Preeclampsia

Preeclampsia is a life-threatening medical condition that happens during the second half of the pregnancy. The major signs of preeclampsia are high blood pressure and protein in the urine. Women with preeclampsia can develop seizures, at wich point preeclampsia becomes eclampsia. Both preeclampia and eclampsia can threaten the baby's and mother's life and potentially injure many organs such as the brain, heart, kidneys and liver. We don't completely understand yet why it happens, and the treatment is usually to deliver the baby. Most women get well as soon as the baby is born.

Predicting Preeclampsia at 13 weeks

Preeclampsia and Your Family
Last week I saw a patient for her first prenatal visit. She was 8 weeks pregnant and her pregnancy was achieved with IVF (invitro fertilization) . There's wasn't really much in her medical history, she was healthy and had not had any medical issues. When I inquired about her family, she said that her sister had delivered a son at 28 weeks after she developed severe preeclampsia and seizures (eclampsia).

We then sat down and discussed her sister's preeclampsia and the possible implications on her own pregnancy. She was surprised to hear that this would increase her risk of developing preeclampsia too. She said that even though she had been seen her regular ObGyn for some time he never mentioned that her sister's eclampsia may indicate that she hereself may be at risk.  

Risk Factors for Preeclampsia
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Pregnancy-associated factors

• Multiple gestations (Twins, Triplets,..) 
• Having a baby with chromosomal abnormalities
• Hydatidiform mole
• Hydrops fetalis
• Oocyte donation or donor insemination
• Structural congenital anomalies
• Urinary tract infection 

 Maternal-specific factors

• Younger and older mothers (less than 20 years  or greater than 35 years)
• Hypertension - before pregnancy
• Black race
• Obesity
• Family history of preeclampsia (Mother or sister)
• Nulliparity  (First baby)
• Preeclampsia in a previous pregnancy
• Women with certain medical conditions: gestational diabetes, type I diabetes, lupus, renal disease, thrombophilias
• Stress
• New husband

Paternal-specific factors

• First-time father
• Previously fathered a preeclamptic pregnancy in another woman

History of prior Preeclampsia
A woman who had preeclampsia in a previous pregnancy has an increased risk of recurring preeclampsia in her next pregnancy. The exact recurrence risk depends on several factors that are related both to the mother's medical condition, when in pregnancy it was diagnosed, and the circumstances of her prior preeclampsia. The risk of recurrence increases if preeclampsia in the previous pregnancy was diagnosed early in pregnancy and if the woman has had preeclampsia in two previous pregnancies. Women with chronic hypertension, for example, have a 70% risk of recurring preeclampsia in the next pregnancy. And women with severe preeclampsia in their first pregnancy have a 45% risk of recurrence.

History of Preclampsia in your Family
In October of 2005 the British Medical Jourrnal published a study called: "Recurrence of pre-eclampsia across generations: exploring fetal and maternal genetic components in a population based cohort.":

• The daughters of women who had pre-eclampsia during pregnancy had more than twice the risk of pre-eclampsia themselves (odds ratio 2.2, 95% confidence interval 2.0 to 2.4) compared with other women.
• Men born after a pregnancy complicated by pre-eclampsia had a moderately increased risk of fathering a pre-eclamptic pregnancy (1.5, 1.3 to 1.7).
• Sisters of affected men or women, who were themselves born after pregnancies not complicated by pre-eclampsia, also had an increased risk (2.0, 1.7 to 2.3).
• Women and men born after pre-eclamptic pregnancies were more likely to trigger severe pre-eclampsia in their own (or their partner's) pregnancy (3.0, 2.4 to 3.7, for mothers and 1.9, 1.4 to 2.5, for fathers).

The authors conclude that maternal genes and fetal genes from either the mother or father may trigger pre-eclampsia. The maternal association is stronger than the fetal association. The familial association predicts more severe pre-eclampsia.

The bottom line is that when assessing certain risks you should not overlook your family's medical history and discuss it with your doctor even if your doctor doesn't ask you about it.

Your Diet and Preeclampsia
A recent study found the presence of ergothione in the blood of women with preeclampsia to be higher than healthy pregnant women. Ergothione is an antioxidant found in fungi. The fungi can be ingested when pregnant women consume unpasteurized dairy products.

Preeclampsia affects 10% of the pregnant population. The condition, which has no known cause, can result in dangerously high blood pressure and fetal death. The only cure for pre-eclampsia is devliery of the baby. Scientists hope the detection of ergothione levels will lead to early detection of pre-eclampsia and a possible cause for the condition.
While doctors are not telling pregnant women to stop eating unpasteurized dairy products, they understand that further study is needed into why ergothione levels are higher in women with pre-eclampsia. "Ergothioneine is known as an antioxidant and antioxidants have been proposed to be helpful in reducing the risk of preeclampsia. It is therefore very interesting that we have found it to be in excess for women with the condition," says Dr Fisher.

The research team used an MRI like scan of blood cells to determine the presence of chemicals in the blood. Chemical markers for pre-eclampsia have also been found in blood plasma in previous studies.

Source: Reproductive Sciences 2009

Migranes and Preeclampsia
Given the high prevalence of migraines in reproductive-age women, that 8 of 10 studies have indicated an association between migraines and pregnancy-induced hypertension (or preeclampsia), and that available evidence suggest that women with either condition are at increased risk of stroke, more rigorous epidemiologic and laboratory studies are needed to clarify the relationship. A true association between migraines and preeclampsia may yield further clues to the mysterious etiologies of both disorders.
If certain women are predisposed to endothelial Headache dysfunction and ischemia (placental or cerebral), they may be at elevated risk for stroke and severe cerebral damage.

Early diagnosis and treatment of migraine may help prevent adverse pregnancy outcomes and future occurrence of serious vascular disorders.