What is preeclampsia, and how can it affect the mother and child?
According to the National Institute of Child Health and Development,
“Preeclampsia is a condition in which a woman with previously normal blood pressure develops high blood pressure at 20 weeks of pregnancy or later. It can be life-threatening and can lead to serious short-and long-term health problems for the mother and her fetus.”
Not only is the high blood pressure bad for the mom, but “the mother’s high blood pressure reduces the blood supply to the fetus, which may get less oxygen and fewer nutrients” as a result. When left untreated, preeclampsia can develop into eclampsia, which results in a coma or seizures for the woman. It is a very serious condition which affects about 4% of pregnancies in the United States — 1 in 25 — and a higher percent of pregnancies worldwide.
During pregnancy for the mom, preeclampsia can damage organ and/or blood systems, affect the placenta (which can result in placental abruption and other outcomes), preterm birth, and in more severe cases, death of the child or stroke. If it escalates to eclampsia, seizures happen, and coma or even death are possible outcomes. The CDC estimates that hypertensive disorders (preeclampsia falls under this family of disorders) are the cause of about 7% of maternal deaths. Fortunately, the majority of cases of preeclampsia are mild, but the condition must be treated and it can progress very quickly if not caught or treated in time.
After pregnancy, the mother can still be affected. While the effects of preeclampsia usually go away within 6 weeks of delivery, a mother will remain at a higher risk for high blood pressure and heart problems, as well as blood clot and stroke. Right after birth or delivery, a mom is at higher risk of developing eclampsia and seizures, so it is important for her to be monitored during this time period. In more rare cases, permanent organ damage or fluid in the lungs can occur. A woman can even develop preeclampsia within 6 weeks after birth, even if she did not have preeclampsia during pregnancy, though this is more rare than developing preeclampsia during pregnancy; this is called postpartum preeclampsia.
Postpartum maternal mental health is also affected by preeclampsia, because the pregnancy experience can be perceived as traumatic. Preeclampsia is associated with higher rates of postpartum depression and anxiety, as well as PTSD. It is normal for women to mourn the loss of a healthy and normal pregnancy and to feel overwhelmed by the difficult experience.
The baby is affected by preeclampsia, too. Since the disorder restricts blood flow and therefore nutrient flow to the baby, it can affect fetal growth. It can also lead to preterm birth. Preeclampsia causes 20% of all preterm births worldwide, and 15% of babies are small for their gestational age. Stillbirth and infant death can also happen. In the United States, between about 1,000-2,000 stillbirths happen due to preeclampsia each year, and about 10,500 infants die. Worldwide, infant death is much higher (about half a million babies), because not all countries have the means to provide medical care to prematurely born or delivered babies. Babies can go on to have a wide variety of long-term health effects due to reduced nutrient and oxygen flow during pregnancy.
What causes preeclampsia?
While the cause or causes of this hypertensive disorder are not fully known, there are known risk factors, such as pre-pregnancy obesity, first pregnancy, preeclampsia with previous pregnancy, diabetes and/or high blood pressure before pregnancy, maternal insulin resistance in the third trimester, and placental lesions. More information on both risk factors for preeclampsia and research on molecular markers which are associated with higher risk for preeclampsia can be found on the NICHD website. Research is ongoing concerning the causes of preeclampsia. Likely, there is not just one certain thing which causes the condition, but several health and genetic factors which can increase risk for developing it. However, the more research done, the better doctors and medical providers can assess the risk of a pregnant woman and provide proper treatment and monitoring throughout and after pregnancy.
What are the signs and symptoms of preeclampsia?
According to NICHD, some of the symptoms of preeclampsia include high blood pressure, swollen hands and face, headache, blurry vision, and abdominal pain. The Preeclampsia Foundation offers some additional information on symptoms to watch out for:
“Important symptoms that may suggest preeclampsia are headaches, abdominal pain, shortness of breath or burning behind the sternum, nausea and vomiting, confusion, heightened state of anxiety, and/or visual disturbances such as oversensitivity to light, blurred vision, or seeing flashing spots or auras.”
Weight gain (3-5 pounds/week), lower back pain (combined with shoulder and/or abdominal pain), and hyperflexia are some other possible symptoms of preeclampsia, and should be mentioned to a doctor when occurring during pregnancy.
Early diagnosis is key to mitigating or delaying negative health outcomes for mothers. Being able to have access to routine, early, ongoing prenatal care allows for better monitoring of blood pressure and protein in urine, which a doctor can use to diagnose preeclampsia and start treatment or further monitoring. The Preeclampsia Foundation has a short video explaining the seven most common symptoms of preeclampsia:
How is preeclampsia treated?
Delivery is the best treatment for preeclampsia, but even that is not a sure cure for every case. As has already been already pointed out, preeclampsia can continue to affect the mother after pregnancy, or can even be developed after birth or delivery. However, as we have also already covered, the majority of cases of preeclampsia are mild and end up with both mom and baby alive and healthy after delivery or birth.
Treatment takes into account both the mother and the child, according to NICHD:
“Ideally, the healthcare provider will minimize risks to the mother while giving the fetus as much time as possible to mature before delivery.”
For the mom, factors like how far along she is, severity of the condition, and potential for complications to her health are taken into account. For the baby, potential risks to their health and gestational age are taken into account.
In general, there are two courses of action.
If the mom is far enough along (37+ weeks) when she develops preeclampsia, delivery as soon as possible is pretty standard protocol. For severe preeclampsia, delivery is recommended even earlier, at 34 week. However, if the mom is less than 37 weeks along, then the factors mentioned above are taken into account when considering the best course of action — waiting and monitoring, medication, hospitalization and monitoring, bed rest, steroid injections (to speed up fetal lung development), testing for mom and baby, etc.
Preeclampsia can put the mother at very high risk for severe health complications, even death, so waiting to deliver at full term is not always an option. Preterm delivery may be necessary to save the mother’s life, even if it could result in higher risk of health complications for the child. However, many of the health risks to the child can be treated, monitored, and/or mitigated. And remember, the majority of cases of preeclampsia do not result in such dire outcomes.
Additionally, treatment and/or monitoring may need to continue after birth or delivery for the mother. If she had preeclampsia or high blood pressure while pregnant, close monitoring for 72 hours after birth or delivery is recommended, either at home or in the hospital.
How can we support research into the causes, risk factors, treatments, and cures?
You can actually participate in research! You can find out more about confidential participation in preeclampsia research here. You can financially support the Preeclampsia Foundation, which works to educate mothers, train healthcare providers, and provides funding for research on preeclampsia and other hypertensive disorders during pregnancy. A Promise Walk is one way to raise financial support and awareness.
You can work to raise awareness of preeclampsia with local, state, and federal officials and representatives; as well as raise awareness in your community and on social media. The Preeclampsia Foundation offers ideas and resources to do all those things so preeclampsia can be addressed in legislation. The MoMMA’s Voices national coalition also seeks patients to partner with to raise awareness of preeclampsia and advocate for research and access to medical treatment.
How can we support pregnant mothers at risk for preeclampsia?
Access to good prenatal care is vital for catching preeclampsia early and being able to treat it and keep it mild. Offer to help a pregnant mom find an OBGYN, midwife, or doula if they do not have one already. It can be daunting sometimes to find a healthcare provider when you first find out you are pregnant. Most pregnancy help centers can offer a referral to an OBGYN, as well, if the search seems too overwhelming. Many can also help the mom apply for pregnancy insurance or find a provider who can help women who are low income, under-insured, or even completely uninsured, if that is a concern.
If you know someone who is pregnant and has complained of one or more of the common symptoms of preeclampsia, talk to them! Many women ignore the symptoms until they worsen, thinking they are merely common pregnancy symptoms. Encourage your friend, family member, coworker, or acquaintance to call their OBGYN and let them know about their symptoms as soon as possible. Even if the pregnant mom you know does not currently have any symptoms, you can share information with her on what to look out for.
Preeclampsia and the pro-life movement
Preeclampsia can require preterm delivery as a treatment to save the mother’s life or prevent permanent loss of function or irreparable damage to her bodily systems and organs. There are pro-choice people, doctors included, who will use preeclampsia as a reason for abortion, stating an abortion can treat preeclampsia or save the mom’s life. Is this true?
It is possible the difference is one of definitions. Pro-life people generally use the term “abortion” to specifically reference induced abortion, which is a procedure to terminate the condition of pregnancy with the intent to prevent a live birth. This is what the CDC defines abortion as:
“For the purpose of surveillance, a legal induced abortion is defined as an intervention performed by a licensed clinician (e.g., a physician, nurse-midwife, nurse practitioner, physician assistant) within the limits of state regulations that is intended to terminate a suspected or known ongoing intrauterine pregnancy and that does not result in a live birth.“
This definition of abortion requires killing the prenatal human to terminate the pregnancy. However, some people call any termination of pregnancy an abortion; this would include natural birth, induced labor, c-section, miscarriage (spontaneous abortion), stillbirth, and induced abortion. So someone could be saying abortion treats preeclampsia, and they may not exclusively mean induced abortion. However, some people truly believe induced abortion treats preeclampsia and use this condition as an excuse to push for legalization of abortion or to make pro-life people look like they do not care about women.
However, it is important to note that no professional (medical), government, and preeclampsia advocacy groups/organizations state induced abortion (which is what pro-life people are against) is the treatment recommended or necessary for even severe maternal health conditions like preeclampsia, HELLP Syndrome, placenta previa, etc. Most best practice information mentions both fetal and maternal health and safety being considered when treating preeclampsia.
The ACOG tells patients that stabilizing their condition and giving the fetus corticosteroids to hasten lung development are options for treating preeclampsia, and “If your condition or the baby’s condition worsens, prompt delivery will be needed.” In their official Committee Opinion Number 764, they list multiple reasons preterm delivery may be medically indicated in pregnancy, including hypertensive disorders during pregnancy, with waiting to deliver being listed at 34+ weeks, or, under severe circumstances “soon after maternal stabilization.” In Committee Opinion Number 767, concerning hypertensive disorders during pregnancy specifically, the ACOG states:
“In the event of a hypertensive crisis, with prolonged uncontrolled hypertension, maternal stabilization should occur before delivery, even in urgent circumstances,” and “Once the hypertensive emergency is treated, a complete and detailed evaluation of maternal and fetal well-being is needed with consideration of, among many issues, the need for subsequent pharmacotherapy and the appropriate timing of delivery.”
Neither abortion nor the phrase “termination of pregnancy” is mentioned in the entire article with detailed best proactive protocols for treating moms with preeclampsia and other hypertensive disorders.
We’ve already seen that the NICDH and ACOG state to take both fetal and maternal health and safety into account and that delivery, not abortion, is the treatment. The Preeclampsia Foundation also never recommends abortion as treatment. Doctors in fetal medicine and women’s health publishing on best practices do not recommend abortion as treatment, either, but rather recommend delivery:
“The cure for preeclampsia is simple – delivery of the placenta will ultimately lead to resolution of the disease. The challenges of management are in balancing the maternal risks of continuing pregnancy against the maternal risks of intervention and the fetal risks of preterm delivery.
It is important to recognize that, although most guidelines include specific gestational cutoffs for expectant and interventional management, a continuum of risk exists. While opting to continue pregnancy, the goals of treatment are to maintain a safe blood pressure, monitor the mother for deteriorating disease and the fetus for signs of placental dysfunction and growth restriction.”
Why would this be? Why would an induced abortion not be recommended treatment even under severe circumstance, even by a blatantly pro-choice medical organization like the ACOG?
Remember, preeclampsia manifests at or after 20 weeks’ gestation. Delivery (especially c-section) takes less time to complete (15 – 45 min) than an abortion (24 to 48+ hours) at that stage of fetal development. If the best treatment to save the mother’s life is to end the pregnancy and separate the placenta from her body, abortion is actually not the fastest way to accomplish those outcomes. Killing the child before delivery of the dead child does nothing to further treat the mother. Induced abortion also does not take the child’s health and safety into account at all, which is directly against best practice guidelines for treating preeclampsia.
It is true that preterm delivery may mean the child is likely to die after delivery, whether due to inadequate technology available to keep the child alive or hospital guidelines which do not include anything but palliative care to children born that early – but induced abortion gives no chance to the child, which is completely against all professional guidelines to take both the fetal and maternal health into account. Additionally, preterm delivery is not induced abortion, and pro-life people know this. Pro-life people are only against the intentional killing of the prenatal child, not their early live delivery if necessary to save the mother’s life. It is disingenuous and insulting for pro-choice advocates to use severe cases of the health of the mother as a pretext for advancing access to induced abortion.