Preeclampsia: Causes, Risk Factors, Diagnosis and Treatment

Preeclampsia is a serious complication during pregnancy that affects 2-8% of all pregnancies globally.¹ It is characterized by high blood pressure and damage to organs, most commonly the liver and kidneys, after 20 weeks of pregnancy.² Preeclampsia is a leading cause of maternal and fetal morbidity and mortality, accounting for approximately 18% of maternal deaths worldwide.³ What follows is an overview of the causes, risk factors, diagnosis and treatment of preeclampsia, based on current research and clinical guidelines.

Causes

The exact cause of preeclampsia is not fully understood, but it is thought to be related to abnormal placental development and dysfunction.¹ During normal pregnancy, the placenta forms a network of blood vessels that supply nutrients and oxygen to the fetus. In preeclampsia, the placenta fails to form these blood vessels properly, leading to reduced blood flow to the placenta and increased oxidative stress and inflammation.¹ This, in turn, can cause damage to the blood vessels and organs of the mother, leading to the symptoms of preeclampsia.

Risk Factors

Several factors increase the risk of developing preeclampsia, including maternal age (younger than 20 or older than 35), first pregnancy, multiple gestation, obesity, pre existing medical conditions such as hypertension or diabetes and a family history of preeclampsia.⁴ Women who have had preeclampsia in a previous pregnancy are at particularly high risk of developing it again in subsequent pregnancies.² Certain ethnic groups, such as African Americans and South Asians, are also at increased risk of developing preeclampsia.¹

Diagnosis

Diagnosis of preeclampsia is based on the presence of hypertension (blood pressure greater than or equal to 140/90 mmHg) and proteinuria (excessive protein in the urine) after 20 weeks of pregnancy.⁴ Other signs and symptoms of preeclampsia may include headache, blurred vision, abdominal pain and swelling of the hands and face.² In severe cases, preeclampsia can lead to seizures, a condition called eclampsia, which requires urgent medical attention.

Treatment

The only cure for preeclampsia is delivery of the baby and placenta. However, if the pregnancy is less than 37 weeks and the preeclampsia is mild, the doctor may recommend close monitoring of the mother and baby, bed rest and medication to control blood pressure and prevent seizures.⁴ If the preeclampsia is severe, delivery may be necessary to prevent complications such as placental abruption, stroke or maternal and fetal death.² In some cases, if the baby is premature, the doctor may need to administer corticosteroids to help the baby’s lungs mature before delivery.

Future Research

Despite the significant progress that has been made in understanding and managing preeclampsia, much remains to be learned about its underlying causes and effective prevention strategies. Current research is exploring various approaches to predicting and preventing preeclampsia, such as identifying biomarkers in the blood and urine that can indicate early signs of the condition, as well as investigating the potential role of nutritional and lifestyle interventions.¹

Several ongoing clinical trials are also investigating new treatments for preeclampsia, such as the use of magnesium sulfate to prevent seizures and the administration of sildenafil, a drug commonly used to treat erectile dysfunction, to improve blood flow to the placenta.¹ In addition, researchers are exploring the potential use of stem cell therapy and gene editing technologies to treat preeclampsia and other pregnancy-related complications.¹

Conclusion

Preeclampsia is a serious complication experienced during pregnancy that can have significant maternal and fetal health implications. Although the underlying causes of the condition are not fully understood, several risk factors have been identified, and current diagnostic and treatment approaches have significantly improved outcomes for affected women and their babies. However, ongoing research is needed to better understand the condition and develop effective prevention and treatment strategies that can improve outcomes for all women and babies affected by preeclampsia.

References

1. Ananth, C. V., & Basso, O. (2019). Preeclampsia: A primer for the practicing clinician. Obstetrical & Gynecological Survey, 74(7), 413-426.
2. National Institutes of Health. (2020). Preeclampsia and eclampsia. Retrieved from https://www.nichd.nih.gov/health/topics/preeclampsia
3. World Health Organization. (2019). WHO recommendations on antenatal care for a positive pregnancy experience. Retrieved from https://www.who.int/publications-detail-redirect/9789241516488
4. Magee, L. A., Pels, A., Helewa, M., Rey, E., von Dadelszen, P., Canadian Hypertensive Disorders of Pregnancy (HDP) Working Group, & SOGC Clinical Practice Guideline (2014). Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Journal of Obstetrics and Gynaecology Canada, 36(10), 1-30.