preeclampsia

Blood pressure is the force of your blood pushing against the walls of your arteries as your heart pumps blood. High blood pressure, or hypertension, is when this force against your artery walls is too high. There are different types of high blood pressure in pregnancy:

• Gestational hypertension is high blood pressure that you develop while you are pregnant. It starts after you are 20 weeks pregnant. You usually don't have any other symptoms. In many cases, it does not harm you or your baby, and it goes away within 12 weeks after childbirth. But it does raise your risk of high blood pressure in the future. It sometimes can be severe, which may lead to low birth weight or preterm birth. Some women with gestational hypertension do go on to develop preeclampsia.
• Chronic hypertension is high blood pressure that started before the 20th week of pregnancy or before you became pregnant. Some women may have had it long before becoming pregnant but didn't know it until they got their blood pressure checked at their prenatal visit. Sometimes chronic hypertension can also lead to preeclampsia.
• Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. It usually happens in the last trimester. In rare cases, symptoms may not start until after delivery. This is called postpartum preeclampsia. Preeclampsia also includes signs of damage to some of your organs, such as your liver or kidney. The signs may include protein in the urine and very high blood pressure. Preeclampsia can be serious or even life-threatening for both you and your baby.

The cause of preeclampsia is unknown.

You are at higher risk of preeclampsia if you:

• Had chronic high blood pressure or chronic kidney disease before pregnancy
• Had high blood pressure or preeclampsia in a previous pregnancy
• Have obesity
• Are over age 40
• Are pregnant with more than one baby
• Are African American
• Have a family history of preeclampsia
• Have certain health conditions, such as diabetes, lupus, or thrombophilia (a disorder which raises your risk of blood clots)
• Used in vitro fertilization, egg donation, or donor insemination

Preeclampsia can cause:

• Placental abruption, where the placenta separates from the uterus
• Poor fetal growth, caused by a lack of nutrients and oxygen
• Preterm birth
• A low birth weight baby
• Stillbirth
• Damage to your kidneys, liver, brain, and other organ and blood systems
• A higher risk of heart disease for you
• Eclampsia, which happens when preeclampsia is severe enough to affect brain function, causing seizures or coma
• HELLP syndrome, which happens when a woman with preeclampsia or eclampsia has damage to the liver and blood cells. It is rare, but very serious.

Possible symptoms of preeclampsia include:

• High blood pressure
• Too much protein in your urine (called proteinuria)
• Swelling in your face and hands. Your feet may also swell, but many women have swollen feet during pregnancy. So swollen feet by themselves may not be a sign of a problem.
• Headache that does not go away
• Vision problems, including blurred vision or seeing spots
• Pain in your upper right abdomen
• Trouble breathing

Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output. If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.

Your health care provider will check your blood pressure and urine at each prenatal visit. If your blood pressure reading is high (140/90 or higher), especially after the 20th week of pregnancy, your provider will likely want to run some tests. They may include blood tests other lab tests to look for extra protein in the urine as well as other symptoms.

Delivering the baby can often cure preeclampsia. When making a decision about treatment, your provider take into account several factors. They include how severe it is, how many weeks pregnant you are, and what the potential risks to you and your baby are:

• If you are more than 37 weeks pregnant, your provider will likely want to deliver the baby.
• If you are less than 37 weeks pregnant, your health care provider will closely monitor you and your baby. This includes blood and urine tests for you. Monitoring for the baby often involves ultrasound, heart rate monitoring, and checking on the baby's growth. You may need to take medicines, to control your blood pressure and to prevent seizures. Some women also get steroid injections, to help the baby's lungs mature faster. If the preeclampsia is severe, you provider may want you to deliver the baby early.

The symptoms usually go away within 6 weeks of delivery. In rare cases, symptoms may not go away, or they may not start until after delivery (postpartum preeclampsia). This can be very serious, and it needs to be treated right away.

A normal pregnancy lasts nine months. Each three-month period of pregnancy is called a trimester. During each trimester, the fetus grows and develops. Regular medical checkups and prenatal tests are very important. They can:

• Help keep you and your baby healthy
• Spot problems with your baby (if there are any). In some cases, health care professionals can treat the problem before your baby is born. But even when they cannot, it can still be helpful to know about the problem early on. That gives you time to learn about your baby's condition and prepare for any challenges you may face after the baby is born.
• Prevent problems during delivery. For example, if your baby is breech (bottom first or feet first, instead of head first), you may need to have a Cesarean section to avoid complications.

Besides getting medical care, there are other things you can do to keep your baby as healthy as possible. It's important not to drink or smoke. Try to eat a healthy diet and make sure to take care of any health problems you have during pregnancy.

Every pregnancy has some risk of problems, but there are certain conditions and health issues that can raise that risk, such as:

• A health condition you had before you got pregnant
• A health condition you develop during pregnancy
• A pregnancy with more than one baby
• A health problem that happened during a previous pregnancy and could happen again
• Substance use during pregnancy
• Being over age 35

Any of these can affect your health, the health of your baby, or both.

If you have a chronic condition, you should talk to your health care provider about how to minimize your risk before you get pregnant. Once you are pregnant, you may need a health care team to monitor your pregnancy. Some common conditions that can complicate a pregnancy include:

• High blood pressure
• Kidney problems
• Autoimmune diseases
• Obesity
• HIV
• Cancer
• Infections

Other conditions that may make pregnancy risky can develop during pregnancy - for example, gestational diabetes and Rh incompatibility. Good prenatal care can help detect and treat them.

Some symptoms, such as nausea, back pain, and fatigue, are common during pregnancy. Sometimes it is hard to know what is normal. Call your health care provider if something is bothering or worrying you.

Nutrition is about eating a healthy and balanced diet so your body gets the nutrients that it needs. Nutrients are substances in foods that our bodies need so they can function and grow. They include carbohydrates, fats, proteins, vitamins, minerals, and water.

When you're pregnant, nutrition is more important than ever. You need more of many important nutrients than you did before pregnancy. Making healthy food choices every day will help you give your baby what they need to develop. It will also help make sure that you and your baby gain a healthy amount of weight.

You need more folic acid, iron, calcium, and vitamin D than you did before pregnancy:

• Folic acid is a B vitamin that may help prevent neural tube defects.
  • Before pregnancy, you need 400 mcg (micrograms) per day.
  • During pregnancy and when breastfeeding, you need 600 mcg per day from foods and/or vitamins. It is hard to get this amount from foods alone, so you will most likely need to take a supplement that contains folic acid.
• Iron is important for your baby's growth and brain development. During pregnancy, the amount of blood in your body increases, so you need more iron for yourself and your growing baby. You should get 27 mg (milligrams) of iron a day.
• Calcium during pregnancy can reduce your risk of preeclampsia. It's a serious medical condition that causes a sudden increase in your blood pressure. Calcium also builds up your baby's bones and teeth.
• Pregnant adults should get 1,000 mg (milligrams) of calcium a day
• Pregnant teenagers (ages 14-18) need 1,300 mg of calcium a day
• Vitamin D helps the calcium to build up the baby's bones and teeth. All women, pregnant or not, should be getting 600 IU (international units) of vitamin D per day.

Keep in mind that taking too much of a supplement can be harmful. For example, very high levels of vitamin A can cause birth defects. Only take vitamins and mineral supplements that your health care provider recommends.

You also need more protein when you are pregnant. Healthy sources of protein include beans, peas, eggs, lean meats, seafood, and unsalted nuts and seeds.

Getting enough fluids is another special nutritional concern during pregnancy. When you are pregnant, your body needs even more water to stay hydrated and support the life inside you. So it's important to drink enough fluids every day.

How much weight you should gain depends on your health and how much you weighed before pregnancy:

• If you were at a normal weight before pregnancy, you should gain about 25 to 35 pounds
• If you were underweight before pregnancy, you should gain more
• If you were overweight or had obesity before you became pregnant, you should gain less

Check with your provider to find out how much weight gain during pregnancy is healthy for you. You should gain the weight gradually during your pregnancy, with most of the weight gained in the last trimester.

How many calories you need depends on your weight gain goals. Your provider can tell you what your goal should be, based on things like your weight before pregnancy, your age, and how fast you gain weight. The general recommendations are:

• In the first trimester of pregnancy, you probably do not need extra calories
• In the second trimester, you usually need about 340 extra calories
• In the last trimester, you may need around 450 extra calories per day
• During the final weeks of pregnancy, you may not need extra calories

Keep in mind that not all calories are equal. You should eat healthy foods that are packed with nutrients - not "empty calories" such as those found in soft drinks, candies, and desserts.

During pregnancy, you should avoid:

• Alcohol. There is no known amount of alcohol that is safe for a woman to drink during pregnancy.
• Fish that may have high levels of mercury. Limit white (albacore) tuna to 6 ounces per week. Do not eat tilefish, shark, swordfish, marlin, orange roughy, or king mackerel.
• Foods that are more likely to contain germs that could cause foodborne illness, including
  • Refrigerated smoked seafood like whitefish, salmon, and mackerel
  • Undercooked meat, poultry, eggs, and seafood
  • Refrigerated meat spreads
  • Store-made salads, such as chicken, egg, or tuna salad
  • Unpasteurized or raw milk
  • Unpasteurized juices or cider
  • Unpasteurized soft cheeses, such as unpasteurized feta, Brie, queso blanco, queso fresco, and blue cheeses
  • Raw sprouts of any kind (including alfalfa, clover, radish, and mung bean)
  • Raw cookie dough
  • Unwashed fruits and vegetables
• Too much caffeine. Drinking high amounts of caffeine may be harmful for your baby. For most people, it's best to limit caffeine to less than 200 mg per day during pregnancy. But first check with your provider about whether you should have caffeine at all.