Dr. Shari Gelber returns to Healthful Woman to talk about preeclampsia, a condition that causes high blood pressure in pregnant women and can potentially lead to stroke or other complications. In this episode, she and Dr. Fox discuss preeclampsia’s symptoms, diagnosis, treatment, and more.
“Preeclampsia: It’s a Big Deal!” – with Dr. Shari Gelber
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In this episode, Dr. Shari Gelber and Dr. Fox discuss preeclampsia. Dr. Gelber jokes that “the way you know a disease is common is when it’s portrayed on TV,” and notes that preeclampsia has been featured in storylines of shows like “ER” and “Downton Abbey.”
Dr. Gelber says that preeclampsia is “a condition that, for the most part, is diagnosed by having high blood pressure and protein in the urine during pregnancy.” Dr. Fox clarifies that preeclampsia only occurs during pregnancy, because it’s thought that it is a reaction to the placenta. It is believed that this condition occurs due to the placenta failing to implant correctly, and most patients experience it after 37 weeks. Dr. Fox says that it’s “a condition that manifests, typically, at the end of pregnancy, but it’s been ‘brewing’ almost from the very beginning,” which is one reason he finds preeclampsia interesting scientifically.
Despite this, it’s difficult for doctors to predict whether a woman will develop preeclampsia. However, there are some risk factors. These include women who are pregnant at what Dr. Gelber describes as “at extremes of age,” meaning younger than 19 or older than 35-40. There is also an increased risk for patients who have had IVF, although Dr. Fox notes that “some of that is overlap, because, on average, they tend to be a little bit older.” Twin pregnancies may also be at higher risk, because, Dr. Gelber says, “twice as much placenta, twice as much trouble.”
Other risk factors include:
- First-time pregnancy
- Donor eggs
- Higher BMI or obesity
- Other conditions such as lupus or diabetes
Preeclampsia is a dangerous condition because the woman’s blood pressure raises so high and so quickly that she is at a risk for stroke or seizure. However, Dr. Fox says that “the end point is so different for each woman.” Some may have high blood pressure just before delivering which quickly subsides after, while others may have to deliver early, require blood pressure medications, or have a baby who requires care in the NICU.
Dr. Gelber clarifies that “we worry the most about patients who get preeclampsia before 34 weeks, but that’s only 10% of the patients.” Symptoms like headaches, blurry or spotty vision, stomach pain, and vaginal bleeding also cause concern.
Dr. Gelber explains that the delivery of the baby is the only cure for preeclampsia. Some medications can be used to prevent stroke or seizure, and baby aspirin can be taken throughout a pregnancy to prevent preeclampsia, though Dr. Gelber notes that “the people who it helps the most are the people who are at higher risk.”
In some cases, an obstetrician may decide that it is necessary to induce labor. However, Dr. Gelber says that before 37 weeks, “if the mom is stable, if her blood pressure isn’t too high…if there are no lab abnormalities, if she’s not having symptoms like headaches” it’s usually preferred to wait. However, they will usually watch patients very closely through weekly or even daily checkups or require a hospital stay. Some patients have concerns that inducing labor increases chances of a C-section. Dr. Fox explains that new studies show that “if you induce women, they don’t have an increased risk of C-section compared to waiting, and they’re less likely to get sick because you’re delivering them earlier.”