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Preeclampsia: What you need to know

Preeclampsia: What you need to know

In the 2018 Vogue cover, Beyoncé briefly shares about her complications with toxemia — another term for pre-eclampsia, which occurs in between 1 and 15 percent of pregnancies, according to global estimates by region. Due to the disorder, Beyoncé had been on bed rest for over a month and had to undergo an emergency C-section to save her and the babies’. 

Pre-eclampsia has been attributed to 2 to 8 percent of pregnancies complications globally. It is considered to be one of the most preventable causes of maternal death, however, there is little recent national population-based data on the prevalence of the condition and its associated coexisting conditions and complications that can inform prevention efforts.

A 2017 report by the Department of Health and Human Services found that pre-eclampsia and eclampsia (seizures that develop after pre-eclampsia that could lead to a coma) are 60 percent higher in Black women and more severe. In the United States, about 3 percent of pregnancies are affected by pre-eclampsia, according to a cohort analysis of 30 years’ worth of data published in the journal BMJ in 2013. 

The American College of Obstetricians and Gynecologists (ACOG) defines preeclampsia as a disorder of new-onset high blood pressure occurring after 20 weeks of gestation. The diagnosis of preeclampsia is characterized by high blood pressure and either excess protein in the urine (one common sign of this is very foamy pee) or, in the absence of proteinuria, other signs or symptoms of organ dysfunction, such as anemia or neurological problems.

Since pregnant women with pre-eclampsia are usually asymptomatic, continuous prenatal medical visits are recommended for early detection to avoid progression.  However, postpartum pre-eclampsia tends to develop suddenly and can progress rapidly leading to life-threatening complications including seizures, strokes, blood clots, excess fluid in the lungs and permanent damage to the brain, kidneys, liver and even death.

Characteristic symptoms of preeclampsia include fatigue, swelling, nausea, shortness of breath, headaches and pain in the back or shoulders, which can be difficult to distinguish from pregnancy pains and complaints. In the U.S, most maternal deaths linked to preeclampsia occur after delivery. It is difficult to predict who will be affected by it after giving birth, since women aren’t seeking medical attention until their symptoms are severe. This is largely in part due to the nature of the condition, which can appear up to six weeks after delivery — when most women are preoccupied with the infant’s needs. It also does not help that the American care system requires a woman to check-in with her doctor at six weeks, in contrast to northern and western Europe models where women with normal pregnancies receive post care home visits by medics even upto weeks after their deliveries.

Research reveals that women at higher risk include those with preexisting hypertension (high blood pressure before pregnancy or within the first 20 weeks of gestation), gestational hypertension (onset of high blood pressure after 20 weeks of gestation), although many women who develop the disorder have no history of high blood pressure. Other risk factors include, having twins or multiple babies, preexisting diabetes, renal disease, obesity, and women giving birth for the first time. Women under 20 and over 40, Black women, and women residing in the poorest areas are also more predisposed.

New research has revealed, exposure of children to preeclampsia renders them at risk to a number of developmental problems. Using a Norwegian health database, researchers studied slightly under 1 million children; over 28,000 of whom were exposed to pre-eclampsia in full-term pregnancies over a period of five years, and others as long as 14 years. The Study, in JAMA Psychiatry found that exposure to preeclampsia was associated with 50 percent increase in the relative risk for epilepsy, a 21 percent increased risk for vision or hearing loss, and a 50 percent increased risk for intellectual disability. Pre-eclampsia also increased the risk for cerebral palsy, attention-deficit hyperactivity disorder and autism spectrum disorder.

One of the most effective treatments of preeclampsia is delivery, whether induced or via C-section, depending on the stage of pregnancy, the mother’s health, and the risks of premature birth. This was what was recommended in Beyoncé’s case. Unfortunately, as a result of the disorder, one can end up ‘over-staying’ in the hospital, which has cost implications. In 2012, in the United States, the estimated cost of preeclampsia within the first 12 months of delivery was $2.18 billion ($1.03 billion for women and $1.15 billion for infants), which was disproportionately due to premature births.

If diagnosed with preeclampsia, it is important to stay focused and not to worry. In most cases things turn out well. Women should also seek medical check-ups where they are monitored even weeks after delivery. With the ever increasing severity of the disorder, investment in preeclampsia research should be made a priority as the gaps in research are real and glaring.

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