Pregnancy Induced Hypertension
Pre-Eclampsia is a leading cause for which women receive the bed rest prescription. Bedrest Coach Darline Turner shares the definition of pre-eclampsia, how it is diagnosed, how it is treated and what Mamas on Bedrest can do to care for themselves and partner in their health care if they are diagnosed with Pre-eclampsia. For more information, see our previous blog posts on Pre-Eclampsia or send e-mail us at email@example.com.
May is National Pre-Eclampsia Awareness Month. Viacord, a cord blood bank company, is planning and supporting activities to benefit the Pre-Eclampsia Foundation. The Campaign is called the “Aware Because I Care” Campaign and it is a month long initiative to raise funds for the Pre-Eclampsia Foundation. They are accepting donations of $10, collecting and donating up to $10,000. The funds will be used for Pre-Eclampsia patient education, medical research and direct support for women with the disorder. Learn more about the #awarebecauseicare campaign here.
Pre-Eclampsia is one of the leading reasons that mamas are prescribed bed rest. Overall, hypertensive disorders (high blood pressure) during pregnancy account for 11% of pregnancy related deaths during pregnancy according to the US Centers for Disease Control and Prevention. Clearly, early recognition and treatment of pre-eclampsia are essential for the health and well being of both mamas and babies. Here, we give a review of pre-eclampsia and some of the latest information and treatments available.
Definition-Pre-Eclampsia is defined as blood pressure > 140/90 mmHg on at least 2 occasions 6 hours apart and protein in the urine (>300mg in a 24 hr period). Pre-Eclampsia is also associated with facial and extremity swelling and in severe cases, kidney failure and grand mal seizures.
Presentation-Pre-Clampsia typically presents after 20 weeks gestation and is often asymptomatic at diagnosis. It can occur in the new first time mother as well as in a “veteran” mama. It presents in singleton pregnancies as well as in multiple gestations. There is no particular presentation or no particular type of mama who will develop pre-eclampsia. What is known is that women with pre-existing conditions such as high blood pressure, cardiovascular disease, diabetes, kidney disease, or clotting/blood disorders are at increased risk of developing pre-eclampsia. Pre-eclampsia is also more common in women with multiple gestations (Twins or more) and older mamas. The wild card is obesity. Some studies have shown that mamas who enter pregnancy overweight or obese increase their risks of developing pre-eclampsia. Other studies have not been conclusive. Currently obesity is not considered an absolute risk factor for pre-eclampsia, but given its negative effects on other aspects of mama’s health and hence baby’s health, obese mamas should be watched closely.
Pre-Eclampsia is classified as mild or severe and treatment is guided depending on the severity. Mild pre-eclampsia is defined as hypertension (BP >140/90 mmHg) on two occasions at least 6 hours apart, but without evidence of end-organ damage (kidney disease inparticular). Severe pre-eclampsia may include an array of signs and symptoms and significant laboratory findings. At least one of the following signs or symptoms must be present with the indicators of pre-eclampsia for the condition to be regarded as severe. Severe Pre-Eclampsia is a medical emergency and must be treated immediately, typically by immediate delivery of the infant so as to save the life of both mama and infant.
Symptoms of Severe Pre-Eclampsia
Neurological: blurred vision, severe headache, altered mental status, stroke, seizures
Liver Damage: Right Upper Quadrant abdominal pain, elevated liver enzymes indicating liver damage (Precursors to HELLP Syndrome, Hemolysis, Elevated liver enzyme levels, low platelet count)
Kidney: Protein in the urine, decreased urine output, dark urine
Pulmonary Edema: Fluid in the lungs
Fetal: Intrauterine Growth Retardation
Blood Disorders: Increase in blood clotting, Low platelet count
Treatment of Pre-eclampsia
As previously stated, severe pre-eclampsia and pre-eclampsia that has progressed to organ damage or HELLP Syndrome is a medical emergency and must be treated aggressively in the hospital setting. Mild pre-eclampsia can be treated with bed rest and medication with close watch for development of symptoms indicating progression to a more severe form.
Magnesium Sulfate-Magnesium sulfate is considered first-line treatment for the prevention of primary and recurrent eclamptic seizures. It is also utilized for prophylactic treatment in all patients with severe preeclampsia.
Anti-Hypertensive (high Blood Pressure)Medications – Medications known to decrease blood pressure but found to be safe in pregnancy are Hydralazine, Labetalol, Nifedipine, Nicardipine and Sodium Nitroprusside.
Aspirin Therapy – Low dose aspirin therapy is controversial in the treatment of pre-eclampsia. While an individual study was unable to prove benefit for using low dose aspirin therapy as a preventive for pre-eclampsia, a meta-analysis of several studies found that using low dose aspirin starting before 16 weeks of gestation and continuing throughout pregnancy. Currently, low dose aspirin therapy is not recommended as a preventive treatment for pre-eclampsia. Physicians and researchers are still trying to determine which women are at greatest risk for developing pre-eclampsia and which women will benefit from low dose aspirin therapy.
US Pharmacist. 2012;37(9):48-53. © 2012 Jobson Publishing
Aspirin in the prevention of pre-eclampsia in high risk women: a randomised placebo controlled PREDO trial and a meta analysis of randomised trials. Villa, P., Kajantie, E., Räikkönen, K., Pesonen, A.-K., Hämäläinen, E., Vainio, M., Taipale, P., Laivuori, H. and on behalf of the PREDO Study group (2012). BJOG: An International Journal of Obstetrics & Gynaecology. doi: 10.1111/j.1471-0528.2012.03493.x
At least that is what statistics released by the US Centers for Disease Control and prevention indicate. According to a recent report, minority women in the United States are more likely to die during and immediately after childbirth than Caucasian women. According to their report,
“Black, Hispanic and Asian women – and a handful of white women not born in the U.S. – accounted for 41% of all births nationwide between 1993 and 2006, but for 62% of pregnancy-related deaths.”
The actual numbers are really quite eye opening. For every 100,000 babies born to white women, between 7 and 9 mothers died from complications related to pregnancy. Yet, in comparison, 32 to 35 black women died for every 100,000 live babies, while deaths among Hispanic and Asian women (born in the US and elsewhere) were closer to rates for white women, at around 10 per 100,000. Older mothers were also more likely to die during and just after childbirth in all groups, eighteen white mothers ages 35 and up died for every 100,000 babies born, while 99 older black women died for every 100,000 births - almost one for every 1,000 babies.
In a country as rich as the United States and with exceptional health care resources, it seems unfathomable that women, particularly women of color, should have such a high rate of perinatal death. These numbers beg the question, is access to care the issue? We know that if women don’t have acces to quality health care, they are more likely to suffer complications. But the numbers seem to transcend economic status. So what else can be contributing to these large disparities?
Researchers found that heart problems, general cardiovascular disease and hypertension were the most common causes of death in childbirth for both white and black women during the latter half of the study period. The researchers wondered if genetic disorders or other unknown health related issues could also account for the disparities. To date, they are unable to explain the disparities.
While similar disparities have been noted in other countries, the fact of the matter is that it is unacceptable for a segment of the population to be at increased risk for death by what should be a natural act-childbearing. Sure, childbearing has risks. But when ethnic and genetic differences have been taken into account, women should have the same opportunity-and risk-to have a healthy baby and the data to date is saying otherwise.
If there are differences in access to care, we should correct those differences. Complications such as post partum hemorrhage, which is a huge cause of perinatal death worldwide, should be appropriately managed.With the barrage of medical treatments and technologies available, most pregnancy complications, especially those that occur in the US should be quickly and thoroughly managed.
The researchers are not able to explain the disparities and are calling for and carrying out further research. As a Black mama, very thankful for her babies, I certainly hope that they are able to find the cause (s) of the disparities and narrow and/or eliminate the gap.
Race, Ethnicity and Nativity Differentials in Pregnancy-Related Mortality in the United States: 1993-2006.
Creanga, Anndrea A. MD, PhD; Berg, Cynthia J. MD, MPH; Syverson, Carla, RN, MPH; Seed, Kristi; Bruce, F. Carol RN, MPH; Callaghan, William M. MD, MPH