Preeclampsia and eclampsia are related conditions of pregnancy that can cause serious complications. When left untreated, preeclampsia may progress into eclampsia.
Preeclampsia is characterized by high blood pressure and affects organs like the kidneys and liver. It is diagnosed after 20 weeks and affects 5-8% of pregnancies. Preeclampsia is rarely diagnosed before 20 weeks.
Preeclampsia can be further divided into subcategories based on whether or not it has severe features.
- Preeclampsia without severe features is diagnosed by finding high blood pressure and protein in the urine in the absence of abnormal laboratory tests or symptoms.
- Preeclampsia with severe features is diagnosed by high blood pressure, protein in the urine, symptoms including spots in the field of vision, persistent headaches, and persistent abdominal pain, and abnormal laboratory tests of blood counts, kidney function, or liver function.
Preeclampsia risk factors & prevention
Some risk factors for preeclampsia include:
- Never having given birth before
- History of preeclampsia
- Obesity or high blood pressure before pregnancy
- Being under 18 or over 40
- Having certain autoimmune disorders, like diabetes or lupus
- Having an underlying kidney disease
- Carrying multiples
- Conceived through IVF
Women who have certain risk factors may benefit from preventive treatment with low-dose aspirin (81mg per day) after 12 weeks of pregnancy to reduce their risk, or delay the onset, of preeclampsia. These risk factors include: women with a history of preeclampsia; women carrying twins; women with chronic hypertension; or those who are diabetic, or have kidney or autoimmune disease. ACOG supports this recommendation, especially when initiated in the first trimester of pregnancy, according to the Preeclampsia Foundation. While experts are still trying to determine what other factors may prevent or reduce the effects of preeclampsia, studies suggest that interventions such as Vitamin D or E supplementation or bed rest do not have any significant benefit.
Women diagnosed with preeclampsia without severe features are often treated with anti-hypertensive medications to control their blood pressures and monitored closely for worsening preeclampsia.
Women with preeclampsia with severe features, in comparison, have an increased risk for maternal and fetal complications and are often treated with anti-hypertensive medications in addition to magnesium sulfate to prevent seizures. Preeclampsia can persist after birth, but because delivery is the only treatment for many of the dangerous symptoms of preeclampsia, depending on the gestational age and severity of the disease, a healthcare provider may recommend delivery for both maternal and fetal benefit.
If a woman diagnosed with preeclampsia develops seizures with no underlying seizure disorder, she is considered to have eclampsia. This is a rare condition that affects 1 out of every 200 women with untreated preeclampsia. The seizures associated with eclampsia suggest that preeclampsia is affecting the woman’s brain. Because of the significance and severity of eclampsia, providers will recommend delivery regardless of fetal gestational age if eclampsia is diagnosed.
Magnesium sulfate is used to prevent seizures in those with either preeclampsia or eclampsia, though in different doses. When women are diagnosed with eclampsia, their doses are individualized and determined by the healthcare provider.
Hypertension is a common complication in pregnancy and it affects many women. In many cases, the presence of high blood pressure is no guarantee of serious health concerns, though it’s always a good idea to keep an eye on high blood pressure, and try to bring it down. Hypertension involves a spectrum of severity and can lead to the more serious conditions of preeclampsia and eclampsia, and even mild high blood pressure can cause complications. It’s critical for healthcare providers to be on the lookout for both complications in women with high blood pressure so that preventive action can be taken as early as possible.
- “Preeclampsia and Hypertension in Pregnancy: Resource Overview.” ACOG. American College of Obstetricians and Gynecologists, 2017. Web.
- Lelia Duley. “Preeclampsia, eclampsia, and hypertension.” BMJ Clin Evid. 1402. Web. Aug 14 2008.
- Mayo Clinic Staff. “Preeclampsia.” MayoClinic. Mayo Foundation for Medical Education and Research, Jul 3 2014. Web.
- “Should you consider low-dose aspirin to reduce preeclampsia risk?” The Preeclampsia Foundation. August 1 2016. Web. Available at: https://www.preeclampsia.org/the-news/138-latest-news/635-should-you-consider-low-dose-aspirin-to-reduce-preeclampsia-risk