Avoiding Preeclampsia: How To Do It and What You Need to Know
Preeclampsia is a complication that happens in pregnancy. It can be serious, even fatal, but it also can be prevented or controlled. We don’t talk enough about avoiding preeclampsia. So this blog post is here to do just that.
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Pregnancy is a miracle. It’s also a time when women and babies can experience unique health complications. One of those unique complications is something called preeclampsia.
I don’t usually focus on risks and complications, but I have a reason for writing about this one.
My main hope in writing about preeclampsia is that you will come to understand that though preeclampsia does affect many women and can be dangerous, it isn’t out of your control.
You have the power to significantly decrease your likelihood of developing preeclampsia and of preventing a future where you get boxed into limited birth choices that you don’t want.
You have the power to avoid preeclampsia in pregnancy.
So let’s start learning.
(If you want to jump straight to what you can do to prevent or reverse preeclampsia, go here: Avoiding Preeclampsia In Pregnancy.)
What is Preeclampsia?
In order to understand preeclampsia (pronounced pree-ee-clamp-see-uh), you have to understand hypertension. Hypertension is just a fancy name for high blood pressure.
High blood pressure (or hypertension) can happen before, during, and after pregnancy. And, of course, it can happen to men and women who never have children too.
When hypertension occurs during pregnancy it is called “gestational hypertension.” Gestational hypertension is when a woman who previously had normal blood pressure levels is now 20 or more weeks pregnant and has a blood pressure reading of 140 over 90.
Gestational hypertension becomes preeclampsia if one or more of the following also occurs:
- Protein in the urine (this is the main means of diagnosis)
- Severe headaches that don’t go away with usual pain relief methods
- Visual disturbances (blurred vision, spots or flashes of light, temporary loss of vision)
- Low platelet count in blood
- Kidney or liver damage (in severe cases)
- Seizure (in severe cases)
Preeclampsia occurs in somewhere between 2 and 12 in every 100 pregnant women (about 2–8%). Of that possible 8%, about 6% of cases will be mild. Only 1–2% are severe. (Severe is usually defined as a blood pressure of 160 over 110, or higher.)
Symptoms of Preeclampsia
In addition to the indicators listed above, the following symptoms may be a sign of preeclampsia:
- Sudden or extreme swelling
- Rapid weight gain (due to fluid retention)
- Pain in the upper right abdominal area
- Severe nausea and vomiting, especially when it hasn’t been a usual symptom for you
- Peeing less often
- Shortness of breath (more than usual, due to fluid in lungs)
- Overactive reflexes
If you notice any of these symptoms, it’s a good idea to check in with your care provider.
How Care Providers Monitor for Preeclampsia
Whether you go to an OBGYN or a midwife, you will be monitored for signs of hypertension and preeclampsia in similar ways.
At each prenatal appointment, they’ll check your blood pressure (using an arm cuff), have you pee in a cup so they can test for protein in your urine, and ask if you’ve had headaches or any visual disturbances.
They’ll also check for swelling. Doctors will probably do this visually. My midwife always checked visually and pressed a finger to my lower leg to see how the skin responded.
What Causes Preeclampsia?
Part of the confusion about preeclampsia stems from the fact that no one is quite sure what actually causes it. There are a lot of ideas, but it’s generally believed to be related to blood flow through the placenta.
If you’re curious what people have speculated about the causes and risk factors of preeclampsia, you can read more here.
Knowing that the cause is likely related to placental blood flow helps explain why it can be so dangerous.
Why is Preeclampsia Dangerous?
Like I explained earlier, preeclampsia is a form of hypertension, which is high blood pressure. Having high blood pressure for long periods of time is dangerous because it increases strain on your heart and can damage blood vessels.
Over time, heart strain can lead to heart disease, heart attack, stroke, and other heart problems.
Strained blood vessels can thin out, lose their elasticity, and even burst. If blood vessels sustain any tiny tears in their weakened state, scar tissue can build up and lead to cholesterol getting stuck in arteries, further compounding heart strain.
If the blood vessels in your kidney also get damaged, that can impair their ability to filter waste from the blood, potentially leading to kidney disease or even kidney failure.
Gestational hypertension can also lead to HELLP syndrome which is very similar to preeclampsia but includes elevated liver enzymes and low platelet count. HELLP syndrome can lead to liver failure.
If preeclampsia worsens, it can become eclampsia which means mom is experiencing seizures.
Sometimes, severe preeclampsia and eclampsia lead to death (though death is far more common in low-income, developing countries).
Risks to Baby
During pregnancy, hypertension and preeclampsia can cause problems for the baby too.
These risks include…
- fetal growth restriction
- placental abruption
- preterm birth
- potential problems later in life (learning disorders, epilepsy, diabetes, etc.)
These complications can lead to death. However, most of the time (especially in high-income countries like the US) the baby will survive.
Can Preeclampsia Be Avoided or Cured?
If you ask most people whether preeclampsia can be prevented or cured, their answer will likely be, “No. We don’t know why it happens and birth is the only way to get rid of it.”
Well, I disagree. Here’s why:
A man by the name of Tom Brewer was an obstetrician who researched the role of nutrition in pregnancy and pregnancy complications.
A website dedicated to the diet he designed states this:
“The cause of pre-eclampsia was discovered in the 1950’s and 1960’s, by an obstetrician by the name of Dr. Tom Brewer. In the process of his medical education, and researching the work of …doctors who had worked on this problem in the 40 years previously, he discovered that the cause of pre-eclampsia was an abnormal blood volume, caused by malnutrition, or food deficiency.”
And it makes perfect sense, really. It’s nothing new.
A woman’s body was designed to grow a baby and give birth to that baby safely. But it can only do so when provided with the nutrients the body needs to function the way it was designed.
If we don’t give our bodies the high-quality fuel it needs, it is far more likely that birth won’t go the way it was designed to.
But is it Evidence-Based?
You may have heard that The Brewer Diet has no evidence to back it up so it’s not a good solution. It is true that no clinical studies have assessed the effectiveness of The Brewer Diet in treating preeclampsia or other complications.
But it’s also true that Dr. Brewer did his own studies and many others have performed studies about the effects of nutrition in pregnancy. And no studies have proven The Brewer Diet to be harmful.
It’s also important to recognize what a good clinical trial would require in order to test this: restricting some pregnant woman to a less-than-optimal diet to test what happened. And that, obviously, is completely unethical.
Evidence Isn’t Required
With all that said, while I do like to cite Dr. Brewer as one who understood the cause of preeclampsia, he actually wasn’t the first to realize that preeclampsia can be avoided. Midwives have known it all along.
When women receive prenatal care from midwives or other holistic providers, they are almost always taught the importance of prenatal nutrition. Why? Because providers who see normal, natural birth regularly know that nutrition is key to avoiding complications.
So while studies and evidence like Dr. Brewer’s work is helpful, it’s not required to “prove” that preeclampsia can be avoided. Thousands, perhaps millions, of women know it’s true because they’ve lived it.
Avoiding Preeclampsia In Pregnancy
The first step in avoiding preeclampsia, then, is to give our bodies the nutrients it needs.
Dr. Brewer’s diet can help us do just that.*
The basics of The Brewer Diet are to get plenty of protein, salt, water, and calories every day during pregnancy.
It’s more than that though. Dr. Brewer outlined 14 categories of foods a pregnant woman needs and how much of each to eat.
Those 14 categories are:
- Milk and milk products – 4 servings
- Calcium replacements as needed (2 per soy exchange from group 1)
- Eggs – 2, any style
- Protein – 6 to 8 servings
- Dark green vegetables – 2 servings
- Whole grains – 5 servings
- Vitamin C foods – 2 servings
- Fats and oils – 3 servings
- Vitamin A foods – 1 serving
- Liver – 1 serving (weekly, optional)
- Salt and other sodium sources – unlimited
- Water – unlimited
- Snacks – unlimited
- Supplements – as needed
For in-depth information about each of these categories, why it’s important, and how to get it in your diet, check out The Brewer Diet: What, Why, and How.
Along with the principles of The Brewer Diet, midwives commonly know additional nutritional, herbal, and other ways of avoiding preeclampsia. These include…
- Reducing stressors
- Meditating and relaxing
- Exercising regularly
- Eating large quantities of garlic, parsley, and onion in your food
- Decreasing processed and fried foods in your diet
- Eating foods rich in probiotics
- Avoiding strong spices (black and white peppers, mustard, ginger, nutmeg, etc.)
- Utilizing acupuncture
- Avoiding stimulants (caffeine, black tea, chocolate, etc.)
- Supplementing with hops tea, passion flower, and corn silk tincture
The sooner you implement these practices into your life—healthy eating, exercise, regular relaxation—the more likely you are to avoid preeclampsia altogether.
If you develop gestational hypertension or preeclampsia, a holistic care provider like a midwife can help you utilize these and other measures to keep your blood pressure in check and, usually, avoid the need for more drastic measures.
*Of course, following The Brewer Diet is just one way to get the needed nutrients during pregnancy. Any balanced whole-food eating habit is just as good. The Brewer Diet can just help to simplify if it all seems overwhelming.
What About Calcium?
If you’ve heard that calcium supplementation can help women avoid preeclampsia, you might be wondering if it can help you.
The truth is this: evidence has shown that calcium supplementation can help women avoid preeclampsia if their normal dietary intake is low.
But if you get sufficient amounts of calcium from your diet (which you probably do if you eat lots of fruits and veggies and a whole-food diet) supplementation isn’t going to help you much in regards to preeclampsia.
What About Aspirin?
If a woman has had preeclampsia in previous pregnancies or if she has risk factors for preeclampsia (more on those in a moment), a doctor will likely recommend she take low-dose aspirin, often called “baby aspirin,” every day starting early in pregnancy.
But does it work?
Yes, evidence has shown that taking a low-dose aspirin (81 mg per day) is an effective way to prevent preeclampsia.
If you are at higher risk of developing preeclampsia, a doctor will likely recommend that you start taking a low-dose aspirin every day starting after 12 weeks but before 16 weeks of pregnancy and continuing until you give birth.
Preeclampsia and Preterm Birth
If preeclampsia is severe, care providers have to strike a balance between the health of mom and the safety of her baby. To do that, most doctors will recommend inducing labor or scheduling a c-section around 37 weeks of pregnancy.
Here’s why it’s tricky:
Babies born before 39 weeks—and especially before 37 weeks—are at higher risk of breathing problems, developmental delays, brain injury, and death, as well as long-term health problems.
But if preeclampsia is severe, serious organ damage or death is more likely for mom the longer she stays pregnant.
That is why preventing or treating preeclampsia is so important.
Vaginal birth—after 39 weeks—is better for both mom and baby. And it’s more likely that they’ll make it to 39 weeks if mom avoids or reverses preeclampsia early on.
Preeclampsia and C-sections
It’s also important to know that most of the time, preeclampsia does NOT mean you have to have a c-section. In fact, vaginal birth will likely be better since you will avoid the added stress, increased blood loss, and possible complications of surgery.
If you do need to give birth earlier than planned (your preeclampsia is severe), ask for an induction rather than immediately scheduling a c-section.
Preeclampsia and Home Birth
If you can give birth vaginally with preeclampsia, does that mean you can give birth at home with preeclampsia?
Yes!
If your blood pressure is well-controlled and monitored, a home birth can be just as safe as a hospital birth, even with preeclampsia.
Risk Factors, Treatment, and More
If you’re wondering whether you’re at risk for developing preeclampsia, take a look through the following lists.
Factors that may put you at high risk for preeclampsia include…
- You’ve had preeclampsia in previous pregnancies
- You have a history of high blood pressure or kidney or liver disease
- You’re pregnant with multiples (twins, triplets, etc.)
- You have certain chronic health conditions, such as high blood pressure, diabetes, kidney disease, or lupus
Factors that may put you at moderately higher risk for preeclampsia include…
- This is your first time being pregnant or giving birth
- You are overweight
- Your family has a history of preeclampsia
- You’re older than 35
- You are black or hispanic
- You gave birth to a low birth weight baby previously
Treatment
A few different medications may be prescribed to help treat preeclampsia. These medications have various purposes, including:
- To lower your blood pressure
- To prevent seizures
- To help your baby’s lungs develop more rapidly (in case of premature birth)
Of course, the other “treatment” is to give birth.
If your preeclampsia is mild, a doctor will likely wait until 37 weeks to induce your labor or do a c-section. A midwife will likely help you keep things under control holistically and wait for you to give birth on your own.
If your preeclampsia is severe, you may need to be induced before 37 weeks, but ideally after 34 weeks.
White Coat Hypertension
Both for an interesting tidbit and so you’re aware of the possibility, I wanted to mention something called “white coat hypertension.”
White coat hypertension is when a person’s blood pressure is elevated when tested in the presence of a care provider but is normal when tested at home.
It is a real condition and can indicate a slightly higher risk of developing preeclampsia.
If your care provider suspects this is the case for you, you will likely be asked to do blood pressure checks at home.
You may also be able to avoid the appearance of white coat hypertension by asking that your blood pressure be checked at the end of appointments rather than the beginning (so traffic or walking up the stairs in the clinic doesn’t affect it).
Care providers can also help blood pressure measurements be more accurate by giving women time to intentionally relax before checking.
TL;DR
To summarize, preeclampsia is a real complication during pregnancy. It occurs in 2–8% of pregnancies and can be a serious risk to mom and baby.
Risks to mom include organ failure, heart problems, seizure, and death.
Risks to baby include fetal growth restriction, placental abruption, preterm birth, potential problems later in life (learning disorders, epilepsy, diabetes, etc.), and death.
But preeclampsia is preventable and treatable!
In addition to (or as an alternative to) low-dose aspirin, which has been shown to be effective, eating a healthy, whole-food diet, exercising regularly, reducing stress, and utilizing herbal supplements can reduce your risk of preeclampsia.
You can still have a vaginal birth if you have preeclampsia. You can even give birth outside of the hospital if you wish to (as long as your blood pressure is well-controlled and monitored).
Medications are also available for severe cases of preeclampsia and can help to lower mom’s blood pressure, prevent seizures, and help baby’s lungs develop faster.
To avoid a false diagnosis of preeclampsia, you can ask to have your blood pressure checked at the end of prenatal appointments instead of the beginning, or you can check your blood pressure at home, rather than at the doctor’s clinic, since some women experience elevated blood pressure when they are with their care provider.
And that’s that! That’s what you need to know about avoiding preeclampsia in pregnancy.
Until next time,
Allison
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