Preeclampsia, a serious medical condition in which a woman, after her 20th week of pregnancy, has high blood pressure, exhibits signs of liver or kidney damage, has high levels of protein in urine, or shows other signs of organ damage, has no cure, and can be treated either through preterm delivery, or by managing the disease until delivery.
A woman with preeclampsia must carefully monitor her blood pressure during pregnancy, and be careful of other risk factors which may aggravate the condition.
Treatments for preeclampsia, and scientific advances and research that can lead to a cure
According to the US National Institutes of Health (NIH), preeclampsia usually resolves within six weeks after the baby is born, and the placenta is delivered, but may persist longer or begin after delivery. Since the baby is usually healthy enough to be outside of the womb at the end of 37 weeks of pregnancy, doctors often recommend a C-section to a woman with preeclampsia, or give her medicines that help trigger labour.
In the cases where a woman has mild preeclampsia, and the baby is not fully developed, the condition is managed at home by consuming medicines to lower the blood pressure, and taking complete bed rest until the foetus has matured.
However, if a woman with preeclampsia is admitted to the hospital, she and her baby must be closely monitored. The pregnant woman is administered medicines to control her blood pressure, and prevent seizures and other complications, and if she has been pregnant for less than 34 weeks, she is given steroid injections to help speed up the development of the baby’s lungs.
In the case of severe preeclampsia, the baby must be delivered, especially if tests show that the baby is not getting sufficient oxygen and nutrients, and hence, is suffering from intrauterine growth restriction, and the mother has abnormal liver function, severe headaches, seizures, changes in mental function, low platelet count, bleeding, pain in the abdomen, fluid buildup in the lungs, low urine output, protein in the urine, and a diastolic blood pressure above 110 mm Hg consistently over a 24-hour period.
According to Mayo Clinic, medications to treat severe preeclampsia include antihypertensive drugs to lower blood pressure, corticosteroids to promote development of the baby’s lungs before delivery, and anticonvulsant medications, such as magnesium sulphate, to prevent seizures in the mother.
“Till now, the only treatment of preeclampsia is the termination of pregnancy. All other treatments are symptomatic. These include anti-hypertensive medications, high protein and calcium diet, rest, and antioxidants, blood-thinning injections, and magnesium sulphate to prevent seizures,” Dr Parinita Kalita, Senior Consultant, Obstetrics & Gynaecology, Max Super Speciality Hospital, Patparganj, told ABP Live.
According to experts, the delivery of the baby and placenta are the only known cure for preeclampsia.
“Certain biomarkers, which are measured during different stages of pregnancy, can help predict the risk of preeclampsia,” Dr Radhamany K, Clinical Professor & Head, Obstetrics and Gynaecology, Amrita Hospital, Kochi, told ABP Live.
She explained that biomarkers such as sFlt-1 (soluble fms-like tyrosine kinase-1) and PLGF (placental growth factor) are measured during early trimester. “These biomarkers can provide insights into the risk of developing preeclampsia.”
Dr K also said that PLGF levels are measured again during the late trimester to assess the risk of preeclampsia. She explained that these biomarkers are useful because they can be detected prior to the occurrence of organ damage, allowing for early prediction and intervention. The sFlt-1/PLGF ratio is one specific measure used to assess the risk of preeclampsia.
Dr K explained: “If the sFlt-1/PLGF ratio is less than 38, it indicates a lower likelihood of developing preeclampsia within the next week. This ratio has a negative predictive value of 98.3%, meaning that if the ratio is below 38, the risk of pre-eclampsia in the near future is significantly reduced.
“On the other hand, if the sFlt-1/PLGF ratio is greater than 38, there is a higher likelihood (36.7%) of developing preeclampsia within the next 4 weeks. In such cases, close monitoring of blood pressure is recommended.”
She also said that several studies have investigated the effects of antioxidant supplementation. However, further research with larger populations is needed for a more comprehensive evaluation.
“Research is required to understand the interaction between the maternal immune response and the placenta, placental injury, endothelial cell injury, altered vascular reactivity, and oxidative stress. Research must also be conducted on the abnormalities in the maternal immune system, and why the insufficiency of gestational immune tolerance seems to play major roles in preventing preeclampsia,” Dr Kalita said.
She explained that the growing foetus often treats paternal genes as foreign bodies, which leads to different chemical reactions. This is commonly seen during first pregnancies, and is an important aspect of research.
Since preeclampsia has no cure, it is important to closely monitor the mother and baby, both before and after delivery, and take appropriate steps as advised by healthcare professionals.
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