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Health Condition

Preeclampsia

About This Condition

Preeclampsia is defined as the combination of high blood pressure (hypertension), swelling (edema), and protein in the urine (albuminuria, proteinuria) developing after the 20th week of pregnancy.1 Preeclampsia ranges in severity from mild to severe; the mild form is sometimes called proteinuric pregnancy-induced hypertension2 or proteinuric gestational hypertension.3

Women with even mild preeclampsia must be monitored carefully by a healthcare professional. Hospitalization may be necessary to enable close observation.4

The cause of preeclampsia is unknown, although several factors have been shown to contribute.1,6 Preeclampsia is more common in women during their first pregnancy,7 as well as in women who are obese,7,9 who have diabetes,10 or who have gestational hypertension.11,1,9 Women who have had preeclampsia during a previous pregnancy are also at increased risk.1 Preeclampsia has also been associated with calcium deficiencies,15antioxidant deficiencies,16,17,18 older maternal age,19 and job stress.20,21,7

Symptoms

Symptoms, which typically appear after the 20th week of pregnancy, include swelling of the face and hands, visual disturbances, headache, and high blood pressure. In severe preeclampsia, symptoms are more pronounced. Jaundice may also be present. Severe preeclampsia may lead to seizures (eclampsia) and may cause death to both mother and fetus if left untreated.17 Like eclampsia, severe preeclampsia is a medical emergency requiring hospitalization.18,19

Other Therapies

Other treatment for preeclampsia includes strict bed rest, maintenance of normal salt intake, intravenous magnesium sulfate, and possibly hospitalization for observation. The definitive conventional treatment of preeclampsia is induced delivery or cesarean section.

References

1. Myatt L, Miodovnik M. Prediction of preeclampsia. Semin Perinatol 1999;23:45-57.

2. Smith GN, Walker M, Tessier JL, Millar KG. Increased incidence of preeclampsia in women conceiving by intrauterine insemination with donor versus partner sperm for treatment of primary infertility. Am J Obstet Gynecol 1997;177:455-8.

3. Rey E, LeLorier J, Burgess E, et al. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy. CMAJ 1997;157:1245-54.

4. Rath W Z. Treatment of hypertensive diseases in pregnancy—general recommendations and long-term oral therapy. Geburtshilfe Neonatol 1997;201:240-6 [in German].

5. Sibai BM. Prevention of preeclampsia: A big disappointment. Am J Obstet Gynecol 1998;179:1275-8 [review].

6. Mounier-Vehier C, Equine O, Valat-Rigot AS, et al. Hypertensive syndromes in pregnancy. Physiopathology, definition and fetomaternal complications. Presse Med 1999;28:880-5 [in French].

7. Sibai BM, Ewell M, Levine RJ, et al. Risk factors associated with preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol 1997;177:1003-10.

8. Persson B, Hanson U. Neonatal morbidities in gestational diabetes mellitus. Diabetes Care 1998;Suppl 2:B79-84.

9. Saudan P, Brown MA, Buddle ML, Jones M. Does gestational hypertension become pre-eclampsia? Br J Obstet Gynaecol 1998;105:1177-84.

10. Hojo M, August P. Calcium Metabolism in Preeclampsia: Supplementation may help. Medscape Womens Health 1997;2:5.

11. Mikhail MS, Anyaegbunam A, Garfinkel D, et al. Preeclampsia and antioxidant nutrients: decreased plasma levels of reduced ascorbic acid, alpha-tocopherol and beta carotene in women with preeclampsia. Am J Obstet Gynecol 1994;171:150-7.

12. Gulmezoglu AM, Hofmeyr GJ, Oosthuisen MM. Antioxidants in the treatment of severe pre-eclampsia: an explanatory randomised controlled trial. Br J Obstet Gynaecol 1997;104:689-96.

13. Valsecchi L, Fausto A, Grazioli V. Severe preeclampsia and antioxidant nutrients. Am J Obstet Gynecol 1995;173:673 [letter].

14. Bianco A, Stone J, Lynch L, et al. Pregnancy outcome at age 40 and older. Obstet Gynecol 1996;87:917-22.

15. Marcoux S, Berube S, Brisson C, Mondor M. Job strain and pregnancy-induced hypertension. Epidemiology 1999;10:376-82.

16. Wergeland E, Strand K. Work pace control and pregnancy health in a population-based sample of employed women in Norway. Scand J Work Environ Health 1998;24:206-12.

17. Rath W Z. Treatment of hypertensive diseases in pregnancy—general recommendations and long-term oral therapy. Geburtshilfe Neonatol 1997;201:240-6 [in German].

18. Rey E, LeLorier J, Burgess E, et al. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy. CMAJ 1997;157:1245-54.

19. Sibai BM, Frangieh AY. Management of severe preeclampsia. Curr Opin Obstet Gynecol 1996;8(2):110-3.

20. 33. Hojo M, August P. Calcium metabolism in normal and hypertensive pregnancy. Semin Nephrol 1995;15:504-11 [review].

21. Hojo M, August P. Calcium Metabolism in Preeclampsia: Supplementation may help. Medscape Womens Health 1997;2:5.

22. Moutquin JM, Garner PR, Burrows RF, et al. Report of the Canadian Hypertension Society Consensus Conference: 2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy. CMAJ 1997;157:907-19.

23. Levine RJ, Hauth JC, Curet LB, et al. Trial of calcium to prevent preeclampsia. N Engl J Med 1997;337:69-76.

24. Belizan JM, Villar J, Gonzalez L. Calcium supplementation to prevent hypertensive disorders of pregnancy. N Engl J Med 1991;325:1399-405.

25. Crowther CA, Hiller JE, Pridmore B, et al. Calcium supplementation in nulliparous women for the prevention of pregnancy-induced hypertension, preeclampsia, and preterm birth: an Australian randomized trial. FRACOG and the ACT study group. Aust N Z J Obstet Gynaecol 1999;39:12-8.

26. Bucher HC, Guyatt GH, Cook RJ, et al. Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: a meta-analysis of randomized controlled trials. JAMA 1996;275:1113-7.

27. Herrera JA, Arevalo-Herrera M, Herrera S. Prevention of preeclampsia by linoleic acid and calcium supplementation: a randomized controlled trial. Obstet Gynecol 1998;91:585-90.

28. Villar J, Abdel-Aleem H, Merialdi M, et al. World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women. Am J Obstet Gyneco 2006;194:639-49.

29. Sibai BM. Prevention of preeclampsia: A big disappointment. Am J Obstet Gynecol 1998;179:1275-8 [review].

30. Lopez-Jaramillo P, Narvaez M, Weigle RM, Yepez R. Calcium supplementation reduces the risk of pregnancy-induced hypertension in an Andes population. Br J Obstet Gynaecol 1989;96:648-55.

31. Lopez-Jaramillo P, Narvaez M, Felix C, Lopez A. Dietary calcium supplementation and prevention of pregnancy hypertension. Lancet 1990;335:293. [letter]

32. Villar J, Repke JT. Calcium supplementation during pregnancy may reduce preterm delivery in high-risk populations. Am J Obstet Gynecol 1990;163:1124-31.

33. Sanchez-Ramos L, Briones DK, Kaunitz AM, et al. Prevention of pregnancy-induced hypertension by calcium supplementation in angiotensin II-sensitive patients. Obstet Gynecol 1994;84:349-53.

34. DerSimonian R, Levine RJ. Resolving discrepancies between a meta-analysis and a subsequent large controlled trial. JAMA 1999;282:664-70 [review].

35. Ritchie LD, King JC. Dietary calcium and pregnancy-induced hypertension: is there a relation? Am J Clin Nutr 2000;71(5 Suppl):1371S-4S [review].

36. Villar J, Belizan JM. Same nutrient, different hypotheses: disparities in trials of calcium supplementation during pregnancy. Am J Clin Nutr 2000;71(5 Suppl):1375-9S [review].

37. Consensus Development Conference Panel. Optimal calcium intake: Consensus Development Conference statement. JAMA 1994;272:1942-8.

38. Camarena Pulido EE, Garcia Benavides L, Panduro Baron JG, et al. Efficacy of L-arginine for preventing preeclampsia in high-risk pregnancies: A double-blind, randomized, clinical trial. Hypertens Pregnancy 2016;35:217–25.

39. Teran E, Hernandez I, Nieto B, et al. Coenzyme Q10 supplementation during pregnancy reduces the risk of pre-eclampsia. Int J Gynaecol Obstet 2009;105:43-5.

40. Leeda M, Riyazi N, de Vries JI, et al. Effects of folic acid and vitamin B6 supplementation on women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction. Am J Obstet Gynecol 1998;179:135-9.

41. Powers RW, Evans RW, Majors AK, et al. Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation. Am J Obstet Gynecol 1998;179:1605-11.

42. Rajkovic A, Catalano PM, Malinow MR. Elevated homocyst(e)ine levels with preeclampsia. Obstet Gynecol 1997;90:168-71.

43. Laivuori H, Kaaja R, Turpeinen U, et al. Plasma homocysteine levels elevated and inversely related to insulin sensitivity in preeclampsia. Obstet Gynecol 1999;93:489-93.

44. Sorensen TK, Malinow MR, Williams MA, et al. Elevated second-trimester serum homocyst(e)ine levels and subsequent risk of preeclampsia. Gynecol Obstet Invest 1999;48:98-103.

45. Ray JG, Laskin CA. Folic acid and homocyst(e)ine metabolic defects and the risk of placental abruption, pre-eclampsia and spontaneous pregnancy loss: A systematic review. Placenta 1999;20:519-29 [review].

46. Roberts JM. Endothelial dysfunction in preeclampsia. Semin Reprod Endocrinol 1998;16:5-15.

47. Hayman R, Brockelsby J, Kenny L, Baker P. Preeclampsia: the endothelium, circulating factor(s) and vascular endothelial growth factor. J Soc Gynecol Investig 1999;6:3-10.

48. Lyall F, Greer IA. The vascular endothelium in normal pregnancy and pre-eclampsia. Rev Reprod 1996;1:107-16.

49. Roberts JM, Redman CWG. Pre-eclampsia: more than pregnancy-induced hypertension. Lancet 1994;341:1447-54.

50. Taylor RN, de Groot CJ, Cho YK, Lim KH. Circulating factors as markers and mediators of endothelial cell dysfunction in preeclampsia. Semin Reprod Endocrinol 1998;16:17-31.

51. Wachstein M, Graffeo LW. Influence of Vitamin B6 on the incidence of preeclampsia. Obstet Gynecol 1956;8:177-80.

52. Sibai BM. Prevention of preeclampsia: A big disappointment. Am J Obstet Gynecol 1998;179:1275-8 [review].

53. Williams MA, Zingheim RW, King IB, Zebelman AM. Omega-3 fatty acids in maternal erythrocytes and risk for preeclampsia. Epidemiology 1995;6:232-7.

54. Laivuori H, Hovatta O, Viinikka L, Ylikorkala O. Dietary supplementation with primrose oil or fish oil does not change urinary excretion of prostacyclin and thromboxane metabolites in pre-eclamptic women. Prostaglandins Leukot Essent Fatty Acids 1993;49:691-4.

55. Onwude JL, Lilford RJ, Hjartardottier H, et. al. A randomised double blind placebo controlled trial of fish oil in high risk pregnancy. Br J Obstet Gynaecol 1995;109:95-100.

56. Salvig JD, Olsen SF, Secher NJ. Effects of fish oil supplementation in late pregnancy on blood pressure: a randomised controlled trial. Br J Obstet Gynaecol 1996;103:529-33.

57. Wynn A, Wynn M. Magnesium and other nutrient deficiencies as possible causes of hypertension and low birthweight. Nutr Health 1988;6:69-88.

58. Spatling L, Spatling G. Magnesium supplementation in pregnancy: a double-blind study. Br J Obstet Gynaecol 1988;950:120-5.

59. Sibai BM, Villar MA, Bray E. Magnesium supplementation during pregnancy: a double-blind randomized controlled clinical trial. Am J Obstet Gynecol 1989;161:115-9.

60. Standley CA, Whitty JE, Mason BA, Cotton DB. Serum ionized magnesium levels in normal and preeclamptic gestation. Obstet Gynecol 1997;89:24-7.

61. Handwerker SM, Altura BT, Altura BM. Ionized serum magnesium and potassium levels in pregnant women with preeclampsia and eclampsia. J Reprod Med 1995;40:201-8.

62. Conradt A, Weidinger H, Algayer G. Magnesium deficiency, a possible cause of pre-eclampsia: reduction of frequency of premature rupture of membranes and premature or small-for-date deliveries after magnesium supplementation. J Am Coll Nutr 1985;4:321.

63. Wacker J, Fruhauf J, Schulz M, et al. Riboflavin deficiency and preeclampsia. Obstet Gynecol 2000;96:38-44.

64. Leeda M, Riyazi N, de Vries JI, et al. Effects of folic acid and vitamin B6 supplementation on women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction. Am J Obstet Gynecol 1998;179:135-9.

65. Powers RW, Evans RW, Majors AK, et al. Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation. Am J Obstet Gynecol 1998;179:1605-11.

66. Rajkovic A, Catalano PM, Malinow MR. Elevated homocyst(e)ine levels with preeclampsia. Obstet Gynecol 1997;90:168-71.

67. Laivuori H, Kaaja R, Turpeinen U, et al. Plasma homocysteine levels elevated and inversely related to insulin sensitivity in preeclampsia. Obstet Gynecol 1999;93:489-93.

68. Sorensen TK, Malinow MR, Williams MA, et al. Elevated second-trimester serum homocyst(e)ine levels and subsequent risk of preeclampsia. Gynecol Obstet Invest 1999;48:98-103.

69. Ray JG, Laskin CA. Folic acid and homocyst(e)ine metabolic defects and the risk of placental abruption, pre-eclampsia and spontaneous pregnancy loss: A systematic review. Placenta 1999;20:519-29 [review].

70. Roberts JM. Endothelial dysfunction in preeclampsia. Semin Reprod Endocrinol 1998;16:5-15.

71. Hayman R, Brockelsby J, Kenny L, Baker P. Preeclampsia: the endothelium, circulating factor(s) and vascular endothelial growth factor. J Soc Gynecol Investig 1999;6:3-10.

72. Lyall F, Greer IA. The vascular endothelium in normal pregnancy and pre-eclampsia. Rev Reprod 1996;1:107-16.

73. Roberts JM, Redman CWG. Pre-eclampsia: more than pregnancy-induced hypertension. Lancet 1994;341:1447-54.

74. Taylor RN, de Groot CJ, Cho YK, Lim KH. Circulating factors as markers and mediators of endothelial cell dysfunction in preeclampsia. Semin Reprod Endocrinol 1998;16:17-31.

75. Wachstein M, Graffeo LW. Influence of Vitamin B6 on the incidence of preeclampsia. Obstet Gynecol 1956;8:177-80.

76. Franx A, Steegers EA, de Boo T, et al. Sodium-blood pressure interrelationship in pregnancy. J Hum Hypertens 1999;13:159-66.

77. Moutquin JM, Garner PR, Burrows RF, et al. Report of the Canadian Hypertension Society Consensus Conference: 2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy. CMAJ 1997;157:907-19.

78. Williams MA, King IB, Sorensen TK, et al. Risk of preeclampsia in relation to elaidic acid (trans fatty acid) in maternal erythrocytes. Gynecol Obstet Invest 1998;46:84-7.

79. Wergeland E, Strand K. Work pace control and pregnancy health in a population-based sample of employed women in Norway. Scand J Work Environ Health 1998;24:206-12.

80. Marcoux S, Berube S, Brisson C, Mondor M. Job strain and pregnancy-induced hypertension. Epidemiology 1999;10:376-82.

81. Katz VL, Ryder RM, Cefalo RC, et al. A comparison of bed rest and immersion for treating the edema of pregnancy. Obstet Gynecol 1990;75:147-51.

82. Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet 1999;354:1229-33 [review].

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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2018.