It occurs usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered.
Preeclampsia can be classified as early onset (before 34 weeks), late onset (after 34 weeks), or term (at 37 weeks or later).
Late-onset preeclampsia is approximately seven times more prevalent than early-onset preeclampsia.
Pre-eclampsia is primarily considered a placental disorder, where failure of the uterine spiral arteries to remodel themselves during pregnancy (a consequence of abnormal trophoblast invasion) results in reduced utero-placental perfusion and subsequent foetal hypoxia (low oxygen levels).
The oxidative stress caused by under-perfusion leads to the release of circulating factors (placental syncytial fragments), which induce a maternal inflammatory response (the body reacts via hot, redness and swelling) that subsequently causes endothelial cell dysfunction, triggering widespread vasoconstriction (blood vessels around the body constrict) and capillary leakage.
This results in the multisystem disorder evident in pre-eclampsia.
Late-onset pre-eclampsia beyond 34 weeks gestation may be attributable to normal maternal perfusion failing to meet the metabolic demands of the placenta and foetus, coupled with an increased maternal susceptibility and immune response to the circulating factors.
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The table below shows factors that may increase the chance of pre-eclampsia and when should aspirin be prescribed by a medically trained healthcare professional.
Hypertension in pregnancy: diagnosis and management. NICE guideline NG133. National Institute for Health and Care Excellence. 2019. https://www.nice.org.uk/guidance/ng133(accessed Apr 2021).
Screening and Diagnosis Tests
Any abnormalities identified during routine antenatal screening check-up should be followed up with regular monitoring, including close to delivery and postpartum (see Box 1).
Box 1: Investigations possibly suggestive of pre-eclampsia
Protein creatinine ratio ≥30mg/mmol; albumin creatinine ratio ≥8mg/mmol;
Thrombocytopenia (platelet count rapidly falling or absolute level <100 x 109/L);
Prolonged clotting times;
Raised serum creatinine ( ≥90micromol/L or ≥1mg/100ml);
Increased haematocrit and haemoglobin levels (above normal pregnancy levels);
Anaemia if haemolysis; associated with raised lactate dehydrogenase and bilirubin;
Abnormal liver function tests, particularly raised transaminases (alanine transaminase ≥70IU/L or twice upper limit of normal range — NB: alkaline phosphatase normally raised in pregnancy);
Abnormal uterine artery Doppler (bilateral notches and increased resistance/pulsatility index at 22–24 weeks gestation predict pre-eclampsia);
Abnormal umbilical artery Doppler (reduced, absent or reversed end diastolic flow indicating foetal compromise);
Low placental growth factor (PlGF; reduced in pre-eclampsia and predictive of delivery for pre-eclampsia within two weeks — NB: reference ranges vary between different PlGF tests).
Source: Handbook of Obstetric Medicine
Definition of High Blood Pressure in Pregnancy
Hypertension in pregnancy is defined as two or more blood pressure readings of at least 140 mm Hg systolic or 90 mm Hg diastolic, measured 4 hours apart. Severe hypertension in pregnancy is defined as blood pressure of at least 160 mm Hg systolic or 110 mm Hg diastolic.
For treatment purposes, severe hypertension can be diagnosed with measurements at least 15 minutes apart.Tita AT, Szychowski JM, Boggess K, et al. Treatment for mild chronic hypertension during pregnancy. N Engl J Med. 2022;386:1781-1792.
Cause
Unknown
Problem with supply of blood to placenta hence not developing properly.
Preeclampsia-related liver disease typically occurs in the third trimester and is a sign of severe disease; complications can include acute fatty liver of pregnancy, hepatic infarction (obstruction of the blood supply to an organ or region of tissue), and rupture.
Source: Adapted from Maternal medicine: medical problems in pregnancy
Samangaya R, Heazell A, Baker P. Hypertension in pregnancy. In: Greer I, Nelson-Piercy C, Walters B, eds. Maternal Medicine: Medical Problems in Pregnancy. Philadelphia, USA: : Elsevier Limited 2007. 40–52.
This condition can lead to in the future (in later life) of the following:
Hypertension (and almost half of women who have pregnancy-related hypertension continue to have high readings at 6 weeks postpartum)
Ditisheim A, Wuerzner G, Ponte B, et al. Prevalence of hypertensive phenotypes after preeclampsia: a prospective cohort study. Hypertension. 2018;71:103-109.
Hauspurg A, Lemon L, Cabrera C, et al. Racial differences in postpartum blood pressure trajectories among women after a hypertensive disorder of pregnancy. JAMA Netw Open. 2020;3:e2030815.
Initiating low-dose aspirin (75-150 mg/d) early in pregnancy, ideally before 16 weeks, can significantly reduce the risk of developing preeclampsia. The medication works by inhibiting platelet aggregation, reducing inflammation, and improving placental blood flow. High-dose aspirin is not recommended during pregnancy owing to increased risk for bleeding.
This medication must be prescribed by your medical Doctor , do not buy this product even if your midwife and/or Medical Doctor ask you to buy this medication without a prescription
Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice
Detailed Information
Please copy and paste any key words from the title: Pre-eclampsia (Check if pregnant or showing symptoms of pregnancy) in the following respective 'Medtick References and/or Sources' to find out more about the disease (this also may include diagnosis tests and generic medical treatments).
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Diet, Exercise and Body Manipulations
Consider a Mediterranean diet (a high intake of fruits, vegetables, whole grains, beans, nuts, and seeds, as well as a lower intake of red meat and dairy), but still be aware of food to avoid in pregnancy especially in conditions:
