World Preeclampsia Day: Why The World Must Unite To Combat Preeclampsia

The month of May marks Preeclampsia Awareness Month, an entire month dedicated to spreading awareness about the perilous hypertensive disorder known as preeclampsia during pregnancy.

World Preeclampsia Day is commemorated to raise awareness of preeclampsia, a serious and hazardous complication of pregnancy. Maternal hypertensive diseases claim far too many lives and have catastrophic consequences.

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By Dr Reema Bhatt

World Preeclampsia Day: Every year, May 22 is observed as World Preeclampsia Day (WPD) globally. The month of May marks Preeclampsia Awareness Month, an entire month dedicated to spreading awareness about the perilous hypertensive disorder known as preeclampsia during pregnancy. This communication campaign aims to promote understanding and knowledge surrounding this condition. In 2023, our theme is "Advancing Preeclampsia Research," emphasising the importance of pushing forward in our quest to enhance our understanding and find effective solutions for this life-threatening condition.

WPD is commemorated to raise awareness of preeclampsia, a serious and hazardous complication of pregnancy. Maternal hypertensive diseases claim far too many lives and have catastrophic consequences, emphasising the importance of identifying the condition well in time. Let's look at some startling figures to grasp the magnitude of the problem, it affects around 10 per cent of all pregnant women globally, along with associated hypertension diseases of pregnancy, each year, these disorders kill nearly 76,000 mothers and 500,000 babies worldwide 99 per cent of deaths due to preeclampsia occur in low to a middle-income group and accounts for 16 per cent of maternal deaths. 

The risk of end-stage renal disease in women with preeclampsia is about three to five times higher than in women who do not have preeclampsia. It affects 6 per cent of pregnancies in the postpartum period. Preeclampsia is a common cause of iatrogenic preterm delivery, accounting for approximately 20 per cent of all newborn intensive care unit admissions. The danger to health does not end with the birth of her child, preeclampsia survivors are two to 10 times more likely to develop cardiovascular disease (CVD), including stroke, and face a fourfold increase in the likelihood of high blood pressure. These facts highlight the enormity of the problem.

Preeclampsia is a potentially fatal condition, which can hit without warning, that occurs in the second half of certain pregnancies and can result in major adversity for both the baby and the mother if not monitored and managed. However, the affirmative part of all this is that  Preeclampsia can be easily recognised during standard pregnancy checkups. The earlier preeclampsia is recognised and monitored, the better the prognosis for both mother and baby, however it can be remedied only by delivering the baby.

The earliest clinical signs and symptoms are new-onset hypertension, and proteins in the urine, other symptoms include abdominal discomfort, haemorrhage, placental abruption, or severe HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets). 

Education is critical in minimising the number of fatalities caused by the illness. While we continue to work for the cause of preeclampsia, we need to educate and prepare our women before the lightning strikes. The tools include self-monitoring of blood pressure, by doing so pregnant and postpartum moms become active partners in their health care. For this, they must maintain blood pressure records, take twice-daily measurements, notice abnormal readings, and seek immediate medical assistance. 

Preeclampsia is a condition that affects many organ systems. Here are some of the most prevalent signs of this illness, severe headache that refuses to go away despite medicine, vision changes (spots, light flashes, or vision loss), breathing difficulties, gasping, or panting, upper right stomach discomfort frequently misdiagnosed as indigestion or the illness, face, feet and hand swelling, more than five pounds (2.3 kg) gained in one week, after-pregnancy nausea. However, if one acquires any signs of this condition, she will require immediate medical care and treatment. We also need to understand our family history, particularly for pregnancy, high blood pressure, and heart disease. 

Although there is no one cause of preeclampsia, numerous factors such as autoimmune illnesses, blood vessel difficulties, and genetic issues can all contribute to the condition's onset. Several variables, including being pregnant with multiple foetuses, pregnant women over the age of 35, first-time pregnancy, obesity, and a history of high blood pressure/diabetes/kidney diseases can all enhance the potential risk of the ailment.

Preeclampsia in addition to maternal complications also warrants active fetal surveillance because of the risk of fetal growth restriction and Doppler changes, due to restricted blood flows to the fetus.

Despite active research, we need to know that this situation cannot be avoided in any manner, nevertheless, proper screening and early diagnosis can allow for preventative measures and avoidance of this crisis during pregnancy. The importance of early detection of preeclampsia stems from the ability to begin preventive therapy on time. For early prediction of the development of pre-eclampsia, a combination of biophysical and biochemical markers outperforms other tests. Preeclampsia screening in the first trimester must become the standard of care and every woman should know her risk of preeclampsia by 12 -13 weeks of pregnancy.

Screening tests for preeclampsia range from gathering a comprehensive history, encompassing obstetric and medical aspects along with maternal demographic characteristics, to a straightforward and feasible test involving blood pressure measurement, of which MAP (Mean Arterial pressure ), to a targeted ultrasound in the form of uterine artery pulsatility index (PI) which is a part of routine nuchal scan in the first trimester and biochemical tests like plasma protein-A (PAPP- A) and placental growth factor (PlGF) at 11–13 weeks gestation. Most importantly, screening for preeclampsia is necessary because there is an evidence-based prevention strategy. 

Several researchers have investigated low-dose aspirin for prophylactic use in the prevention of preeclampsia. If the treatment is started earlier (12 weeks), there is a significant reduction in early-onset PE, which is supported by evidence-based medicine (Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention (ASPRE) trial). We should use universal screening for all first-trimester pregnancies because it has a 95 per cent detection rate.

We need to raise awareness for this severe and dangerous pregnancy complication. We also need to stress universal screening for all mothers to enable us to offer early intervention, and intensive monitoring to ensure optimal fetal and maternal outcomes. Our motto should be to "Increase awareness, Screen early and Prevent Preeclampsia!"

(The author is the Head, Department of Fetal Medicine, Amrita Hospital, Faridabad)

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