Q&A with a Preeclampsia Expert: Dr. Strickland Answers Top Questions

Understanding the signs and symptoms of preeclampsia, combined with routine screening, can save lives. 

Preeclampsia impacts more than 400,000 women in the U.S. each year, and it is a leading contributor to maternal/perinatal mortality worldwide. But around 60% of preeclampsia-related deaths can be prevented. Many pregnant women do not know the signs and symptoms of preeclampsia, so awareness of symptoms is vital to early detection, according to Sydney Strickland, PhD, DABCC, and biochemical genetics discipline director and laboratory director for Labcorp Women’s Health and Genetics.

“Preeclampsia can quickly become a medical emergency,” Dr. Strickland says. “It can have risks for both the mother and fetus. We know that early detection can improve outcomes, and it’s important for patients to understand more about the disease so they can better advocate for themselves.”

Here are a few of the most commonly asked questions about preeclampsia. 

What is preeclampsia?

Preeclampsia is one of the hypertensive (i.e., high blood pressure) disorders that can occur during pregnancy. In preeclampsia, placental dysfunction reduces the blood supply to the fetus, resulting in less oxygen and fewer nutrients to the developing baby. This placental dysfunction is thought to be the driver of hypertension in the mother.

Like gestational hypertension, preeclampsia involves high blood pressure at or after 20 weeks gestation in a woman whose blood pressure was normal before pregnancy. It can also include blood pressure at or greater than 140/90 mmHg, increased swelling in hands and feet and elevated amounts of protein in the urine.

What causes preeclampsia?

Obstetricians don’t know why some patients develop preeclampsia and some don’t, or who will develop mild or severe symptoms, but several factors, such as placental dysfunction, could contribute to the development and progression of hypertensive disorders.

How is preeclampsia diagnosed?

Per the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), during each prenatal visit, your provider will measure your blood pressure and perform a urinalysis. If you’re more than 20 weeks into your pregnancy, and your blood pressure reading is high (at least 140/90 mmHg), your provider may run more tests. These tests allow them to look for extra protein in the urine along with other preeclampsia symptoms.

The NICHD provides detailed criteria for a preeclampsia diagnosis—including mild and severe forms of the condition—from the American College of Obstetricians and Gynecologists (ACOG).

Mild preeclampsia is diagnosed when a pregnant person has:

• Systolic blood pressure of 140 mmHg or higher or diastolic blood pressure of 90 mmHg or higher and either:
  • Urine with 0.3 or more grams of protein in a 24-hour specimen or a protein-to-creatinine ratio greater than 0.3 
    or
  • Blood tests that show kidney or liver dysfunction
  • Fluid in the lungs and difficulty breathing
  • Visual impairments

Severe preeclampsia is diagnosed when a pregnant person has any of the following:

• Systolic blood pressure of 160 mmHg or higher, or diastolic blood pressure of 110 mmHg or higher on two occasions at least four hours apart while on bed rest
• Urine with 5 or more grams of protein in a 24-hour specimen, or 3 or more grams of protein on two random urine samples collected at least four hours apart
• Test results suggesting kidney or liver damage (e.g., blood tests revealing low numbers of platelets or high liver enzymes)
• Severe, unexplained stomach pain that does not respond to medication
• Symptoms that include visual disturbances, difficulty breathing or fluid buildup
   

How is preeclampsia treated?

Per the NICHD, if your pregnancy is at 37 weeks or later, your healthcare provider will likely want to deliver the fetus to treat preeclampsia and avoid further complications.

If your pregnancy is at less than 37 weeks, your provider may consider the following options:

• Additional testing for mother and fetus: For the mother, a provider may order blood and urine tests to determine if preeclampsia is progressing (e.g., tests to assess platelet counts, liver enzymes, kidney function and urinary protein levels). For the fetus, your provider may recommend an ultrasound, heart rate monitoring, assessment of fetal growth and amniotic fluid assessment
• Anti-seizure medication: Because hypertension (i.e., high blood pressure) puts pressure on the blood vessels, there can sometimes be swelling in the brain as a result, which may lead to seizures. To prevent seizures with preeclampsia, your provider may prescribe anticonvulsive medication, such as magnesium sulfate
• Hospitalization: In some cases, such as with severe preeclampsia, you may be admitted to the hospital for close and continuous monitoring. Treatment in the hospital may include intravenous medication for blood pressure control, seizure prevention and other potential complications
• For those who are at high risk for preeclampsia, the U.S. Preventive Services Task Force recommends taking low-dose (81 mg per day) aspirin starting after 12 weeks of pregnancy to prevent preeclampsia
   

What happens if it progresses or is left untreated?

If preeclampsia is left untreated or progresses, it can develop into an emergency for the pregnant person and the baby. If a pregnant woman progresses into eclampsia, which is the onset of seizures or coma in a pregnant person, organ damage/failure, stroke, preterm birth, pregnancy loss and even death can happen. For a baby, possible outcomes include impaired growth due to lack of oxygen, preterm birth, stillbirth and infant death. 

What patients are at risk?

According to the NICHD, preeclampsia typically occurs in first pregnancies. However, if you have had preeclampsia in a previous pregnancy, you are seven times more likely to develop preeclampsia in a later pregnancy. If it has been 10 years or more since your previous pregnancy, you are also at heightened risk for preeclampsia.

Per the NICHD, other risk factors for preeclampsia include:

• Chronic high blood pressure or kidney disease before pregnancy
• High blood pressure or preeclampsia in an earlier pregnancy
• Those who are overweight or obese 
• Maternal age greater than 35 years 
• Pregnancy with more than one fetus
• Black women are at higher risk. Also, among those who have had preeclampsia before, women of color are more likely than white women to develop preeclampsia again in a later pregnancy
• Family history of preeclampsia

Additionally, the NICHD notes that preeclampsia is more common in pregnancies that involve egg donation, donor insemination or in vitro fertilization. Preeclampsia risk is also higher among those with a history of certain health conditions, such as:

• Migraines
• Diabetes
• Rheumatoid arthritis
• Lupus
• Scleroderma
• Urinary tract infections
• Gum disease
• Polycystic ovary syndrome
• Multiple sclerosis
• Gestational diabetes
• Antiphospholipid syndrome
• Sickle cell disease

What are some additional health concerns that may impact those who experienced preeclampsia?

According to the Preeclampsia Foundation, people who are diagnosed with preeclampsia have greatly increased risk of high blood pressure, heart disease and stroke. The condition also increases the risk of developing diabetes later in life, but Dr. Strickland adds that it is unknown whether these risks are caused by preeclampsia, or if the person was already predisposed or if the condition may emerge following a complicated pregnancy.

Infants of preterm birth are at risk for certain long-term health issues. These include learning disorders, cerebral palsy, epilepsy, deafness and blindness. Infants born preterm due to preeclampsia  are at greater risk for those long-term health issues and more, including poor intrauterine growth restriction (IUGR), cardiovascular problems, metabolic issues and kidney problems. These are potential risks, and not all preterm infants experience these issues. 

Know the symptoms and talk to your provider if you experience symptoms

If you are pregnant, Dr. Strickland says regular prenatal care throughout your pregnancy is key so that your provider can monitor your blood pressure and other vital signs of preeclampsia. While the condition can be serious, with early diagnosis and prophylaxis treatment, most people with preeclampsia go on to have healthy pregnancies and deliveries.

Together, you and your provider can discuss the risks and symptoms of preeclampsia and, if needed, develop a treatment plan that is right for you.

Dr Strickland lives in central North Carolina and is continually chasing a toddler and puppy with her husband. When not working, Dr Strickland enjoys reading and watching sports (football and basketball predominately).