A number of maternal medical disorders or diseases, such as diabetes, hypertension, and preeclampsia are associated with increased maternal and neonatal health difficulties and mortality, as well as increased rates of preterm delivery.

Understanding the terminology

Approximately 6% to 8% of pregnancies in the United States are complicated by high blood pressure. Although most of these do not result in a preterm birth there is an increased risk compared with mothers who do not have hypertension or preeclampsia. There are different terms used to refer to mothers with high blood pressure and the associated difficulties, which can lead to preterm birth. The focus of this article will be on preeclampsia

• There are several different terms used to describe women who are affected by high blood pressure. Chronic hypertension is the term used to describe women who have high blood pressure before becoming pregnant, or a woman who develops high blood pressure before the 20th week of gestation.
• Gestational hypertension on the other hand is used to describe women who develop high blood pressure after 20 weeks’ gestation.
• Preeclampsia is an additional complication of gestational hypertension and occurs when protein leaks from the kidneys into the urine (in addition to high blood pressure).
• Eclampsia is the term used to describe women who have seizures as a result of their gestational hypertension.

Signs & Symptoms of Preeclampsia

Health conscious pregnant women can be shocked to find out they have gestational hypertension, since high blood pressure is typically associated with an unhealthy lifestyle. However, this type of high blood pressure can occur only during pregnancy, meaning the mother’s blood pressure will return to normal following the birth of their baby.

Women who are pregnant with multiples, are overweight, already have high blood pressure, or have kidney disease or diabetes are at increased risk for preeclampsia. These factors are also risk themselves for preterm birth. Approximately 70% of women with preeclampsia do not have any of these known risk factors.

The signs and symptoms of preeclampsia include protein in the urine and fluid retention, which presents as rapid weight gain, or a puffy face and hands. Women with chronic hypertension are more at risk for developing preeclampsia compared with those without it.

Preeclampsia & Preterm Birth

Preeclampsia is fairly common affecting around 10% of expectant mothers. Research has indicated that approximately 90% of women who develop high blood pressure during pregnancy will deliver their baby at term. However there is an increased risk of having a preterm birth for women with gestational hypertension or preeclampsia, particularly those with severe cases of preeclampsia.

The risks of preeclampsia to your developing baby are usually associated with the reduction in blood flow. Decreased blood flow can affect a baby’s growth and development since they receive less blood through the placenta and therefore receive less oxygen and nutrients, for this reason babies of mothers with preeclampsia are often underweight at birth, or what is called small for gestational age. This reduction in blood flow can also cause serious problems for mother’s health and so women with preeclampsia will be monitored closely by their doctor.

The earlier preeclampsia occurs and the more severe the symptoms are the greater the likelihood that preeclampsia will affect both mother and baby. Women with mild preeclampsia are more likely to make it to term but women with severe preeclampsia are often hospitalized and will deliver prematurely a couple of weeks afterwards. Preeclampsia is the most common reason for elective preterm delivery. This varies between patients so you should speak with your doctor to get a better understanding of what to expect in your particular case.

For women who have suffered from early, severe preeclampsia in a previous pregnancy have around a 40% chance of getting severe preeclampsia again.

Preeclampsia & Treatments

Usually women with preeclampsia are advised to rest, which can lower blood pressure and therefore allow her baby to receive more blood flow. Depending on the severity of preeclampsia your doctor may recommend bed rest at home or may admit you to the hospital.

Medications used to treat hypertension such as methyldopa (Aldomet(, propranolol hydrochloride (Inderal), and magnesium sulphate are used to lower mother’s blood pressure so they may result in reducing the blood flow through the placenta.

Mothers treated with magnesium sulphate for preeclampsia can sometimes have high levels of magnesium in their blood. Symptoms of high magnesium levels in your premature baby include poor feeding, intolerance to feedings (i.e. vomiting, food left in stomach from a previous feed, abdominal swelling), failure to pass stools, tiring easily, muscle weakness, and/or apnea (pauses in breathing).

HELLP Syndrome

If gestational hypertension leads to serious problems with blood clotting as well as liver function, it is called HELLP syndrome, which stands for hemolysis (breakdown of red blood cells), elevated liver enzymes, and low platelets.

(Aliyu et al., 2011; Backes et al., 2011; Bramham et al., 2011; Ersch, Baenziger, Bernet, & Bucher, 2008; Jelin et al., 2010; Kim et al., 2006; Kock, Kock, Klein, Bancher-Todesca, & Helmer, 2010; Lykke, Paidas, & Langhoff-Roos, 2009; Samuel, Lin, Parviainen, & Jeyabalan, 2011)

Technical Reference List

Aliyu, M. H., Lynch, O. N., Wilson, R. E., Alio, A. P., Kristensen, S., Marty, P. J., et al. (2011). Association between tobacco use in pregnancy and placenta-associated syndromes: a population-based study. Archives of gynecology and obstetrics, 283(4), 729-734.
Backes, C. H., Markham, K., Moorehead, P., Cordero, L., Nankervis, C. A., & Giannone, P. J. (2011). Maternal preeclampsia and neonatal outcomes. Journal of pregnancy, 2011, 214365.
Bramham, K., Briley, A. L., Seed, P. T., Poston, L., Shennan, A. H., & Chappell, L. C. (2011). Pregnancy outcome in women with chronic kidney disease: a prospective cohort study. Reproductive sciences (Thousand Oaks, Calif.), 18(7), 623-630.
Ersch, J., Baenziger, O., Bernet, V., & Bucher, H. U. (2008). Feeding problems in preterm infants of preeclamptic mothers. Journal of paediatrics and child health, 44(11), 651-655.
Jelin, A. C., Cheng, Y. W., Shaffer, B. L., Kaimal, A. J., Little, S. E., & Caughey, A. B. (2010). Early-onset preeclampsia and neonatal outcomes. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 23(5), 389-392.
Kim, H. Y., Sohn, Y. S., Lim, J. H., Kim, E. H., Kwon, J. Y., Park, Y. W., et al. (2006). Neonatal outcome after preterm delivery in HELLP syndrome. Yonsei medical journal, 47(3), 393-398.
Kock, K., Kock, F., Klein, K., Bancher-Todesca, D., & Helmer, H. (2010). Diabetes mellitus and the risk of preterm birth with regard to the risk of spontaneous preterm birth. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 23(9), 1004-1008.
Lykke, J. A., Paidas, M. J., & Langhoff-Roos, J. (2009). Recurring complications in second pregnancy. Obstetrics and gynecology, 113(6), 1217-1224.
Samuel, A., Lin, C., Parviainen, K., & Jeyabalan, A. (2011). Expectant management of preeclampsia superimposed on chronic hypertension. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 24(7), 907-911.