The Onset of Toxemia
Dr. Abdulla Al-Khan, the director of perinatal diagnostics and therapeutics at Hackensack University Medical Center in Hackensack, New Jersey, says the syndrome can start gradually or come on suddenly. "Its complications can be extensive to the mother," he says. "It can affect every organ system in the female patient, causing, for example, stroke, renal failure, convulsions, coagulation abnormalities, blindness, and more. In terms of the fetus, the complications can include growth restriction, placental separation that could lead to infant death or other [effects]."
Symptoms of Toxemia
Dr. Robert Atlas, chairman of the department of obstetrics and gynecology at Mercy Medical Center in Baltimore, says the symptoms can vary greatly between patients. "Not all preeclampsia is the same," he says. "Some women develop seizures right away. However, the most common symptoms are headache, blurry vision, the sense of not feeling well and swelling in non-dependent extremities, though this has been removed from the diagnostic criteria. There also may be epigastric pain, right upper quadrant pain, nausea, and vomiting."
And if the issue of symptoms seems hazy at best, the cause of this illness is even less understood. "The exact cause is still unknown," admits Dr. Atlas. "We believe there are a number of theories as to why it happens. There are genetic components, immunologic components that cause the placenta to attach abnormally to the uterus. We've identified a number of markers that are associated with preeclampsia ... however, these may just be markers for the disease and not the cause."
Who's at Risk?
While the symptoms and the cause of preeclampsia are still under debate, doctors have determined several factors appearing to have at least a tenuous link to the disease. "There are certain ethnic groups that suffer from a higher incidence of preeclampsia," says Dr. Atlas. "The African-American population is at a higher risk. And we know that there are families at risk of developing preeclampsia, especially when first-degree relatives such as a mother or sister have had it. Because of this, it's important to bring this information up with your physician, as they may watch your pregnancy differently."
Reducing the Risk
So what can moms do to help lower their chances of suffering from toxemia? "Risk factors include obesity, so you may be able to lower your risk by having a normal weight entering pregnancy," says Dr. Ira Bernstein, professor of obstetrics and gynecology and vice chair of obstetrics and director of the Maternal Fetal Medicine department at the University of Vermont College of Medicine. "People who exercise more seem to have a lower risk of preeclampsia, so regular exercise prior to pregnancy may help to reduce your risk. As well, the risk for preeclampsia increases in very young and older women—those in their teens and late 30s. The risk seems to increase if the interval between pregnancies is long, so a shorter interval between pregnancies may lower your risk."
And good follow-up with obstetricians is imperative, says Dr. Al-Khan. "Control of diabetes, underlying chronic hypertension, or other medical disorders is very important," he says. "Secondly, artificial reproductive technology with multi-fetal pregnancy poses a significant risk, so appropriate consultation with a reproductive endocrinologist and counseling is very important even in the absence of underlying medical problems."