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Preeclampsia (toxemia in pregnancy) is a disorder of pregnancy that is characterized by hypertension (high blood pressure) and proteinuria (excessive protein in the urine), often including edema (swelling) and occasionally involving thrombocytopenia (low platelets) or liver function abnormalities.
Preeclampsia-eclampsia can occur any time after 20 weeks of gestation and up to six weeks postpartum (after delivery). Some 5% of all patients with preeclampsia progress to eclampsia.
Incidence; Causes & Development; Risk Factors
Preeclampsia complicates 5-7% of pregnancies in otherwise healthy patients.
The cause of preeclampsia is not known, but may be related to immune factors. Preeclampsia may result from fetal antigens -- elements of the fetus that trigger an immune response in the mother.
The risk of preeclampsia is highest in primagravidas (women in their first pregnancy) and in women who have had minimal exposure to sperm (having used barrier methods of contraception, e.g. condoms).
Signs & Symptoms
Preeclampsia is characterized by increasing blood pressure, headaches, the presence of albumin (a blood protein) in the urine, and edema (accumulation of water) in the lower extremities.
A person with mild preeclampsia may feel perfectly well. Therefore, it is important to attend all prenatal checkups to spot this condition early. The symptoms of severe preeclampsia, which can develop during the last weeks of pregnancy are headaches, blurred vision, intolerance for bright light, nausea and vomiting, and salt and water retention. It may progress to eclampsia, the symptoms of which are convulsions (seizures) and sometimes unconsciousness.
Diagnosis & Tests
The diagnosis of preeclampsia is primarily, but not exclusively, made on the basis of proteinuria and edema in a hypertensive pregnant woman. Other factors helpful in making the diagnosis are hemoconcentration, hyperreflexia, hypoalbuminemia, liver function abnormalities, thrombocytopenia, and hyperuricemia. Abnormal prostaglandin synthesis may be the pivotal defect causing increased peripheral vascular resistance, severe vasoconstriction, endothelial injury and secondary hypertension.
Treatment & Prevention
Management of preeclampsia has centered on aggressive maternal/fetal assessment and earliest safe delivery. Frequent monitoring of maternal blood pressure, urinary protein excretion, weight change, and symptoms is mandatory. Regular biophysiologic assessment of the fetus is also essential.
Prognosis; Complications
Most patients with preeclampsia are treated on an inpatient basis. If the preeclampsia is mild and blood pressure is adequately controlled with no signs of impending seizure, patients may be managed at home with bedrest. In this case, blood pressure should be monitored twice daily and fetal status should be assessed at least twice weekly with a non-stress test and a biophysiologic profile. Delivery at maturity is still mandatory in this group of patients, unless induction has been unsuccessful. In the latter case, cesarean section or a second trial of induction must be considered.
If the condition is not properly treated, the patient may develop eclampsia, a potentially fatal condition involving coma and convulsions.
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Conditions that suggest Eclampsia / Preeclampsia:
Eclampsia / Preeclampsia can lead to:
Recommendations and treatments for Eclampsia / Preeclampsia: | | | | | Drug | Not recommended:
 GHB (Gamma-Hydroxybutyrate) |
Mineral |
 Magnesium | Magnesium has been used specifically to lower blood pressure in pregnant women with preeclampsia, and as a mild anticonvulsant in cases where the condition progresses to eclampsia.
The backbone of management continues to be parenteral (intravenous) administration of magnesium sulfate and delivery as soon as the fetus is mature or when maternal risks outweigh any risks to the fetus. The main purpose of this therapy is to inhibit progression to eclampsia. Magnesium may be given intramuscularly or intravenously. |
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Vitamins |
 Vitamin C (Ascorbic Acid)| | Several studies imply that harmful free radicals called lipid peroxides contribute to preeclampsia [Khan KS, Chien Pl. Brit J of Obst & Gyn 1997;104(10): pp.11739], and that women with this condition are low in the antioxidants that combat them. [Ziari SA, et al. Am Jl of Perinat 1996;13(5): pp.28791]
The U.S. RDA is 70mg. NOTE: Be very careful to avoid high doses. |
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KEY | | Strong or generally accepted link |  | | Proven definite or direct link |  | | Very strongly or absolutely counter-indicative | | | May do some good | | | Highly recommended | | | Reasonably likely to cause problems |
GLOSSARY
Antigen (Antigenic, Antigens)
A substance, usually protein or protein-sugar complex in nature, which, being foreign to the bloodstream or tissues of an animal, stimulates the formation of specific blood serum antibodies and white blood cell activity. Re-exposure to similar antigen will reactivate the white blood cells and antibody programmed against this specific antigen.
Antioxidant (Antioxidants)
A chemical compound that slows or prevents oxygen from reacting with other compounds. Some antioxidants have been shown to have cancer-protecting potential because they neutralize free radicals. Examples include vitamins C and E, beta carotene, the minerals selenium and germanium, superoxide dismutase (SOD), coenzyme Q10, catalase, and some amino acids.
Checkup (Check-up, Checkups, Check-ups)
A thorough physical examination that includes a variety of tests depending on the age, sex and health of the person.
Eclampsia
Convulsions, unrelated to other cerebral conditions, in pregnant or puerperal women (women who have just given birth).
Edema
Abnormal accumulation of fluids within tissues resulting in swelling.
Endothelium (Endothelia, Endothelial, Endothelioid)
A thin layer of flat epithelial cells that lines serous cavities, lymph vessels, and blood vessels.
Free Radical (Free Radicals)
A free radical is an atom or group of atoms that has at least one unpaired electron. Because another element can easily pick up this free electron and cause a chemical reaction, these free radicals can effect dramatic and destructive changes in the body. Free radicals are activated in heated and rancid oils and by radiation in the atmosphere, among other things.
Hyperreflexia
Dysreflexia characterized by an exaggeration of reflexes, for example the 'knee jerk' reflex.
Hypertension
High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Lipid (Lipids)
Fat-soluble substances derived from animal or vegetable cells by nonpolar solvents (e.g. ether); the term can include the following types of materials: fatty acids, glycerides, phospholipids, alcohols and waxes.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Nausea
Symptoms resulting from an inclination to vomit.
Parenteral
Not in or through the digestive system, introduced otherwise than by way of the intestines and occurring outside the intestine. Examples are intravenous, subcutaneous, intramuscular, or intramedullary injection.
Peroxides (Peroxide)
Free radicals that are by-products formed in our bodies when molecules of fat react with oxygen.
Picoliter (pL)
0.000000000001 or one trillionth of a liter.
Platelets (Platelet)
Cells that help the blood to clot.
Postpartum
After childbirth.
Preeclampsia (Toxemia Of Pregnancy)
A toxic condition developing in the last 4 or 5 months of pregnancy that is characterized by a sudden rise in blood pressure, excessive weight gain, generalized edema (especially hands, ankles, feet and face), albuminuria, severe headache, and visual disturbances. It used to be called toxemia of pregnancy.
Some rise in blood pressure is normal during pregnancy, but in preeclampsia the rise is dramatic and is accompanied by other changes. The most notable of these are high concentrations of protein in the urine and a tendency to swell up, especially in the face and hands. This can cause women with preeclampsia to put on several pounds in a few days.
Prostaglandin (Prostaglandins)
Any of a class of physiologically active substances present in many tissues, with effects such as vasodilation, vasoconstriction, stimulation of the smooth muscles of the bronchus or intestine, uterine stimulation; also involved in pain, inflammation, fever, allergic diarrhea, and dysmenorrhea. A potent hormone -- similar in structure to an unsaturated fatty acid -- that acts in extremely low concentrations on local target organs; first isolated from the prostate.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Proteinuria
The presence of protein in the urine, sometimes a symptom of kidney compromise.
RDA (RDAs, US RDA, USRDA)
Recommended Daily Allowance of vitamins or other nutrients as determined by the FDA. U.S. RDAs are more widely used than RDAs, and focus on 3 age groups: Infants of 0-12 months; Children of 1-4 years; Adults and children of more than 4 years.
Seizure (Seizures)
While there are over 40 types of seizure, most are classed as either partial seizures which occur when the excessive electrical activity in the brain is limited to one area or generalized seizures which occur when the excessive electrical activity in the brain encompasses the entire organ. Although there is a wide range of signs, they mainly include such things as falling to the ground; muscle stiffening; jerking and twitching; loss of consciousness; an empty stare; rapid chewing/blinking/breathing. Usually lasting from between a couple of seconds and several minutes, recovery may be immediate or take up to several days.
Thrombocytopenia
Condition of abnormally small number of platelets circulating in the blood, characterized by inability to properly clot blood and easy bruising.
Uric Acid (Hyperuricemia)
The final end product of certain native or dietary proteins, especially the nucleoproteins found in the nucleus of cells. Unlike the much smaller nitrogenous waste product urea, which is mostly recycled to form many amino acids, uric acid is an unrecycleable metabolite that must be excreted: nucleoprotein to purine to uric acid to the outside in the urine or the sweat. Hyperuricemia: Having elevated blood uric acid, either from a rapid rate of cell breakdown and synthesis (such as might occur from fasting, heavy training, trauma or any number of major diseases), a high consumption of organ meats, glandular supplements or spirulina, or the inability (usually hereditary) to excrete uric acid in the urine as fast as it is produced, even though production itself is not elevated.
Vascular
Relating to the blood vessels of the body. The blood vessels of the body, as a group, are referred to as the vascular system. They are composed of arteries, veins and capillaries - arteries that pass oxygen-rich blood to the tissues of the body; veins which return oxygen-depleted blood from the tissues to the lungs for oxygen; and the capillaries that are the tiniest vessels and are between the arteries and veins.
Vasoconstriction (Vasoconstrictor, Vasoconstrictors)
A narrowing of any blood vessel, especially the arterioles and the veins in the blood reservoirs of the skin and the abdominal viscera.
Last updated: Apr 13, 2008
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