Preeclampsia As a Leading Cause of Maternal Death

Preeclampsia is a rare but serious condition that affects about 3% to 7% of all pregnancies. It is a dangerous form of high blood pressure that can occur during and after pregnancy.

Preeclampsia has gotten plenty of buzz in popular culture. It's been a plot point on at least two popular television shows—"Downton Abbey" in 2013 and "Black-ish" in 2017. And Beyoncé told Vogue she had an emergency C-section due to "toxemia," another word for preeclampsia.

Despite its brushes with fame, there's still a lot that people get wrong about preeclampsia. Here's a deeper look at this condition and what healthcare providers want you to know.

What Is Preeclampsia?

Preeclampsia is characterized by the elevation of an expectant parent's blood pressure and signs of liver or kidney damage, usually after the 20th week of pregnancy.

We don't know what causes preeclampsia. It was once thought that a toxin called "toxemia" was responsible. Healthcare providers now know this isn't true, but the name has stuck around.

Preeclampsia Risk Factors

Certain risk factors can increase your chances of preeclampsia:

• First pregnancy
• Multiple pregnancies (twins or more)
• Previous experience with preeclampsia
• Chronic hypertension
• Pregestational or gestational diabetes
• Obesity
• Antiphospholipid antibody syndrome
• Maternal age of 35 years or older
• Kidney disease
• Assisted reproductive technology (like IVF)

Diagnosis of Preeclampsia

There are two types of preeclampsia—preeclampsia with or without severe features. Both are diagnosed by measuring blood pressure and checking for protein in the urine. What defines one from the other is how high blood pressure and protein levels are.

• Preeclampsia without severe features is diagnosed if a pregnant person has a systolic (top number) blood pressure of 140 mm Hg or higher or a diastolic (bottom number) of 90 mm Hg or higher, and the amount of protein in the urine is 300 mg or more in a 24-hour urine specimen.
• Preeclampsia with severe features is diagnosed when the systolic number is greater than 160 mm Hg, or the diastolic pressure is greater than 110 mm Hg for two readings at least four hours apart, or the amount of protein in the urine is five or more grams in a 24-hour period.

Dangers of Preeclampsia

Preeclampsia can be dangerous to the pregnant person and the fetus. The pregnant person may not even feel sick, so it's important to have health monitored throughout pregnancy.

Preeclampsia can damage the pregnant person's kidneys, liver, brain, and other organs. It can cause complications during pregnancy, including loss of pregnancy. Sometimes preeclampsia can even cause organ failure and stroke. If severe, it can become eclampsia, which can be very dangerous.

The fetus is not isolated from the effects of preeclampsia. This condition can cause several problems with the placenta. The placenta is an organ that connects the fetus to the uterus. Preeclampsia-related problems can cut off the fetus's supply of oxygen and nutrients, which can impair growth. They can also cause preterm birth, stillbirth, and infant death.

Preeclampsia Death Rates

To reiterate, preeclampsia is rare. It occurs in less than 7% of pregnancies.

Nevertheless, preeclampsia is still one of the leading causes of maternal death in the United States. It is also one of the leading causes of maternal, fetal, and infant deaths worldwide.

The rate of preeclampsia in the U.S. has increased by 25% in the last two decades and is a leading cause of maternal and infant illness and death.

Postpartum preeclampsia and eclampsia should be treated immediately because they can quickly lead to stroke or death.

Preeclampsia Symptoms

The symptoms of preeclampsia can vary from patient to patient, but here are some things many people experience:

• Headaches
• Abdominal pain
• Shortness of breath
• Burning in the chest
• Nausea and vomiting
• Confusion
• Visual disturbances like flashing spots or blurred vision

A person can also look and feel swollen in the face or hands and experience sudden weight gain.

If the condition goes untreated, it can be fatal. Preeclampsia increases the risk of fetal growth restriction, preterm birth, C-section (Cesarean) delivery, and long-term maternal cardiovascular disease. It is also a leading cause of maternal and fetal morbidity and mortality.

What Do People (and Health Sites) Get Wrong?

It's important to spread awareness of preeclampsia, and it's also easy for people to be misinformed. Here are some of the most common things people get wrong.

Preeclampsia Does Not Only Occur During Pregnancy

Preeclampsia is often described as a condition that occurs "only during pregnancy," which is incorrect. The risks also extend into the postpartum period (the period after delivery).

Life-threatening conditions can develop and put the person at risk after delivery, even if that person didn't have high blood pressure during pregnancy. Postpartum preeclampsia is a serious but rare condition. It requires medical treatment and can be fatal.

People in the postpartum period should continue to have their health, including blood pressure, monitored.

Delivery Is Not the Only Cure

Delivering a baby is the way to stop the process that's causing high blood pressure. However, if the due date is still far away, healthcare providers will want to hold off on delivery until the baby is developed enough. Typically that will be at 37 weeks of pregnancy or later.

Still, it's wrong to think delivery will cure preeclampsia. Even though it's rare, postpartum preeclampsia can occur in people with high blood pressure during pregnancy and those without it. It can show up anywhere from 48 hours to six weeks after delivery.

Also, people who had preeclampsia have a higher risk of developing high blood pressure, kidney disease, heart disease, and stroke later in life than people who didn't have preeclampsia.

Racial Disparities

Black people are at especially high risk for preeclampsia. Black people who have had one pregnancy with preeclampsia should be extra vigilant if they get pregnant again. They may also be more likely to develop preeclampsia again in a future pregnancy.

Health disparities may be one factor that prevents Black people from getting proper care. They can also increase the risk of illness.

A Quick Review

Preeclampsia is a rare, dangerous form of high blood pressure that can happen during and after pregnancy. There is no clear cause. Preeclampsia is defined by high blood pressure and the presence of protein in your urine. If you're concerned about your risk for or that you may have preeclampsia, see your healthcare provider for a diagnosis.