FUNMILAYO AREMU-OLAYEMI reports on the causes, symptoms, complications and misconceptions surrounding preeclampsia and how the condition can be avoided and/or overcome.
YETUNDE, a fruit vendor in her early 30s, eased herself onto a seat after arranging her produce in front of her shop. Cradling her pregnancy bump, she chugged down a bottle of chilled carbonated drink. The day’s intense heat prompted her to fan herself with a church programme pamphlet as she waited for customers to patronise her.
A couple of hours later, having sold some of her produce, Yetunde got up from her seat to water some of her fruits to prevent them from withering/drying up, then she felt a subtle discomfort. She clutched at her pregnancy bump as she also noticed a persistent headache. Determined to soldier on, she continued tending to her fruits, occasionally pausing to catch her breath. However, the symptoms persisted.
Mrs Joy, Yetunde’s neighbour, approached the shop with a big smile, but as she drew nearer and saw Yetunde, her smile was replaced with a frown. Noticing the signs of distress on Yetunde’s face, she asked: “Are you alright? Is anything the matter?
“I’m fine, Mrs Joy. Just the usual stress, you know how it is,” she replied, brushing off the symptoms as part of her demanding routine. Mrs Joy’s concern deepened as she noticed Yetunde’s swollen feet, hands and face. She understood the symptoms as she had experienced preeclampsia during her pregnancy some years ago.
Urging Yetunde to prioritise her health and that of her unborn child, the neighbour insisted they visit the nearby hospital together. Yetunde, however, refused and chose to go on with her tasks.
In the next few days, the consequence of her decision unfolded as the persistent headache intensified and the swelling in her limbs became more pronounced. Yetunde remained oblivious of the fact that she had developed a pregnancy complication called preeclampsia.
One fateful afternoon, as Yetunde arranged her fruits under the scorching sun, she became overwhelmed by dizziness and sudden weakness. She collapsed and was rushed to a nearby hospital where it was confirmed that she had preeclampsia and had to be induced for labour as she and her unborn baby were at risk.
Many pregnant women suffer from this condition unknowingly. Yetunde’s experience is just one of the numerous cases of preeclampsia.
According to the Pan American Health Organisation (PAHO), a specialised international health agency of the World Health Organisation (WHO), preeclampsia is a hypertensive disorder that can occur during pregnancy and the postpartum period and affects the mother and the foetus.
“Globally, preeclampsia and other hypertensive disorders of pregnancy are the main cause of maternal and neonatal illness and death,” PAHO disclosed.
According to data from WHO, more than 20 percent of maternal deaths are caused by hypertensive problems.
Sunday Tribune spoke with an obstetrician and a midwife on the disorder and how it affects pregnant women.
Dr Anthonia Obalim-Chris, a consultant Obstetrician and Gynaecologist at the Federal Medical Centre, Jabi, Abuja, disclosed that preeclampsia contributes to a significant cause of maternal death globally.
She explained that “preeclampsia is one of the hypertensive disorders of pregnancy and is characterised by an increase in blood pressure and presence of protein in the urine, often after the first half of pregnancy, that is, after 20 weeks gestational age.”
A Senior Nursing Officer at Oyomesi Specialist Hospital, Ibadan, Oyo State, Beatrice Adegoke-John, who spoke with Sunday Tribune also disclosed that the disorder is a result of high blood pressure and added that “a pregnant woman can develop the condition commonly from the second trimester, but it can happen from 20 weeks to six weeks after delivery. It can also happen anytime in pregnancy but commonly from 34 weeks.”
Risk factors and symptoms
Sunday Tribune examined the risk factors that predispose pregnant women to the development of preeclampsia and the symptoms that indicate the condition’s onset or progression.
According to Dr Obalim-Chris, the exact cause of preeclampsia is unknown, but many theories have been proposed to explain the clinical manifestations of the disorder.
She, however, explained that “Maternal Vascular Dysfunction (abnormalities in the function of the mother’s blood vessels during pregnancy) has been suggested to play a central role in preeclampsia and is responsible for most of the clinical manifestations of eclampsia.”
She added that the risk factors which have been identified to increase the likelihood of preeclampsia include “maternal age: when a woman is older than 40 years, there is an increased risk of preeclampsia; first pregnancy, multiple pregnancies: that is a woman carrying more than one baby, inter-pregnancy interval greater than 10 years, when the last delivery was 10 years ago, the woman is at risk of having preeclampsia.
“Others are maternal obesity; family history of preeclampsia, if a sister or mother has had preeclampsia, that woman is at risk of having preeclampsia and if the woman has chronic kidney disease, she is also at risk.
“Hypertensive diseases in previous pregnancies diabetes mellitus and autoimmune diseases are some other factors that increase the risk of developing preeclampsia.”
Mrs Adegoke-John corroborated Dr Obalim-Chris’ submission and added that obesity and chronic hypertension are also predisposing factors.
On the symptoms of preeclampsia, Mrs Adegoke-John named swelling of the foot and face, high blood pressure, protein in the urine, sudden weight gain, blurry vision and severe headache as indications of preeclampsia. She, however, added that some pregnant women might have only two of the symptoms and not all.
Dr Obalim-Chris, while confirming the symptoms mentioned by Mrs Adegoke-John, added that epigastric pain or chest pain, nausea and vomiting, restlessness and decreased urine output and dizziness are all symptoms of preeclampsia.
Complications and prevention
But what are the potential complications associated with preeclampsia and how can the condition be prevented.
According to Dr Obalim-Chris, there are several complications in both mother and baby that can arise from preeclampsia as it is a multi-organ system dysfunction.
For maternal complications, she said they include “Eclampsia, the onset of seizures, separation of the placenta before the delivery of the baby, there could also be kidney failure, blindness, HEEPS Syndrome (Hemolysis, elevated liver enzymes, low platelet count). DIC (disseminated intravascular coagulation) and also Pulmonary Edema or acute respiratory distress syndrome. There could also be cerebral haemorrhage or Edema. It can also lead to preterm labour and post-partum haemorrhage.”
For complications in the baby, she disclosed that preeclampsia could result in intrauterine growth restriction; the baby will be born with low birth weight, foetal distress, and can even lead to foetal death if there is no prompt intervention.
On the prevention of preeclampsia, Mrs Adegoke-John said one of the ways to prevent preeclampsia is to control blood pressure, especially for a patient with chronic blood pressure, and to have a healthy weight. She also encouraged pregnant women to ensure that they attend antenatal clinics so that they can be monitored.
She added: “Controlling diabetes is another way of preventing preeclampsia. If a person has diabetes, it can in the long run lead to hypertension. Talking about weight gain, people need to control what goes into them and cultivate healthy eating habits.”
According to Dr Obalim-Chris, some interventions can reduce or prevent the occurrence of preeclampsia in pregnant women.
She said: “Studies have shown that some interventions which have been employed to prevent or reduce the incidence of preeclampsia in pregnant women at risk of developing this disorder include low-dose aspirin. That is 25 milligrams of aspirin which is taken daily and calcium supplementation and these are usually started early in the second trimester.”
Myths and accurate information
There are various common misconceptions surrounding preeclampsia and accurate information as explained by healthcare professionals.
According to Dr Obalim-Chris some of the misconceptions surrounding preeclampsia include that “the condition only happens during the first pregnancy and bed rest can delay the onset and even make it progress slowly. Some say that it is only overweight women that will be affected. These are some of the misconceptions.
“However, preeclampsia can occur in any pregnancy and even after pregnancy. Preeclampsia can occur in the post-partum period, provided the woman has the risk factors I mentioned earlier. Several studies done on preeclampsia have not shown any evidence that bed rest delays the onset or makes the prognosis move slowly, neither has it shown any difference in the diet of women who develop preeclampsia and those who don’t, nor demonstrated that only overweight women develop preeclampsia. It can occur regardless of weight. We have seen women with healthy weight develop the disorder.”
Mrs Adegoke-John enumerated other myths surrounding preeclampsia, saying that some people believe that the condition can be cured, that it only happens in late pregnancy, that it can be predicted, that there are no complications with it and that it only happens in the first pregnancy.
Debunking these misconceptions, she explained that “the only cure for preeclampsia is to deliver the baby. What we do as medical practitioners is to give the woman and the foetus close monitoring, then control with some medications till the baby is mature enough to live an extra uterine life – live outside the womb. When we notice that the baby is mature enough to be born, we deliver the baby, and the placenta comes out, once this happens, everything is fine.
“Its occurrence is not limited to 34 weeks and above, it can happen at any time in pregnancy, even six weeks in pregnancy, and on rare occasions, it happens before 20 weeks. Preeclampsia cannot be predicted. It cannot be known if a particular woman will have preeclampsia or not.
“There are also very serious complications with preeclampsia. Apart from the foetal complication, there would be serious complications in the mother, it could lead to heart failure, fluid build-up and stroke. It could affect the sight and lead to irreversible blindness, it could affect the liver, and when this happens, it leads to another serious condition, which we refer to as HELLP syndrome (Hemolysis, elevated liver enzymes, low platelet count). It has a lot of complications attached to it.”
She also added that preeclampsia can occur in any pregnancy, not just the first but most times, when it has happened in the first pregnancy, there is a tendency for it to happen again.
Recommendations from experts
Dr Obalim-Chris advised that pregnant women should eat a balanced diet and include enough fruits and vegetables in their diet as they provide the baby with vitamins and minerals needed for development.
She also encouraged pregnant women and women planning to conceive to desist from smoking or taking alcohol as they could have adverse effects on the baby such as congenital abnormalities, birth defects and there is also an increased risk of miscarriage, low birth weight and risk of intrauterine fetal death.
She added: “For those that take alcohol, even after delivery, there is this foetal alcohol syndrome that can occur in a child. It has a long-term effect on the baby. The baby becomes hyperactive, has poor cognition, may suffer learning disabilities, short attention span and so on. It is better to stop alcohol consumption and smoking before conceiving.”
She further advised pregnant women to get enough rest and sleep because it increases placenta perfusion and blood flow to the foetus. She also advised pregnant women to have light exercises like walking, carrying out normal household chores, and squatting.
“In addition to improved fitness and appropriate weight gain, it reduces back and waist pain. It lowers even glucose levels. Physical inactivity during pregnancy is discouraged because it causes maternal obesity with its attendant complications during pregnancy, labour and the postpartum period. However, strenuous exercises are not recommended,” she said.
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