Taking the Pressure Out of Pregnancy

Simple treatments may protect against blood pressure problems

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By
HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

SUNDAY, Sept. 7, 2003 (HealthDayNews) -- When people hear the phrase "high blood pressure," most immediately think "heart disease."

But for a significant number of women, high blood pressure is a potentially dangerous condition that's intimately linked to pregnancy.

The problem is preeclampsia, a little understood pregnancy complication often characterized by a rapid and dramatic rise in blood pressure, usually in the third trimester.

"Other symptoms can include a rapid swelling, usually of the hands, feet and face, as well as protein in the urine, which, together with a rise in blood pressure, can mean a pregnancy is in trouble," says Dr. Andrei Rebarber, director of Maternal Fetal medicine at New York University School of Medicine.

Left untreated, preeclampsia can rapidly progress to eclampsia -- a potentially deadly condition that causes, among other problems, a dramatic swelling of the brain, Rebarber says.

Currently, the only known way to relieve preeclampsia and prevent the progression to eclampsia is immediate delivery, usually by an emergency Caesarean section.

"This often means delivering a baby very prematurely, which has its own set of complications and problems," Rebarber says.

As dangerous as preeclampsia can be, sometimes the simplest of treatments may help to reduce the risk for thousands of women each year. They include antioxidant vitamins, calcium and aspirin, the focus of ongoing research.

"As to the reason why aspirin may work, there are many theories. But they mainly center on the role of aspirin inhibiting the production of thromboxane, a substance which is known to be produced in excess in women with preeclampsia," says Dr. Arri Coomarasamy, a high-risk pregnancy researcher from Birmingham Women's Hospital in England.

Coomarasamy is one of a number of physicians worldwide conducting clinical trials on aspirin and preeclampsia, with encouraging results. His most recent research, published in the June issue of Obstetrics and Gynecology, analyzed a series of studies involving the use of aspirin on some 12,000 pregnant women.

Aspirin not only reduced the risk of preeclampsia by some 14 percent, it also lowered the risk of premature labor by 21 percent, and miscarriage by 14 percent, while increasing the weight of babies by up to one half a pound.

"There is generally no obstetric contraindication for aspirin," says Coomarasamy, who believes women at risk for preeclampsia have nothing to lose by trying the therapy -- so long as their doctor agrees.

But some doctors point to conflicting study results, and remain uneasy about routinely prescribing aspirin for women at risk for preeclampsia.

"I think the jury is still out on the role of aspirin in preeclampsia. There are studies showing it works, studies showing it doesn't, and some that indicate a potential for other problems," Rebarber says. "So I don't believe it can be a blanket recommendation for all women at risk."

In fact, eight recent trials involving more than 30,000 women showed only minimal benefits from taking aspirin for preeclampsia, and in many instances no benefits at all.

In addition, some studies have shown aspirin may cause a slight increase in the risk of placental abruption -- a separation of the pregnancy sac from the uterus that can put a baby's life at risk.

For Rebarber, a far more promising treatment involves still another simple remedy -- vitamins E and C, in large doses beginning at the start of the pregnancy.

In studies published last year in Obstetrics and Gynecology, this treatment was found to be both safe and effective, particularly for women who experienced an early onset of preeclampsia in a previous pregnancy.

Other studies done in Europe and the Middle East have shown similar results using a combination of calcium and vitamin D supplements.

The American College of Obstetricians and Gynecologists estimates the risk of preeclampsia to be between 5 percent and 8 percent of all pregnancies. If you're carrying twins or triplets, or if you've had preeclampsia in a previous pregnancy, your risk may be even higher -- up to 18 percent for some women.

"The point is that until we know for certain what's causing preeclampsia, we won't have a definitive treatment," Rebarber says. "And, in fact, it may turn out that the cause is not the same in every woman. So, prevention may involve more than one approach and more than one treatment."

Until then, experts say women can help safeguard their pregnancy by seeking the care of a high-risk pregnancy doctor and keeping a keen eye out for symptoms of preeclampsia.

"If you are pregnant, and you experience rapid swelling in your hands, feet or face, if you have sudden vision difficulties, or if your blood pressure takes a dramatic jump, then call your doctor right away," Rebarber says.

Both Rebarber and Coomarasamy caution against using any treatment during pregnancy without consulting with your doctor -- even something as simple as vitamins or aspirin.

"What you don't want to do is try to diagnose, treat or even prevent preeclampsia on your own. It's a serious condition and requires expert medical care," Rebarber says.

More information

To learn more about preeclampsia, visit The Preeclampsia Foundation or The March of Dimes.

SOURCES: Andrei Rebarber, M.D., director, Maternal Fetal Medicine, New York University School of Medicine, New York City; Arri Coomarasamy, MBChB, MRCOG, Specialist Registrar, Obstetrics and Gynecology, and Honorary Lecturer, Public Health and Epidemiology, Birmingham Women's Hospital, Birmingham, England; June 2003 Obstetrics and Gynecology

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