by Craig L. Bissinger, MD, FACOG

I am often asked about a very common condition associated with pregnancy called preeclampsia, once known as toxemia. Preeclampsia occurs when a woman's blood pressure rises, and it affects seven percent of all pregnancies worldwide. It most frequently strikes first-time mothers and women who are carrying twins, or multiple pregnancies.

The women most at risk for preeclampsia are women with:

• Family histories of preeclampsia
• Long-standing high blood pressure or kidney disease
• Pregnancy-induced diabetes
• Autoimmune diseases (systemic lupus and others)

Preeclampsia is a vexing problem for obstetricians. Many fine researchers have devoted their life's work to finding a cure for this condition because of the potential dangers it poses to both mother and baby. In countries like the United States, this condition is readily diagnosed and treated, whereas in third-world countries, it may go unrecognized until serious health damage has occurred.

When I talk to my patients about preeclampsia, I start by describing the most common finding in this condition: an elevation in blood pressure. In some cases, a blood pressure of 130/80 can represent preeclampsia, whereas others might not be diagnosed until their pressure reaches much higher numbers.

The reason for the variation is that every woman has her own unique blood pressure. Some women have blood pressures of 90/60. For them, a pressure of 130/80 represents a significant change. In contrast, if her early pregnancy blood pressure is 130/80, then we need to adjust our levels to make a diagnosis of preeclampsia. Simply put, if the top number goes up by 30 or the bottom number by 15, over her base blood pressure, we begin our evaluation for preeclampsia.

Common Questions

The following are a series of questions I often hear from my patients about pre-eclampsia.

When does preeclampsia occur?
In general, preeclampsia is a disease that manifests itself in the second half of pregnancy, generally in the last weeks of a woman's term. For the rare patient, especially those with risk factors (listed above), it may begin much earlier.

What are the symptoms?
Some of the symptoms of preeclampsia are:

• Headaches
• Blurry vision
• Swelling of the face or hands
• Rapid weight gain
• Right upper-abdominal pain
• Less frequent urination

Many of these symptoms are associated with normal pregnancies too. In order to make the correct diagnosis we have to look at the whole patient, not just a few symptoms.

Are there any lab tests to help determine a preeclampsia diagnosis?
If I suspect a patient may have preeclampsia, I order a series of blood tests including a complete blood count (including platelets) and liver and kidney tests. If the platelet (blood cells responsible for clotting) count is low or the other tests are abnormal, these results help to establish a diagnosis. In addition, I check the woman's urine for signs of protein. This is another rapid test to help diagnose the condition.

If I had preeclampsia during my first pregnancy, will I have it again?
Ten percent of women will have preeclampsia with a subsequent pregnancy. The likelihood of recurrent preeclampsia increases for women with high risk factors (listed in the introduction).

Is there any way I can prevent preeclampsia?
Not at the present time. Several years ago, doctors believed that baby aspirin could prevent an onset of preeclampsia. Unfortunately, it proved not to be effective and most doctors have stopped using it for this purpose.

Are there any long-term consequences of preeclampsia?
No. However, ten percent of my patients with preeclampsia have high blood pressure for some weeks following delivery and some of them require treatment with medication. Still, preeclampsia is not a predictor of high blood pressure later in life.

Preeclampsia, Different Degrees

I'd like to tell you how we go about making this important determination before I discuss the way we treat each condition.

Severe preeclampsia is characterized by at least one of the following findings:

• A blood pressure of 160/110
• Large quantities of protein in the urine
• Visual blurring and headaches
• Right upper abdominal pain
• Reduced urination
• Low-platelet count
• Elevated liver tests

(If a patient suffers from a seizure, then she is known to have eclampsia).

Mild Preeclampsia is characterized by:

• Blood pressure not to exceed 160/110
• Mild facial or hand edema (swelling)
• Brisk reflexes
• Mild to moderate amounts of protein in the urine

In reality, the distinction between the two types of preeclampsia is not so cut and dry. A woman may have a significant amount of protein in her urine and a marginally elevated blood pressure. There are many factors involved in a diagnosis, and it is a physician's job to sort through the signs and symptoms to determine what is happening to the mother and baby.

Case Studies

The following are some real case studies from my practice that will help to underscore the diagnosis and treatment options available for severe and mild preeclampsia.