Understanding Preeclampsia: Expert Q&A


Preeclampsia is a
common condition during pregnancy characterized
by high blood pressure. Without treatment, it can
lead to serious, even fatal complications for
both mother and baby. Today on “At the
Forefront Live,” you can have your questions
answered by our experts. That’s coming up now on
“At the Forefront Live.” And today on “At
the Forefront Live,” we have Dr. Sarosh
Rana and Nurse Macaria Solache joining us. Welcome. Thank You thank. Thank you very much. Quick reminder, everyone. The show is not designed to
take the place of a visit with your health
care professional. But please ask
lots of questions, and you could type them
in the comments section right below the picture there. And we’ll get to as many as we
can over the next half hour. Let’s start off with
the basics, though. And Doctor, if you can kind of
start us off and just tell us what is preeclampsia? So thank you, Tim, so
much for having us here. So preeclampsia is a common
condition of pregnancy, like Tim mentioned. It is essentially characterized
by high blood pressures. And you can sometimes have
protein in your urine. So that’s kind of the basic
definition of preeclampsia. Many patients, though
with preeclampsia and have other associated symptoms,
such as they can have seizures. Sometimes, the patients can have
liver dysfunction, even kidney dysfunction, and
small sized babies. So what actually
causes preeclampsia? So the question, I think, if
you ask me in one sentence, the cause of preeclampsia
is not really known. But it’s a placental disease. So essentially, what
happens is somehow– and people have looked at
it– there are certain auto antibodies, genetic factors,
even environmental factors that can affect your placenta,
which can essentially then let, people believe, release
some of these factors, which can cause preeclampsia. And one of the things
that surprised me, and I mentioned in the intro,
that actually, it’s more common than people might think. Yeah, so the prevalence
of how common it is varies by country to country. And also, different races. So preeclampsia in
general, is about 7% to 8%. So in certain populations,
definitely at the University of Chicago, it’s
even more common. So about 17% of our patients
have some sort of high blood pressures in pregnancy. So yes so you can see one in
10 women will suffer from it. And Macaria, let’s bring
you into the conversation a little bit. And just tell us a
little bit about what you do here at UChicago
Medicine to start, please. OK. Thank you, Tim. So I’ve been a labor
and delivery nurse here for about 14 years. And I’ve seen a lot
of success stories on us treating our
preeclamptic patients. But the ones that
stick close to home are the ones that got late care
or didn’t come in for care. And that made me ask myself
what I could do more. And so what would happened then? Our patients were coming
back after having birth and seizing, coming into our ER. The ER didn’t know necessarily
how to treat these moms or didn’t realize that
this was preeclampsia. So I joined Dr.
Rana’s team to come up with ways to help prevent
this in our institution. And that’s why we’re here today. This is World
Preeclampsia Day as well. So we want to get the
word out to people exactly what
preeclampsia is, the fact that it is more common than
people oftentimes think. And preventative
measures, what to take, what to be aware of as well. I think that’s very important. So let’s talk a little bit about
the folks that are at risk. And can you kind of go
through that for us? Yeah, so there are certain
identified risk factors for somebody to
develop preeclampsia. Obviously, and I joke
about it, the risk factor is that you are pregnant. So men can’t get it. But if you’re
nulliparous– so if this is your first pregnancy– if
you have high blood pressures, African-American
patients are at high risk not only to develop
preeclampsia, but more importantly to
develop complications related to preeclampsia. Obesity is a risk factor–
even IVF pregnancy, patients who have
kidney transplants, or renal dysfunction diabetes. So there are a whole host of
risk factors for the disease. So Macaria, from
your standpoint, that was very important to
you to really get the word out to women so that they
knew what to be aware of, and what to look for. And that’s always been
kind of a calling for you, is that correct? That’s correct. So my call to action was
when I realized that only 30% of our patients were coming
back for postpartum care. And that was very scary. Can we talk a little bit
about postpartum care and how critical that is for people,
not only for the mom, but for the baby as well? Right. So I think everything starts
with educating our patients. We’ve had a lot of
our patients say that they thought preeclampsia
ended with delivery. And that is not the case. And through education,
we stress that it can go on up to six weeks, that
preeclampsia problems, if not longer. One of the things that I
thought was interesting. There was an interview that
you’d done with a patient, and we’re going to play a
little clip from that interview. And it talks about
some of the things that she was told
to be aware of. And John, if we go
ahead and roll that, and we’ll talk a little
bit about that afterwards. My doctor said to me, there was
something I wanted to look for. If you see a color wheel
go across your eyes, I want you to go directly
to the emergency room. And I asked, what
does that mean? And he said, because
your blood pressure has been a little elevated these
past couple of appointments. That was the only
instructions that I received. I remember it was
a Sunday morning. I was getting ready for church. I took a shower. And got off the shower. And the color wheel
went across my vision. I said, this is so pretty. And then I remembered
this is something that I need to call
my doctor about. When I was getting ready to tell
my daughter’s father that we need to call the doctor, after
that, I don’t have the memory. So she’s talking about a color
wheel going across her vision. What is she referring to? So sometimes, when you have
preeclampsia– our patient here that we just
showed, she actually ended up having an
eclamptic seizure. So that’s something that when
you have severe preeclampsia, you can actually have a seizure. And the majority of
patients will have a seizure or complain of headache
sometimes, and also, just kind of flashing lights
and spots in front of your eyes. And then just from
edema in the brain. So there’s obviously a
very, very severe symptom, and she ended up
having a seizure, and ended up delivering early
actually, because of that. And Macaria, when you
see patients come in and they’re going through
this situation, what what’s done from your standpoint? The first thing we
do is we educate the patient of what is
happening, because it is very stressful and scary. So let them know that
they’re in the best care. And what the treatment is. Yeah, I imagine that would be
a very scary experience if you don’t know that
this is happening or don’t know what’s
happening, and this comes on all of a sudden. In her case, it sounds like it
was completely out of the blue. She didn’t anticipate
this at all. I would agree. And I think that’s a major
problem in terms of– and that’s why we’re
big into education. So there’s not only
systematic lack of knowledge, I want to say, in
terms of patients don’t know what they have. But also, if they are
even at risk for it. But also, the providers. So a couple of years ago,
I did a study in Boston, and it was very
clear that people who are seeing these patients
in postpartum center– for, example I did it in between
cardiologists– they don’t even know that association for
example, between preeclampsia and cardiovascular disease. So what we have created here
is a part of our initiative is we have a video that we
created for all our patients, which is a snippet
we just showed. Which everybody who has
preeclampsia actually watches that video, and if
they have hypertension, to educate the patients. At least start there with
patient education for her to know exactly what
she is suffering from and what her risks. Well, it’s great that they
can hear from other patients, and really hear that
in lay people’s terms. I think that’s important. So we’ve got a question
from one of our viewers that I want to throw out
at you for an answer. And it says, I was
diagnosed with preeclampsia, and that same evening I had
a blood pressure of 248. Went to the ER, had
my baby the same day. What could I have
done to prevent it? It’s been 22 days now, my
blood pressure is normal, and I’m on the highest dosages
of three different blood pressure medications. My headaches are awful without
the meds and Tylenol and Advil. What can I do to get better? So thank you for
sharing this question. Yeah, so postpartum hypertension
is a common problem, actually. About 50% of the patients–
so one in two people who have preeclampsia will
have post-partum hypertension. And I know you had preeclampsia
then had hypertension, but just what
everybody’s knowledge, you can have new onset
hypertension just after having the baby, so we’re actually
giving instructions to anybody who
delivers is at risk for postpartum hypertension. I think for you
specifically, I would suggest seems like you aren’t
taking your medications, a large majority of
patients, your blood pressure should normalize. And sometimes, it takes time. And like Macaria was
saying, even sometimes, I’ve seen patients who
need medications for even like a year or even two out. So I would just keep your
care with the cardiologist, with the medicine doctor
that you are seeing, and continue to take
their medications. And of course, if you’re
experiencing anything that you think is out of
the ordinary or significant. Make sure contact
your physician. Call your doctors, yes. So one of the questions
that we had was, are certain women, such
as African-American women, at higher risk of
developing complications? And if so, why? So the second question
is a difficult one. But yes, definitely, women
who are African-American are at higher risk to
develop complications related to pregnancy in general. And there is lots of data
that the maternal mortality– so just, frankly mothers dying
in pregnancy– is about three to four, and in some literature,
about six times higher in women who are African-American. And it’s so unfortunate
that this has been continued for six decades. So for the past 60 years,
more African-American women are dying from pregnancy
related complications. Now if you ask me why, I think
it’s a combination of physician lack of awareness
for preventable causes that we can work
with hospital levels, for lack of access to care. And I personally
believe there is some systematic bias
against women and the care that they receive. And central to what
you do, and your belief is education– you’re
trying to get the word out and an awareness. I think that’s also
very important. Yes. And hospital level
interventions such as we have. We participated in
the ILPQC, which was management of hypertension. We have AIM bundles, which are
bundles that hospitals adopt. And so yeah, I think
hospital level interventions for every patient every
time, correct management. Now the patient we
just saw a moment ago, I think we have
one more soundbite. And let’s go ahead and
hear from her again, and we’ll chat
about that a minute. The next memory I have is waking
up at the University of Chicago actually in labor. I had already been moved
from the emergency department to a room. I found out that I had
an eclamptic seizure. I was 35 weeks when
I had my daughter. And we stayed in
hospital for a few days. She was in the neonatal
intensive care unit. About a little
over a year later I was diagnosed with
chronic hypertension. After going to see my
primary care physician, he did a lot of tests. We did my family history. And then he asked me
about my delivery. When he saw the records that
I had, the eclamptic episode, he wanted to start
putting together if there was a connection
between the preeclampsia and my chronic hypertension. So she mentions hypertension,
as you mentioned just a few moments ago. It seems like that’s an
interesting connection. And how many women have you
found– is it very common for them to suffer from
hypertension and then preeclampsia? Yeah, so previously
a few years ago, people would believe that
perhaps it’s the long term. It takes 10 years, 12 years. But there’s recent data that
women who have preeclampsia are about 25 times higher
chance to have hypertension at one year– within a
year of their delivery– compared to women who had a
normal chance of delivery. And then in terms of
cardiovascular risks such as history of
MI, you can have MI cardio- and cerebrovascular
accidents, such as a stroke. There is about a
two-fold increase. So that increases as much
as if you’re smoking. So history of preeclampsia
puts a woman at higher risk to have cardiovascular disease
as much as for example, somebody who’s smoking. So pretty significant risk. So Macaria, when you work
with women that come in, and you educate them, and
teach them about preeclampsia, what do you find are some of
the most common misconceptions? The most common and one
of the most dangerous one is when they believe that
once the baby is out, that they’re cured. That the preeclampsia is gone. And you mentioned up to
six weeks after delivery? Yes, if not longer. So that’s pretty significant. I do think that’s something
that probably a lot of people don’t realize. That is actually correct. So we’re getting more
questions from our viewers. The next one is since
I’ve had preeclampsia, I’ve started
experiencing migraines. Is that normal? I don’t think there’s a direct
link between preeclampsia and migraines. There is a connection
between preeclampsia and Alzheimer’s
many years later. But I think your
migraines are probably unrelated to your preeclampsia
postpartum, definitely. I would just see a
neurologist to make sure it’s not something
that’s significant and more than the migraine. So that’s a fascinating point. There is a connection
between preeclampsia and Alzheimer’s later in life. Wow. That’s very interesting and
kind of alarming, as well. Yes. Very few studies done on that. More questions from our viewers. We’re getting quite a few. Keep them coming. We love them. Is there any connection
between maternal malnutrition or being underweight prior
to pregnancy at conception, and the development
of preeclampsia? So I guess nutrition is
what they’re talking about. Good question. Actually, epidemiologically,
people have looked at it. People who are underweight are
also at significantly higher risk to develop preeclampsia. I’m exactly not sure, and I
don’t think this literature as to why, like there’s
a particular nutrient. But certainly being underweight
also puts you at risk to have preeclampsia. It’s interesting because
we get so many physicians and scientists on the program. And they talk about how
critically important nutrition is just in general. And here’s another example. Very, very important. So again, from an
education standpoint, if you are pregnant, you
need to see your provider and talk to somebody
like Macaria as well to get information
about proper nutrition and how to be healthy
throughout their pregnancy. That makes a big
difference, right? That’s correct. And I want to put a plug in that
the last question is about– and even in general, about
recurrence of preeclampsia. I don’t know if you have
a question about that. But if you had preeclampsia
in your prior pregnancy, you should certainly seek
some sort of a high risk care. So definitely have your
obstetrician be aware. And aspirin. Taking aspirin every day
from about 20 weeks onwards to 36 weeks is the only
preventative strategy that we have to
prevent preeclampsia. So make sure that you talk to
your physician about aspirin. So if you’ve experienced
preeclampsia before, you’re more likely? Yes. Or if you have risk factors. So the risk factors that are
enumerated in the beginning, they are good guidelines about
who these patients should be. So essentially, if you’re obese
and you’re African-American, you pretty much should
be getting aspirin throughout your pregnancy. And I would like to put the
plug in to kind of remind your physicians and also,
for other physicians to see if your patient will
benefit from aspirin therapy. Which is very much in
line with this question we just received from a viewer. And she had severe preeclampsia
starting at 19 weeks, delivered at 23 weeks. She’s pregnant again. She’s worried about
getting it again. And so you just answered that. So aspirin, yes, would be
something that you should do. And then in my clinic, I
see a lot of hypertensives. I do have a hypertension
clinic for pregnancy. I give all my patients
blood pressure cuffs, so you should ask your
doctor whether home blood pressure monitoring
is something that they would recommend you to do. Know your signs and
symptoms of preeclampsia, and we can integrate them. So headache, low
vision, swelling of your face, severe
pain in your abdomen. And then kind of keep
going over those signs and make sure that you are in
touch with your health care provider to tell them
that obviously you had this severe preeclampsia
so early in your pregnancy. And you mentioned blood
pressure monitoring at home. Is that something that you
would do on a daily basis? So kind of depends
on who you are, but you can do once a day
blood pressure monitoring. Sometimes, if my patients
are not on antihypertensives, I say maybe two times a week. And they can record
those blood pressures. Then you can bring them to
your physician’s office. There is actually data that
blood pressures at home can be higher about a week
before your doctors will catch it. And then I teach
them about what are for example, severe blood
pressure, such as 160 over 100, 110. That’s when you can
call your doctor. So if you have symptoms, you
can check your blood pressure. And if it’s really high,
you can call your physician. So just kind of
empowering my patients and empowering yourself to
take care of your health. Another question from a viewer,
is nicotine a risk factor? So if you’re a smoker. So that’s a good question. You shouldn’t smoke
anyway if you’re pregnant. No, you should not smoke. But I don’t even
want to say this, but smoking is the
only risk factor that reduces your
prevalence for preeclampsia. But smoking increases so
many other complications, such as you are at risk
for preterm delivery. I would not recommend that. But scientifically, yes, there’s
been epidemiological studies showing that. Interesting. I would have never
have guessed that one. No. More questions, I was diagnosed
with gestational hypertension in my first pregnancy
three years ago. I was on watch for preeclampsia,
but did not get the diagnosis. Took a low dose of
aspirin, just as you said, with my second pregnancy. I developed preeclampsia
my 34th week and had to deliver baby in 34
weeks, five days this April. Is there anything else
that could have been done to prevent preeclampsia? Are my chances of
developing preeclampsia even higher in
future pregnancies? It’s a long one,
but it’s a good one. So not really. So for the first part,
aspirin is really just the only recommended
thing that’s been proven in large studies
to prevent preeclampsia. Yeah, not died. I tell all my patients to
do some moderate degree of exercise, because
I kind of believe that you kind of need to be
a little bit more holistic. But no, nothing else
that you could have done. I would say that since you
had preeclampsia first time or gestational
hypertension first time, and then had early
preeclampsia less than 34 weeks or around 34 weeks,
I think you all have significant risk of
developing preeclampsia if you get pregnant again. So I would just kind of
watch through the things that I just talked about. Now the question, is
caffeine a risk factor? No. No. That’s an easy one. Yeah. No, I don’t you want to
go into detail, but no. The short answer is no. Great. So if you’re African-American
and obese– this is another question–
should you take aspirin throughout your pregnancy
even before a preeclampsia diagnosis? Yes, so very good point. I think I didn’t make it clear. So aspirin is a prevention
for preeclampsia. So if you’re at high risk, so
if you have high blood pressure, or like you said, you’re
African-American and obese, yes. So you start your aspirin
at 12 weeks to 16 weeks, somewhere there. So after your first trimester. And then I continue my patients
all the way through delivery. So it’s to prevent preeclampsia,
not once you have preeclampsia. So Macaria, talk to us a little
bit about just the education process both pre-
and post-delivery. What kind of things
do you tell moms? What do they need to know? So after the provider talks
about their diagnosis, we go through it
again, make sure that they understand
what was said to them. We talk about how the delivery
is going to look like. If the baby might have
a little bit of distress afterwords, if
they’re on magnesium. We talked to them about
their medications, what that means for them. How they’re
restricted with that. And then postpartum,
we standardize the care so that we’re all teaching
them the same thing. And we’re running through every
single detail of what they need to know when they’re at home. And we give them numbers to
call when they have a question. We also have been giving
them blood pressure cuffs to take their
blood pressure at home. And we talk about how to
take their blood pressure, how not to take their
blood pressure at home. And we give them also,
a medical alert band that says preeclampsia and
postpartum on the back, so that if they were to
go to an emergency room, that they can
communicate that they are a postpartum
preeclamptic patient. That sounds perfect. And I imagine it’s a little
overwhelming if you are being treated, if you’re
in the hospital, sometimes, the information
comes at you pretty fast. So it’s great that you’re taking
the time to really kind of walk through the steps
and what needs to be done with moms and families. I think that’s great. A question here that I
neglected to ask earlier, but it’s a good one,
does preeclampsia impact the child, my baby? I was just going to say that. We’ve been talking for almost
20 minutes now about the moms. Yes, so obviously,
preeclampsia affects the baby. Preeclampsia is actually
the most common indication for a preterm delivery. So almost about 42%. So about 50% of the babies are
born preterm iatrogenically. So somebody is delivering
them because of preeclampsia. And yeah, preeclampsia
still is killing moms and still is killing babies. It’s a common cause for growth
restriction, for preterm delivery, for days in the ICU. And also, fetal deaths. Question from a viewer,
and this one is– this is the big question. So should you not get
pregnant if you’ve had multiple pregnancies
with preeclampsia? And I imagine that kind of
depends on the individual, obviously. You know, I don’t know. I do take care of
a lot of patients who are very high risk. I never tell a patient
don’t get pregnant. If that’s what she wants
to do, we’re here to help. We describe the risks. I think the absolute
risk is to not– I never tell any patient your
risk to have preeclampsia is 100%. I think if you have other
underlying conditions, if you have lupus, if you
have antiphospholipid antibody syndrome, if there’s
something else systematically, I think those patients
are at significant risk for having recurrent
preeclampsia. I think it’s such an
individual discussion that has to be held between what
the patient’s values are, rather than kind of a global
statement, I would say. And again, it’s about
awareness and education. When you have a great team
like Dr. Rana and Macaria to help you through the
process, if you are a high risk, that obviously
makes a difference. And we appreciate
you doing that. So if somebody actually
does have preeclampsia– we’ve touched on
this a little bit– but what are the
treatment methods? So big picture, the
treatment– there is no treatment
for preeclampsia. The treatment for
preeclampsia is– and I don’t want to say
this in this virtual sense– but it is essentially for
some of the maternal syndrome, is delivery. So once you deliver,
the patient, a large majority of
the symptoms that she is having and blood pressure
is usually resolved, barring the fact that
you can obviously develop and continue to have
postpartum blood pressures. But if you’re preterm,
we do try to do something called expectant management. So we keep them in the hospital. The management includes
controlling blood pressures. For patients who
have severe disease, we give them magnesium, which
is an IV medication that helps prevent seizures. And then we give
betamethasone, for example. It’s a drug that we give
to mature babies’ lungs. And then we obviously
keep them in the hospital, review their labs, review
their blood pressures, and time delivery to
optimize the fetal growth. Are there any new
developments in the management of preeclampsia? Research wise, yes. So actually, at the
University of Chicago, we are doing an FDA study. We’re going to start that. I’ve been studying
biomarkers to predict adverse outcomes of preeclampsia
for almost about 15 years. And some of these
biomarkers are actually now being hopefully,
put in front of the FDA to be approved for perhaps,
prompt diagnosis, or even management decisions for
patients with preeclampsia. So if you will, talk
to us a little bit more about long term effects. You mentioned
Alzheimer’s as one. Are there other
long term effects? Yes, so cardiovascular
disease is the number one. So it’s your risk to have an MI. It’s risk to have
your cerebral vascular disease, such as stroke,
severe hypertension. And then very long
term is Alzheimer’s. But cardiovascular
disease would be and hypertension would be
the most common long term effect of preeclampsia. Because you mentioned seeing
a cardiologist earlier. So is this something
that commonly happens? So unfortunately, no. And I think very recently– I think it was in 2015 when
they actually put preeclampsia as one of the risk factors
for cardiovascular disease. In our institution here– so one thing that
Macaria was saying is that we actually created
a post-partum hypertension clinic, where all these
patients are coming back. And once we see these
patients, immediately we at postpartum, 7, 10
days out, we actually have collaboration
with our cardiologist. And we send them to a
cardiologist for long term follow up. And Macaria I, would
imagine that the postpartum hypertension clinic, that’s
a fairly unusual thing, I would guess, right? Yes. Not many people are doing it? It’s new to our institution. And it’s an important
part of our program. And what happens there? So I mentioned earlier we give
the moms their blood pressure cuff. So they have to do something
with that information. So they come to our clinic,
and they give us their log. A provider reviews
the log, and sees if treatment needs to
be done, or treatment needs to be adjusted. And go from there. So we are just
about out of time. If you would want to leave
the moms watching or families watching with a parting
thought, what would it be? So I would say just
be your own advocate. Like I said, be aware
of your symptoms. It’s a real thing. It’s a very common
complication that can happen to you or
to your family member. I would also say that
ask a lot of questions. And obviously, there
are lots of websites. There’s a very good
patient driven website such as preeclampsia.org. You can empower
yourself with knowledge. And I would say,
ask your physicians and push them to make
sure that they’re diagnosing it correctly, and
treating it correctly, too. As I would just say
be your own advocate in terms of pushing and
improving your care. Macaria, any final
thoughts for our viewers? I would like to
say that in order to take care of your baby, you
need to take care of yourself. And you need to
think about that. Coming back to your
clinic and making sure that you’re healthy
for your baby. Perfect. Well, that’s all the time
we have for the program. You guys were fantastic. Thank you. Thank you. Thanks for being on. And thank you for all of
the wonderful questions that you gave for our experts. If you want any
more information, please contact the maternal
fetal medicine physician team at 773-702-6118. Or you can visit the online site
at uchicagomedicine.org/high risk ob. Thanks for watching,
and have a great week.

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