Science & Sensibility

Today, I highlight the recent news about the significant drop in teenaged births in the US, including some interesting trends.  Then on Thursday, we will continue our “Welcoming All Families’” series with “Working with Teen Parents” and take a look at childbirth classes for teenage mothers.  Some ideas and suggestions for working with pregnant teens, in a specialized class designed to meet their needs or integrated within your regular childbirth class offerings. – SM

Number of babies born to US teen mothers 2011

The National Center for Health Statistics, part of the Center for Disease Control and Prevention recently released the most up to date data for teen birth rates in the United States.  The good news is that teen birth rates dropped by 25% from 2007-2011.  Since 1991, teen birth rates have been on a decline,  with the exception of 2006-2007, but this drop has picked up steam in most recent years.  In 2011, a total of 329,797  babies were born to women aged 15–19 years, for a live birth rate of 31.3 per 1,000 women in this age group. (Hamilton, 2012.) In 2007, the teen birth rate had been 41.5/1,000 teenagers aged 15-19.  The rate dropped by 8% just between 2010 and 2011.  Just two states, North Dakota and West Virginia did not experience significant changes.

http://www.cdc.gov/nchs/data/databriefs/db123_fig2.png

This is particularly good news, as babies born to teenaged mothers are more likely to be born prematurely, have low birth weights and have a higher rate of infant mortality, when compared with mothers aged 20 or older.  All of these consequences carry significant financial costs for families.  These consequences cost the US government 10.9 billion dollars annually.

High school drop out rates are increased amongst teen mothers, and many may not go back and receive a high school diploma or GED.  This has a major financial impact for these young families  for years to come.  Only 50% of teenage mothers receive a diploma by the age of 22. (Perper, 2010.)

The decline in teen birth rates may be linked to economic and attitudinal factors, according to the Pew Research Center. Overall, birth rates amongst all age groups go down during rough economic times, as the United States has been experiencing since the recession began in  2007-2008. Currently, teens seem to be less sexually active and the teenagers that are choosing to have sex are more likely to use birth control then ever before. (Martinez, 2011.)

Declines in rates were steepest for Hispanic teenagers, averaging 34% for the United States, followed by declines of 24% for non-Hispanic black teenagers and 20% for non-Hispanic white teenagers. Interestingly, the difference in long-term birth rates for non-Hispanic black and Hispanic teenagers has essentially disappeared by 2010.  Even though the USA has seen these large drops in teenage birth rates,  the US teen birth rate is one of the highest amongst Western countries.

http://www.cdc.gov/nchs/data/databriefs/db123_fig1.png

 References

DeSilver, D. (2013, May 28). What’s behind the falling teen birth rates?. Retrieved from http://www.pewresearch.org/fact-tank/2013/05/28/whats-behind-the-falling-teen-birth-rates/

Hamilton BE, Mathews TJ, Ventura SJ. Declines in state teen birth rates by race and Hispanic origin. NCHS data brief, no 123. Hyattsville, MD: National Center for Health Statistics. 2013.

Martinez G, Copen CE, Abma JC. Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2006–2010. National Survey of Family Growth. National Center for Health Statistics. National Vital Health Stat. 2011;23(31).

The National Campaign to Prevent Teen and Unplanned Pregnancy.Counting it up: The public costs of teen childbearing: Key data

Perper K, Peterson K, Manlove J. Diploma Attainment Among Teen Mothers. Child Trends, Fact Sheet Publication #2010-01: Washington, DC: Child Trends; 2010.

United Nations Statistics Division. Demographic yearbook 2009–2010.

Sharon Muza Babies, Childbirth Education, New Research, News about Pregnancy, Research, Uncategorized CDC birth rates, Childbirth Education, Sharon Muza, Teen birth rate, teen pregnancy

With Father’s Day being celebrated this Sunday, Certified Doula David Goldman shares his experiences as both a birth doula and expecting father, as he ponders the role birth professionals and health care providers have in welcoming or marginalizing the partner during pregnancy, birth and early parenting.  The role of men at births has been questioned, mocked and celebrated over the years.  Read and hear how David has been able to experience it from both sides. – Sharon Muza, Community Manager

___________________

© Patti Ramos Photography

My head was spinning with joy, fear and uncertainty as I walked into the birth room for the first time as a doula. I squatted to the side as I acclimated to the calm energy and slowly made my way toward the laboring mother. A nurse walked in and with unexpected excitement shook my hand and smiled deep into my eyes as she walked passed me. My doula mentor stepped in to explain that I was not the dad but was the doula. I laughed to myself, having once again forgotten the rarity of men, especially those in non-medical roles, in the birth room. Since then, I carry a shirt in my birth bag that reads, “Nope, I’m not the Daddy, I’m the Doula” to avoid the confusion and the awkward and misplaced, but well intentioned congratulations. I also wear the shirt because once the staff knows I’m a birth professional, I’m often accepted as part of the ‘real team’ rather than just a ‘bystander’ who might get in the way and needs to be looked out for.

As we are likely well aware, the history of childbirth in North America has included discrimination, sexism, misogyny and other forms of oppression against women. Birth communities have become a source of strength and have collectively fought and won major battles including public breastfeeding, rights to options and evidence-based care in childbirth and so much more. But as with all forms of oppression and marginalization, we can’t bring one person up by bringing another down.  As one of a very small handful of certified male birth doulas  in North America and a birth professional who has completed a Lamaze International approved childbirth educator workshop on the path to obtaining LCCE status, I feel honored to work among thousands of strong women who are pushing the boundaries every day to make childbirth and parenting less traumatic and more empowering for all birthing women.

As a birth professional, I have worked with many amazing dads who glowed at least as bright as their pregnant partners. At most of the births that I have attended, the tears coming from the eyes of men overwhelmed with joy and relief at the birth of their baby have been just as wet as those of the mothers. I am not trying to equate the experiences of becoming a father with becoming a mother.  However, I do hope to shed light on how birth professionals’ communication with fathers can influence the pregnancy and childbirth experience not just for fathers but also for mothers and babies. Like many birth professionals, I have worked hard to support the whole “client family” and honor the role of each person involved. However, now that I find myself in the role of the client family for the first time, I am quite surprised by my experience.

The presence of a father, birth partner or family member can help to improve women’s birth experience by providing emotional support and reassurance during labour and delivery. While unexpected emergencies may arise, for many couples, birth can be a very positive experience.  Royal College of Obstetricians and Gynecologists

Currently, my partner and I are halfway through a pregnancy and, as you can imagine, I now have the opportunity to see things from a whole new perspective. As a birth professional who has taken many courses, attended conferences, read piles of books, shared dialogue via various internet forums and participated as an active and founding member of the local birth professional group in my community, I feel relatively empowered and knowledgeable on the topic of pregnancy, labor, birth and postpartum.

I’m surprised, however, by how marginalized I feel being the partner in the pregnancy and that I feel less and less central in the birth of our baby as we include and add professionals to our team. Providers make little eye contact with me and ask for decisions almost exclusively from my partner. People frequently ask where she will be birthing and whom she has chosen to attend. I’m finding that images in advertising and instructional materials with partners in primary support roles are not as common as those with birth professionals at the center. Many online birth communities are specific to “Mommas” and a large group that had once made an exception (not at my request) to include me as a birth professional recently removed me from the group now that I am a “Dad-to-be” reducing my access to the very support that I had previously offered to many new families. Overall, while we often intend to honor the role of partners, I’m seeing that we are missing the mark throughout the field.

If a well-trained and experienced birth doula and an active part of the local birthing community is feeling disempowered, how must partners who are brand new to birth feel? After all, we may hold knowledge and experience but as we have all seen, a sweet smile or a kiss from a partner can be an amazingly effective medicine for a birthing mother. We already know that the experience of women and babies is improved by continuous care during childbirth. (Hodnet, 2012). What can we do as birth professionals to better support partners in being fully present and connected?

One of the most significant things that birth professionals and health care providers can do is to welcome partners with mutual respect and honoring their challenging and important roles.  By doing so, we can likely improve the experience overall and help foster attachment between the parents and with the partner and the baby even before the birth. The bonds, attachment and successes fostered in childbirth are likely to be a great springboard into future parenting experiences.

In order to improve the likelihood that partners will feel central in the birth team, we as birth professionals must include them from the beginning. We can frequently make eye contact, ask for their opinions and check in to see how they are feeling about decisions. In our prenatal discussions, we can help partners address any barriers they may feel to fully supporting the birth. We can create communities that include partners to seek advice, support and dialogue. Just as we reassure birthing women throughout the process, we might provide acknowledgement for the hard work and endurance of partners. Discussions that promote collaborative dialogue between partners can be encouraged when decisions are needed. Childbirth educators can offer suggestions on how to ask care providers to include the partner more substantially and role-play scenarios with couples in class.

© Patti Ramos Photography

Birth professionals should stop applying the standard stereotypes that have been around for ages, and are continually propagated through the media, assuming fathers are bumbling fools who are being dragged to childbirth classes,  panic at the first contraction, don’t know their way around a newborn, just might “pass out” at the birth and who are easily excited and unable to contribute anything positive to the experience.  This is just not the truth.  Today’s father is often researching right along with the mother for best practices, exploring choices and celebrating each milestone in the pregnancy.  During labor and birth, many fathers want to be the main support and fully share the experience with their partners.

We want the professionals we have chosen to participate with us on this journey to recognize the unique roles and needs that each parent has.  Their very actions and choice of words can help fathers to feel more involved and respected or can marginalize the father to a spot on the edge of the process.  Welcome us as an equal player, celebrate what we bring to the table, share resources and information sources that are specific to our needs as fathers and partners in creating this life.  Have office and classroom spaces filled with diverse images celebrating the amazing role that we are honored to play as partners. Use posters, films and activities that highlight and honor the special place we hold.  Allow us to grow into the role of father, feeling secure, supported and respected by the professionals who are helping us to birth our baby.

As childbirth educators, do you often make light of the lack of information and experience that fathers bring to the birth experience.  Do you make assumptions about the dads in your classes?  Have you perpetuated any of the longstanding stereotypes by the media you use, activities you conduct or your choice of words?  Can you share what you are doing in your class to be as inclusive as possible and to help the couple to moving into parenting by setting them up for a labor and birth filled with connection and support?  Let us know in the comments. – Sharon Muza

References

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub4. 

About David Goldman, MAEd, CD(DONA, PALS)

David P. Goldman, MAEd. CD(DONA, PALS), was trained as a birth doula six years ago at the Simkin Center, Bastyr University and has become one of the very few male certified birth doulas in North America. He has been an educator working with students of all ages for over fifteen years and has completed a Lamaze International approved childbirth educator workshop on the path to obtaining LCCE status. David works with the WISE Birth Doula Collective in Bellingham, WA as well as Open Arms Perinatal Services in Seattle, WA. David can be reached at douladavid@gmail.com

Sharon Muza Babies, Childbirth Education, Guest Posts, Infant Attachment, Maternity Care, Newborns, Parenting an Infant, Uncategorized Birth Professionals, Childbirth Education, David Goldman, doulas, fathers, Health Care Providers, labor support, prenatal care, Sharon Muza

Breastfeeding Solutions; Quick Tips for the Most Common Nursing Challenges by Nancy Mohrbacher, IBCLC, FILCA is a recently published book, (April 2013) designed  for breastfeeding mothers.  This book is small and lightweight, measuring just 5 x 7 inches, with 202 pages, including appendices, which makes it practically pocket sized and easy to throw in a diaper bag or read while nursing a little one.  There is also an e-book version available as well.

The book is divided in to 7 chapters, and includes a short and concise resource list at the back, along with some brief citations referred to in the book.  The chapters have simple titles such as “Nipple Pain” or “Night Feedings” making it easy to find the information a mother might be looking for.  Each chapter is divided into the typical challenges that mothers might be dealing with under that particular topic.  With a clear, easy to read large font for each section,  the pages are well designed and simple, making it a breeze for a tired and sleep-deprived mother or partner to find exactly what information s/he needs. Occasional, basic, black and white line drawings reinforce the information provided in the text.  The language used throughout the book consists of common terms and is easy to read and understand. I really liked how Nancy reassures the reader with her writing style, that the while the mother or baby may be experiencing some struggles, that things can be fixed and will get better.   In many places throughout, the author lets us know that if things do not improve that the mother should seek out help from an appropriately skilled expert, with her first recommendation being an international board-certified lactation consultant (IBCLC).

Right from the start, Nancy encourages and explains laid back breastfeeding positions for the mother-baby dyad, sharing why these positions makes so much sense for the mother and baby who are just starting to breastfeed.  She even references and provides a link for a short video on this from Suzanne Colson. In several places in the text, Nancy encourages readers to refer to a linked video to reinforce the information provided in the book.

Nancy emphasizes throughout the book that mothers can follow their instincts and will know what to do, but problems can arise and that help is available. She uses some of the same vocabulary that I use when teaching breastfeeding classes, such as “breast sandwich” to help mothers understand getting a deep latch. When discussing weight gain in breastfed babies, Nancy references the WHO exclusively breastfed growth charts as the appropriate guide for how baby is doing.  This is good to know information when a mother will be discussing weight gain with the baby’s provider.

Important information is repeated throughout the book, so a mother who has opened the book to find specific information will not miss key points such as “drained breasts make milk faster, full breasts make milk slower” even if she never turns to the “Milk Supply Issues” chapter.

One of my favorite sections was Nancy’s accurate explanation of breastfeeding norms for the newborn.  Reassurance that cluster feedings, having night and day time mixed up, frequency and length of feedings in the first six weeks really go along way to reassure the new mother that her baby is normal and doing what normal newborns do.  She also shares information about the volume of milk a baby can expect to need as she grows. Every pregnant woman or new mom should read this section, so they don’t wonder if things are normal in their sleep-deprived state.

The old foremilk-hindmilk discussion is squashed as Nancy explains how fat molecules are released from the milk ducts as the feed progresses, but reassures mothers that this is not something to be concerned about.  When a mother feeds on demand and offers both breasts over the course of a day, the baby will be provided with adequate breastmilk that contains everything needed.

There is a great section on going back to work and maintaining supply, along with how to make a pumping session most effective. There are even tips on choosing the right pump for your pumping needs.  I loved the information and drawings included for making sure that your pump has the proper sized phalanges (or nipple tunnels as they are called in the book) for each woman’s nipples, as I frequently see women who have poor fitting phalanges, making pumping so much more uncomfortable.

Nancy shares several different strategies for solving the common problems, so women have many things to try and includes a section for each topic called “If these strategies don’t work” with even *more* information and other things to consider. There are also little sidebars with “Myth and Reality” nuggets scattered throughout the book.  Women are provided with current evidence based information for best breastfeeding practices.

The book closes with a lovely chapter on weaning, sharing ideas on how to decide when the time is right and how to make it easy on both mother and child.  The entire book is non-judgmental, acknowledges that there can be challenges and offers encouragement and information in a non-biased manner and easy to read style that will provide support and answers to the most common concerns facing breastfeeding mothers today.  This book would be a great accompaniment to a breastfeeding class, and lactation consultants,  childbirth educators, doulas, midwives and doctors that work with breastfeeding families will want a few copies to put in their lending libraries for new moms to borrow.

About Nancy Mohrbacher

Nancy Mohrbacher, IBCLC, FILCA, is author of the books for breastfeeding specialists, Breastfeeding Answers Made Simple (BAMS) and its BAMS Pocket Guide Edition.  She is co-author (with Julie Stock) of all three editions of  The Breastfeeding Answer Book, a research-based counseling guide for lactation professionals, which has sold more than 130,000 copies worldwide. She is also co-author (with Kathleen Kendall-Tackett) of the popular book for parents, Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers.  Nancy has written for many publications and speaks at breastfeeding conferences around the world. Contact Nancy by email: nancymohrbacher@gmail.com

Sharon Muza Babies, Book Reviews, Breastfeeding, Childbirth Education, Healthy Birth Practices, Healthy Care Practices, Infant Attachment, Newborns, Parenting an Infant, Uncategorized book review, breastfeeding, Childbirth Education, doulas, how to breastfeeding, lactation consultants, lactation support, midwives, Nancy Morhbacher, problems with breastfeeding, Sharon Muza

© http://flic.kr/p/3mcESR

Both expectant families and childbirth professionals alike would like nothing more than pregnancy and birth to remain uncomplicated and proceed normally. We can celebrate when that happens but we have a responsibility to also teach and share about some of the variations from normal that may come up during pregnancy and birth.

Cara Terreri, the Community Manager for Lamaze International’s parent blog, Giving Birth with Confidence, is looking for women’s input on pregnancy complications for a new series that she will be running in the coming months.

If you have had personal experience with one or more of the following (or know students, clients or patients who do) and would like to participate, please contact the blog manager, Cara Terreri at cterreri@lamaze.org. 

• Preeclampsia/eclampsia & HELLP
• Placental abruption/hemorrhage 
• Placenta previa/accreta
• Intrauterine growth restriction (IUGR)
• Incompetent/weakened cervix
• Hyperemis Gravidarum
• Preterm labor

Sharon Muza Giving Birth with Confidence, Lamaze International, News about Pregnancy, Patient Advocacy, Pre-eclampsia, Pregnancy Complications Cara Terreri, complications, Giving Birth With Confidence, Lamaze International, pregnancy, Sharon Muza

by Caryn Rogers

May is National Preeclampsia Awareness Month and the Preeclampsia Foundation has been holding Promise Walks all around the country to raise awareness of this disease and generate funds for research.  Caryn Rogers, Senior Science Writer for the Preeclampsia Foundation has provided a research update and information about the etiology of the disease.  The Preeclampsia Foundation is rich in resources for birth professionals and women, including an active forum for mothers dealing with this complication of pregnancy (or postpartum). Lamaze International is a proud web content sponsor of the Promise Walk.- Sharon Muza, Science & Sensibility Community Manager

The Preeclampsia Foundation would like to thank Lamaze International and Science & Sensibility for this opportunity to present a research overview during National Preeclampsia Awareness Month. Preeclampsia, which means “before the lightning” in Greek, is a leading cause of maternal and neonatal mortality and morbidity worldwide. The syndrome probably got the name from its tendency to strike suddenly, out of nowhere. One in ten women develops gestational hypertension during her first pregnancy, while about one in twenty develops preeclampsia. The latter condition has historically been poorly understood, but new research has led to a deeper understanding of preeclampsia. Some of the new research has been supported with Preeclampsia Foundation Vision Grants over the last ten years.

What is Preeclampsia

Preeclampsia is a multifactorial, heterogeneous pregnancy syndrome diagnosed after the appearance of both hypertension and proteinuria (protein in the urine) any time after mid-pregnancy. Its cause is still unknown. Though called the “disease of theories,” research is closing in on triggers of the disorder, which will help to design specific treatments. Certain women have predisposing factors such as the presence of other diseases that make preeclampsia more likely. There may be specific genetic factors. While the disease’s primary symptoms are hypertension and proteinuria, many other organ systems may be involved, especially the liver, brain, and platelets. Symptom presentation is unpredictable, with some cases appearing to fulminate within hours and other cases remaining mild for weeks. Finally, some preeclamptics progress to a convulsive phase – the disease known as eclampsia.

How is Preeclampsia diagnosed

Two blood pressure readings, taken at least six hours apart, of 140/90 mm Hg or greater, and the excretion of 300 mg or more of proteinuria in a 24-hour urine sample are the primary diagnostic requirements. Currently, many clinics are measuring the ratio of protein to creatinine in a single urine sample, using a value that predicts the total will be 300 mg or more in a day. In some instances, the disease is diagnosed without proteinuria when preeclampsia-specific signs and symptoms of other organ system involvement occur.

What are the risk factors for Preeclampsia

Risk factors for preeclampsia include: first pregnancy, previous history of preeclampsia, multiple gestation, preexisting hypertension, diabetes, kidney disease, or organ transplant, obesity, age over 40 or under 18 years, maternal family history of preeclampsia.  Polycystic Ovary Syndrome (PCOS); Antiphospholipid Antibody Syndrome (APS), lupus or other autoimmune disorders; and use of any Assisted Reproductive Therapy (ART).

Much of what is included in standard prenatal care was developed primarily to detect preeclampsia. This is why blood pressure and urine protein are checked at every visit and why visits come more closely together as the end of pregnancy approaches. The careful attention of care providers to these potentially invisible symptoms, and their communication of worrisome signs and symptoms to patients, has saved countless lives. Women who have been educated to know the signs and symptoms are able to practice the Preeclampsia Foundation’s motto, “Know The Symptoms. Trust Yourself.” 75% of those who knew the risks were able to take life-saving action when symptoms developed, versus 6% of those who did not know the signs and symptoms.

Pathophysiology

Placentas from preeclamptic pregnancies are characteristically shallowly implanted. During differentiation, the blastocyst will divide into an internal set of cells (the embryoblast), and an outer layer that will become the placenta (the trophoblast). When the blastocyst embeds into the decidua, the trophoblast remodels the uterine spiral arteries that supply blood to the endometrium. This remodeling activity persists into the second trimester of pregnancy. In normal pregnancies, this remodeling produces arteries that deliver appropriate blood flow to the placenta; in preeclamptic pregnancies the remodeling process is flawed.

Trophoblastic cells enter the spiral arteries and induce apoptosis, which is the initiation of cell death in the endothelial cells lining the walls of the arteries. Once the cells have died, the trophoblastic cells convert into an endothelial form and adhere to the walls of the vessels. These cells ignore maternal signaling to contract the vessel, which is why, in a normal pregnancy, these arteries are relaxed at all times, bathing the placenta in oxygen and nutrients. In preeclamptic placentas, the remodeling does not extend as far as normal, impeding appropriate nutrition and oxygenation.

One theory is that shallowly implanted placentas may not be able to transfer the total of oxygen and nutrients the fetus requires to develop ideally. The flow of blood through the spiral arteries is affected by their smaller size. Several genetic mechanisms that can cause shallow implantation have been identified with more likely to be discovered as investigation into trophoblastic cells continues. (Colucci, 2011; van Dijk, 2010)

Once fetal growth accelerates in the later trimesters of pregnancy,  the fetal demand for more oxygen than the placenta is capable of ferrying eventually leads to placental hypoxia. Hypoxia triggers the placental release of a protein called soluble fms-like tyrosine kinase (sFlt-1.) SFlt-1 binds to vascular endothelial growth factor (VEGF) and a placentally derived factor that mimics it, placental growth factor (PlGF), rendering both unavailable to the receptors they usually target. SFlt-1 levels are measurably elevated in pregnant women who go on to develop preeclampsia. (Levine 2006; Maynard 2003)

In the vasculature, VEGF shepherds repair molecules along the walls of the blood vessels, plugging the holes that appear with normal wear and tear. When free VEGF is bound by sFlt-1, it cannot do this repair work.  Because the rate at which the repair slows depends on the amount of sFlt-1 that the placenta is producing and also on the amount of VEGF a woman’s body naturally produces, the symptoms that follow this damage vary widely. The effect of reduced levels of free VEGF and PlGF is that the vasculature is unable to achieve normal vasodilation and resists signals to contract or dilate appropriately.

Another circulating antiangiogenic factor is soluble endoglin, or sEng, which binds to and disrupts the normal functioning of TGF-beta, a protein that controls proliferation, cell differentiation and other functions in most cells.. Thus sEng, too, has also been identified as a culprit in preeclampsia. Although its mechanisms are not as clearly understood as those of sFlt-1, it’s been empirically confirmed that women who develop preeclampsia at term have increasing serum levels of sEng beginning as early as gestational week 25. There are also suggestions that women are more likely to develop the dangerous variant of preeclampsia known as HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) if their levels of sEng are highly elevated relative to their sFlt-1 levels, and that they are more likely to develop severe preeclampsia when sFlt-1 levels are high relative to sEng. (Baumwell, 2007)

Depending on individual underlying susceptibilities and the ratios of antiangiogenic factors, a pregnant woman can develop the following symptoms at any rate and in any order, combination, and degree of severity, starting after midgestation and continuing for up to six weeks postpartum: hypertension, proteinuria, sudden weight gain and swelling, nausea, vomiting, upper right quadrant abdominal pain, shoulder pain that feels like a pinched nerve along the bra strap (referred from the liver), lower back pain, headache, visual disturbances, hyperreflexia, racing pulse, mental confusion, heightened sense of anxiety, shortness of breath or chest pain, sense of impending doom, abruption, IUGR, fetal distress, thrombocytopenia, either very low or conversely a large increase in urine output, seizure, pulmonary edema, liver rupture, abruption, and death.

The multi-organ nature of the syndrome means that a woman can feel fine, have hypertension and proteinuria that becomes apparent after testing, and then be admitted to the hospital with failing kidneys, liver and other organs. Or she can have a headache and begin seizing with comparatively low blood pressure and only mild proteinuria. The various presentations of preeclampsia make it challenging to consistently diagnose and manage appropriately.

The blood pressure increase indicates vascular damage that compromises the mother’s health and damages the spiral arteries which connect the placenta to the woman’s body. Women with preeclampsia also have a dysregulated metabolic response to pregnancy. (von Versen-Hoeynck, 2007)  Gestational diabetes is a risk factor for preeclampsia, and women with PE are more likely to have elevated cholesterol readings and alterations in many serum biomarkers. Placental debris from an enhanced inflammatory immune response is thought to sweep into the maternal bloodstream and trigger these metabolic responses. (Redman, 2012) Researchers are newly aware of this signaling mechanism and further research is in progress.

Treatment and Prevention

As of May 2013, the only definitive treatment for preeclampsia is delivery of the placenta. These pregnancies, whether or not they are initially low-risk, are medically complicated and are generally managed by OB-GYNS, sometimes in consult with maternal-fetal medicine specialists. Timing of delivery is one of the only tools available to manage and balance the competing interests of worsening maternal disease, a failing placenta, and a potentially premature baby. Patients are managed with close monitoring, anti-hypertensives as necessary, and sometimes steroid shots to accelerate fetal lung maturation, depending on gestational age. In severe cases, this monitoring occurs while the woman is hospitalized in a tertiary care center. Magnesium sulfate may be given to reduce the risk of seizure. In severe disease, delivery sometimes must take place regardless of gestational age to best protect both lives (even a very preterm baby can be better out than in when the placenta is failing and the mother’s liver is threatened) and is seriously considered in cases of severe preeclampsia for any worsening of symptoms after 34 weeks.

The HYPITAT trial has led to a new ACOG recommendation, to be released later this year, that any gestational hypertension (readings above 140/90 mm Hg) be induced at 37 weeks gestation. (Koopmans, 2009) The data show equally good outcomes for the neonate in either arm of the trial, and substantially reduced maternal risk of severe hypertension. 

Calcium supplementation to prevent preeclampsia has been evaluated in large randomized controlled trials (RCTs) and found to have no benefit except perhaps in populations with very low dietary intake. Antioxidant supplementation – specifically vitamins C and E, also evaluated in large RCTs, has shown no benefit. Supplemental baby aspirin showed no benefit or harm in two large RCTs, but meta-analysis showed a potential benefit to an as-yet-unidentified high-risk population when begun in the first trimester. The older therapies of dietary salt restriction, diuretics, and bed rest have not been shown to have benefits and may cause harm so are not recommended.

Risk of Cardiovascular Disease

In addition to being at higher risk of preeclampsia in any subsequent pregnancies, women with a history of preeclampsia are at roughly double the risk of developing heart disease or stroke over the five to fifteen years following delivery. Many women develop chronic hypertension postpartum. There are risk factors common to both preeclampsia and heart disease, and there is also evidence that preeclampsia can cause damage to the heart. 

Lifestyle changes are known to lower risk of heart disease, so women with a history are recommended to stop smoking (or never start), eat a heart-healthy diet, get regular exercise, and maintain a normal BMI. Because preeclampsia unmasks a higher risk, proactively consulting her physician and preferentially a general internist or cardiologist to discuss heart health postpartum can also help to monitor for the chance that heart disease will develop.

Lowering the Risk

Although there are no known therapies at this point, there are ways to reduce the risk of preeclampsia to mother and baby. Pre-conception or inter-conception care is gaining increasing value as women can be assessed and counseled to begin a pregnancy in the best possible health. Regular prenatal care, with close monitoring of symptoms, will detect the onset of hypertension in many women. For those whose disease progresses rapidly between appointments, knowledge of the signs and symptoms of the condition is the best protection. To this end, the Preeclampsia Foundation provides evidence-based patient education materials to care providers and encourages women to contact their care providers to report any headache, nausea, elevation in hypertension, changes in swelling or urine output, visual disturbances (like sparkles and flashing lights,) and pain in the upper right of the abdomen or along the bra strap. Being informed and closely monitored saves lives.

References and Recommended Reading

Baumwell, S., & Karumanchi, S. A. (2007). Pre-eclampsia: clinical manifestations and molecular mechanisms. Nephron Clinical Practice, 106(2), c72-c81.

Colucci, F., Boulenouar, S., Kieckbusch, J., & Moffett, A. (2011). How does variability of immune system genes affect placentation?. Placenta, 32(8), 539-545.

Garovic, V. D., Bailey, K. R., Boerwinkle, E., Hunt, S. C., Weder, A. B., Curb, D., … & Turner, S. T. (2010). Hypertension in pregnancy as a risk factor for cardiovascular disease later in life. Journal of hypertension, 28(4), 826.

Koopmans CM, Bijlenga D, Groen H, Vijgen SM, Aarnoudse JG, Bekedam DJ, van den Berg PP, de Boer K, Burggraaff JM, Bloemenkamp KW, Drogtrop AP, Franx A, de Groot CJ, Huisjes AJ, Kwee A, van Loon AJ, Lub A, Papatsonis DN, van der Post JA, Roumen FJ, Scheepers HC, Willekes C, Mol BW, van Pampus MG; HYPITAT study group. (2009) Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet. 374(9694):979-88

Levine, R. J., Lam, C., Qian, C., Yu, K. F., Maynard, S. E., Sachs, B. P., … & Karumanchi, S. A. (2006). Soluble endoglin and other circulating antiangiogenic factors in preeclampsia. New England Journal of Medicine, 355(10), 992-1005.

Maynard, S. E., Min, J. Y., Merchan, J., Lim, K. H., Li, J., Mondal, S., … & Karumanchi, S. A. (2003). Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. Journal of Clinical Investigation, 111(5), 649-658.

Powers RW, Jeyabalan A, Clifton RG, Van Dorsten P, Hauth JC, et al. (2010) Soluble fms-Like Tyrosine Kinase 1 (sFlt1), Endoglin and Placental Growth Factor (PlGF) in Preeclampsia among High Risk Pregnancies. PLoS ONE 5(10): e13263. doi:10.1371/journal.pone.0013263

Redman, C. W. G., Tannetta, D. S., Dragovic, R. A., Gardiner, C., Southcombe, J. H., Collett, G. P., & Sargent, I. L. (2012). Review: Does size matter? Placental debris and the pathophysiology of pre-eclampsia. Placenta,33, S48-S54.

Turner, J. A. (2010). Diagnosis and management of pre-eclampsia: an update.International journal of women’s health, 2, 327.

van Dijk, M., & Oudejans, C. (2010). Stox1: key player in trophoblast dysfunction underlying early onset preeclampsia with growth retardation.Journal of pregnancy, 2011.

von Versen-Hoeynck, F. M., & Powers, R. W. (2007). Maternal-fetal metabolism in normal pregnancy and preeclampsia. Front Biosci, 12, 2457-2470. 

Warning, J. C., McCracken, S. A., & Morris, J. M. (2011). A balancing act: mechanisms by which the fetus avoids rejection by the maternal immune system. Reproduction, 141(6), 715-724.

World Health Organization. (2011). WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. Geneve: WHO.

About Caryn Rogers

A native of Tempe, Arizona, Ms. Rogers is a graduate of Arizona State University. A freelance science writer and editor for medical nonprofits, she has been the senior science writer for the Preeclampsia Foundation since 2006. She lives with her family in Mt. Lebanon, PA, where she also plays the violin. Ms. Rogers can be contacted through the Preeclampsia Foundation or via email

Sharon Muza Childbirth Education, Evidence Based Medicine, Maternity Care, New Research, News about Pregnancy, Pregnancy Complications, Research, Uncategorized Caryn Rogers, eclampsia, gestational hypertension, preeclampsia, Preeclampsia Foundation, research, Sharon Muza, tests in pregnancy, treatment for pre-eclampsia