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Pre-eclampsia: awareness needed

pre eclampsia
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SHOCKING SCENES: Eclampsia features in season three of Downton Abbey, currently screening on Prime, Thursdays at 8.30pm.

It is one of the leading causes of illness and death in mothers and newborns around the world, but the founder of an organisation determined to educate health providers and the public on the dangers of Pre-eclampsia says many mums-to-be are not aware of the symptoms of the disease.

The SCOPE study, which hopes to identify identify markers in early pregnancy, which can predict if a woman might develop late pregnancy complications states that the disease affects five per cent of first time mothers worldwide.

Each year, the number of maternal deaths from Pre-eclampsia is equivalent to the loss of 170 jumbo jets of pregnant women, a quarter of the babies born to mothers with Pre-eclampsia are growth restricted and a third are premature.

What is Pre-eclampsia?

Pre-eclampsia is defined as "a severe high blood pressure condition where the mother can develop kidney or liver problems, stroke and seizures".

Also referred to as toxemia, it is marked by high blood pressure, a high level of protein in the urine and in some cases, swelling in the feet, legs and hands.

Usually it appears during the second half of pregnancy and generally in the later part of the second or third trimesters, although it can occur earlier.

If left untreated pre-eclampsia can develop into eclampsia, in addition to high blood pressure, women with eclampsia often have seizures.

Eclampsia can cause coma, or even the death for mum and baby, during or after childbirth.

What causes it?

The exact causes of pre-eclampsia are not known, however, research has shown that poor nutrition, high body fat or insufficient blood flow to the uterus could be possible causes.

According to founder of the New Zealand Action on Preeclampsia (NZAPEC) Joyce Cowan, who has over four decades experience as a midwife, pre-eclampsia is most often seen in first-time pregnancies and in pregnant teens and women over 40.

However, other risk factors can include:

  • A history of chronic high blood pressure prior to pregnancy
  • Previous history of Pre-eclampsia, a history of Pre-eclampsia in mother or sisters,
  • Obesity prior to pregnancy.
  • Carrying more than one baby.
  • A history of diabetes, kidney disease, lupus or rheumatoid arthritis.

What kind of support is there in New Zealand?

NZAPEC aims to raise awareness about pre-Eclampsia in the community and to support sufferers, their families and research into the disease as well as training and support to maternity providers.

"I think people just expect that everything will be normal and this is such a common pregnancy complication," she told Essential Mums.

"The majority of women who get pre-eclampsia don't get it very severely but the complications for a woman and her baby are quite significant."

Cowan is in the process of writing a book with two other authors from the UK, who work for a Britain-based APEC group.

"We conducted an international survey of women who have experienced Pre-eclampsia in the last few years and we found that the vast majority of these women, many who were very well educated said they did not have enough information about Pre-eclampsia and they were totally shocked by what happened."

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Cowan said that even during and after the illness, many of these women felt they were not given enough information by their care givers.

"For various reasons there is a need for more information to get out there and mainly for women to know what the symptoms are and can seek help immediately," she explains.

What to watch out for:

Cowan says NZAPEC has received anecdotal evidence that some women who experienced symptoms of Pre-eclampsia were sometimes treated for other illnesses when they saw their doctor.

"It is such a varying disease and the two traditional signs are high blood pressure and protein in the urine but it can present in so many other ways as well."

It is for this reason that maternity providers, including midwives, are trained on how to identify the disease in a timely way so it can be managed.

Research has shown that there is a genetic component to developing the disease and this could come from either the father of the baby, or the mother's side.

"If a woman's mother, or sister had it, then there is obviously a much greater chance she might develop it, opposed to the father's side," Cowan says.

What is the risk?

If a women develops pre-eclampsia in the early stages of her pregnancy, there is a higher risk for the baby, given it has not yet grown.

"There is obviously a greater risk of post-natal depression and post traumatic stress disorder if a woman feels she has lost control of her pregnancy and lost her dreams of a normal birth and a full term pregnancy if she has to have an emergency ceasar," says Cowan.

"There is also not a lot of research on the impact this has on their partners, but after speaking to a lot of dads, they suffer quite a lot of emotional distress as well."

If I am worried, what can I do?

If there is a risk that you might develop Pre-eclampsia, you may be able to mitigate the risk by going onto low doses of aspirin and calcium.

It is important that your medical carer, doctor or midwife, takes a careful history so that you can be referred to a specialist as soon as possible, to help manage the disease.

"The majority of women develop it closer to full term, so they can be induced at 37 weeks and they will recover quickly and their babies will be fine, but we do know that women who had eclampsia have an increased risk of developing cardiovascular disease in the future, so they will need to look after their health and make sure they go for regular medical checks in the future," says Cowan.

How can I avoid it?

It may be possible to limit your chances of developing pre-eclampsia when you are pregnant by doing the following before you fall pregnant:

  • Be a good weight before conceiving.
  • Healthy diet - recent research shows that a diet rich in leafy greens and fruit and vegetable minimises the risk.
  • Maintaining a normal level of blood pressure, including a reduction in stress.

"It is important to keep in mind that most pregnancies are normal and we don't want to frighten people, but the key is to be aware of the symptoms and to report them properly and for people to look after their health pre-conception, because that is something people can have control over," says Cowan.

- © Fairfax NZ News

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