Many people who become pregnant don’t expect to have complications. However, now more than ever before as our US population of pregnant people ages and comes into pregnancy with more medical conditions, complications of pregnancy have also become more prevalent and dangerous. Historically, preeclampsia developed in 2-8% of pregnancies and with higher risk conditions can develop in 25-75% of pregnancies. [1]
As a high risk pregnancy doctor, I see pregnant people and their families at their most vulnerable and sometimes riskiest moments of their lives. Preeclampsia is a pregnancy or recently-pregnant condition that threatens the life and abilities of those who develop it. Preeclampsia is diagnosed based on elevated blood pressure in pregnancy that develops after 20 weeks of gestation. [2] It can be associated with protein in the urine, decreased platelets, abnormal kidney function or failure, abnormal liver enzymes, seizures or brain damage, fluid in the lungs, and even cardiac disturbances. Rarely, in about 10% of cases, elevated blood pressure and preeclampsia develop in the postpartum period. [3] This happened to my sister about a week after she delivered and she nearly died from lung and kidney complications. Luckily, prompt treatment for her in the intensive care unit (ICU) allowed her to heal and survive. While death from preeclampsia is rare in the developed world, it is still one of the leading causes of death in our developing nations worldwide.
Pregnant people with some medical conditions like lupus, type 1 and type 2 diabetes, renal disease, hypertension or high blood pressure, and other autoimmune diseases are at increased risk of preeclampsia during and after pregnancy. [4] While there are some tests that have been used to stratify risks, there is no test that is 100% accurate in its prediction of who will develop preeclampsia. Therefore, prenatal care that is early and often is recommended for the monitoring of the development of complications like preeclampsia during and after pregnancy.
There has been promising research into risk reduction of developing preeclampsia in certain people who are at high risk for development of the disease. Research indicates that starting a low dose aspirin at 12 weeks of pregnancy and continuing to delivery can reduce the risk of developing preeclampsia by 10-15%. [5] Of note, we formerly called this “baby” aspirin, but we don’t give aspirin to actual babies due to the risk of developing Reye Syndrome [4], so we use low dose aspirin terminology now! Please DON’T give any babies aspirin directly. However, taking aspirin during pregnancy has never been associated with Reye syndrome in newborns so it is considered safe and helpful.
Prevention is always better than treatment when it comes to preeclampsia. Low dose aspirin itself does not lower your blood pressure or increase the risk of bleeding. Some people want to wait to take the aspirin until they “need it” or develop preeclampsia. Unfortunately, it is too late and often not helpful once preeclampsia has developed. Low dose aspirin is believed to help the placenta to grow more normally and avoid the development of preeclampsia in some pregnant people. In the US, we have 81 mg daily dosing of aspirin. The studies were conducted in Europe where standard low dose aspirin comes in 100-150 mg daily dosing. For this reason, some high risk pregnancy doctors will recommend taking 2 tabs of the 81 mg low dose aspirin in the US due to current available formulations. This is typically recommended for pregnant people who are at higher risk of preeclampsia or who have higher body mass index (BMI) over 30.
Once preeclampsia develops, then it is usually best to follow closely with your ob/gyn and/or high risk pregnancy doctor to see when delivery might be indicated. Preeclampsia remains one of the leading causes for indicated preterm birth in the US. [7] Delivery is the only known cure for preeclampsia. Magnesium sulfate is also used to prevent progression of preeclampsia into eclampsia which is when seizures occur. Postpartum preeclampsia is managed with seizure prevention and blood pressure control. Delivery might take time over days to weeks to resolve the preeclampsia completely. In addition, pregnant people with a history of preeclampsia are at increased risk of heart and cardiac complications later in life. [8]
Please listen to your body and your healthcare team to prevent and treat preeclampsia. Please also follow up on your long term health once you have had preeclampsia due to increased risk of cardiac complications, so you can continue to be present in the lives of your loved ones for decades to come.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9723483/
- https://www.preeclampsia.org/
- https://my.clevelandclinic.org/health/diseases/17733-postpartum-preeclampsia
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9090120/
- https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/12/low-dose-aspirin-use-for-the-prevention-of-preeclampsia-and-related-morbidity-and-mortality
- https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/symptoms-causes/syc-20377255
- https://pubmed.ncbi.nlm.nih.gov/26479171/
- https://pubmed.ncbi.nlm.nih.gov/28228456/