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Preeclampsia
Anne Marie Valente, MD; Katherine E. Economy, MD
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W
omen are at risk for elevations
of blood pressure during their
pregnancy. An elevated blood pressure
≥140/90 mm Hg associated with significant protein in the urine, which occurs
in the second half of pregnancy, is
known as preeclampsia. Preeclampsia
can vary in severity from women without any symptoms and a mild form
to significant symptoms and laboratory alterations resulting in a severe,
dangerous condition. Untreated preeclampsia may lead to eclampsia (seizures during pregnancy). Preeclampsia
usually resolves after delivery of the
fetus and placenta. However, women
who develop preeclampsia appear to
be at increased risk for developing cardiovascular complications later in life.1
Therefore, regular healthcare followup is essential in these women.
What Is Preeclampsia?
Preeclampsia is a hypertensive condition that women develop during the
second half of pregnancy (after 20
weeks gestation or postpartum). It is
characterized by high blood pressure
and protein in the urine.2 This can
occur in women with or without preexisting high blood pressure. This condition occurs in 5% to 8% of pregnancies
and may involve other systems, such
as the liver. Preeclampsia may result
in poor growth of the fetus. HELLP
(Hemolysis, Elevated Liver enzymes,
Low Platelet count) syndrome is a
severe form of preeclampsia with laboratory findings of anemia, low platelets,
and elevated liver enzymes. The treatment for preeclampsia is delivery of the
fetus and the placenta. Occasionally,
preeclampsia can take several weeks or
months to resolve after delivery.
What Are the Risk
Factors for Development
of Preeclampsia?
• A past history of preeclampsia,
particularly if the previous episode was severe
• A family history of preeclampsia
in a first-degree relative
• First pregnancy
• Twin or triplet pregnancy
• Advanced maternal age (>40
years)
• Diabetes mellitus
• Hypertension
• Obesity
• Antiphospholipid antibody
syndrome
What Signs and Symptoms
Should I Look for
During Pregnancy?
Many women with preeclampsia do
not have symptoms. However, severe
preeclampsia may cause any of the
following:
• Persistent or severe headache
• Changes in vision
• Nausea, vomiting
• Abdominal pain
• Swelling of the hands/face
• Sudden weight gain
If you have any of these symptoms during pregnancy, you should alert your
healthcare providers. These symptoms
are not always associated with preeclampsia. However, it is important to
consider this diagnosis.
How Is Preeclampsia
Diagnosed?
Preeclampsia is defined by an elevated
resting blood pressure and an excess of
The information contained in this Circulation Cardiology Patient Page is not a substitute for medical advice, and the American Heart Association
recommends consultation with your doctor or healthcare professional.
From the Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston,
MA (A.M.V.); Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA (A.M.V.); and Department of Obstetric and
Gynecology, Maternal-Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (K.E.E.)
Correspondence to Anne Marie Valente, MD, Co-Director, Pregnancy and Cardiovascular Disease Program, Brigham and Women’s Hospital, Department
of Medicine, Division of Cardiology, 75 Francis St, Boston, MA, 02115. E-mail [email protected]
(Circulation. 2013;128:e344-e345.)
© 2013 American Heart Association, Inc.
Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.113.003858
e344
Valente and Economy Preeclampsia e345
Table. Types of Hypertension During Pregnancy
Diagnosis
Findings
Timing
Chronic hypertension
Elevated BP ≥140/90
Onset before 20 wk gestation
Gestational (pregnancy-induced)
hypertension
Elevated BP ≥140/90
Onset after 20 wk gestation with
resolution by 6 wk postpartum
Elevated BP ≥140/90
≥ 0.3 g of protein in 24 h
Onset after 20 wk gestation with
resolution by 6 wk postpartum
Preeclampsia
BP indicates blood pressure.
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protein in the urine. The blood pressure
should be documented by 2 separate
recordings, at least 6 hours apart. The
systolic pressure (top number) is ≥140
mm Hg, and the diastolic blood pressure (bottom number) is ≥90 mm Hg.
Proteinuria is defined as ≥0.3 g of protein in a 24-hour urine collection or 3+
protein on a urine dipstick.
How Does Preeclampsia
Affect My Body
and My Fetus?
Preeclampsia can affect many organ
systems, including the lungs, kidneys,
liver, heart, and neurological system.
Women with preeclampsia are also at
increased risk for placental abruption,
which is separation of the placenta from
the wall of the uterus, which presents
as vaginal bleeding. Preeclampsia may
result in poor growth of the fetus. It may
result in a reduction in the amount of
amniotic fluid that surrounds the fetus
in the uterus. You may have frequent
ultrasound monitoring of the baby to
monitor for poor growth, unusual blood
flow patterns in the umbilical cord,
and low amniotic fluid. Women who
develop preeclampsia are at increased
risk for developing cardiovascular
complications later in life, and regular healthcare follow-up is essential in
these women.
your obstetrician if you are diagnosed
with preeclampsia to closely follow
your blood pressure, symptoms, and
the growth of the fetus. If preeclampsia is severe or early, this may lead to
prematurity in the fetus. You may be
admitted to the hospital for monitoring, and your obstetrician will work
with you to determine the safest time
for delivery.
If I Have Elevated Blood
Pressure in Pregnancy, Do
I Have Preeclampsia?
Not necessarily. There are several conditions that result in high blood pressure during pregnancy (Table).
Disclosures
None.
How Is Preeclampsia
Treated?
References
The only treatment for preeclampsia is
delivery. Most women can have a vaginal delivery. It is important to treat the
high blood pressure with medications.
Commonly used medications include
β-blockers, α-methyldopa, and calcium channel blockers. Typically, magnesium sulfate is used during labor and
delivery and in the postpartum period,
as well, to prevent seizures.3 It is likely
that you will have frequent visits with
1. Garovic VD, Bailey KR, Boerwinkle E, Hunt
SC, Weder AB, Curb D, Mosley TH Jr, Wiste
HJ, Turner ST. Hypertension in pregnancy as
a risk factor for cardiovascular disease later
in life. J Hypertens. 2010;28:826–833.
2.Hakim J, Senterman MK, Hakim AM.
Preeclampsia is a biomarker for vascular
disease in both mother and child: the need
for a medical alert system. Int J Pediatr.
2013:953150.
3. Diagnosis and Management of Preeclampsia
and Eclampsia. ACOG Practice Bulletin No.
33. American College of Obstetricians and
Gynecologists; 2002.
Preeclampsia
Anne Marie Valente and Katherine E. Economy
Circulation. 2013;128:e344-e345
doi: 10.1161/CIRCULATIONAHA.113.003858
Downloaded from http://circ.ahajournals.org/ by guest on June 18, 2017
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