pregnancy - even as late as several days after delivery. In the mother, the condition causes a number of symptomless disturbances - including raised blood pressure (hypertension) and leakage of protein into the urine (proteinuria) - which can progress to serious illness if undetected. The unborn baby may grow more slowly than normal or suffer potentially dangerous oxygen deficiency.
How common is it - and how dangerous?
Pre-eclampsia affects as many as one in 10 of all pregnancies, making it the commonest antenatal complication. It occurs more often in first pregnancies, although a minority of women who have suffered it once get it again in one or more subsequent pregnancies. Pre-eclampsia is usually mild, but one first pregnancy in 100 is so severely affected that there is serious risk to the life of the baby - and even the mother. Every year in the UK about 500-600 babies die because of pre-eclampsia - many of these as a consequence of premature delivery rather than the disease itself. And some 7-10 mothers die each year from complications of pre-eclampsia.
Who is most at risk?
No one can predict with certainty who will get pre-eclampsia. Every woman is at risk in her first pregnancy, although the risk is greater for those with a strong family history of the condition. Women who have had pre-eclampsia in a first pregnancy may get it again. However, those who have enjoyed normal first pregnancies rarely get pre-eclampsia in subsequent pregnancies. The risk of first or repeat attacks is increased if the mother is carrying twins or has one of several chronic medical problems, including high blood pressure, kidney disease, diabetes or, to a lesser extent, migraine. Older mothers (particularly the over 35s) and those of short stature may also be at increased risk.
Are there any long-term effects?
For the great majority of mothers, delivery reverses all the effects of pre-eclampsia, although recovery may be preceded by a final crisis. For an unfortunate few, however, some organ damage remains after the disease itself is cured. It is not uncommon for women who have suffered pre-eclampsia in one or more pregnancies to develop chronic high blood pressure later in life. But this is thought to reflect an inbuilt tendency to blood pressure problems rather than a history of pre-eclampsia. There are no known health problems for babies and children who have been affected by pre-eclampsia unless they suffered extreme starvation or oxygen shortage in the womb or had to be delivered very prematurely.
What happens in the next pregnancy?
Women who have suffered pre-eclampsia in a first pregnancy should be monitored more closely and more frequently than usual in subsequent pregnancies, since there is a risk that the condition will recur, although usually in a milder form. Nevertheless, most mothers who have suffered even the most severe form of the disease in a first pregnancy enjoy perfectly normal subsequent pregnancies. (For more detailed information on this point see APEC’s other Information Leaflet - ‘After Pre-eclampsia. What Happens Next Time?’)
Can pre-eclampsia be prevented?
There is no hard evidence that pre-eclampsia can be caused or prevented by what you eat, whether you smoke or drink, how hard you work or how much rest you take. However, there is some evidence that small daily doses of aspirin, taken under strict medical supervision, may be able to prevent or delay the onset of the disease in some high-risk mothers. This is because aspirin works directly on specialised blood cells known as platelets, which help with clotting and are involved in the disease process.
What can be done to reduce the risk of recurrence?
Your best plan is to co-operate fully with the system of antenatal checks, which is designed to detect the earliest signs of pre-eclampsia. If possible, have yourself referred to a consultant who takes a special interest in pre-eclampsia, and see him or her early in your pregnancy - or even before conception - to plan your antenatal care programme. Take an active interest in your antenatal checks; never miss an appointment; make sure you are monitored more frequently if your blood pressure is raised, and admitted to hospital if protein appears in your urine. (Only one or more ‘plusses’ (+) in a urine test is important: ‘trace’ amounts can be ignored.) Always report any worrying signs or symptoms to your doctor and do not allow him or her to dismiss you without first checking your blood pressure and urine.