Dr. Kirtly Parker Jones: Preeclampsia or toxemia of pregnancy. What is that? For all of you Downton Abbey fans, it's what killed Lady Sybil Crawley at the end of her first and only pregnancy, and you all got to see it misdiagnosed and untreated on TV. What is preeclampsia? Who gets it? How can we prevent it? This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care and this is The Scope about preeclampsia.
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Dr. Kirtly Parker Jones: Toxemia is such an old fashioned term but it refers to a common condition of pregnancy, associated with high blood pressure, kidney problems, and possible seizures called eclampsia. The term toxemia came from the fact we didn't know what caused it but thought it was some sort of pregnancy toxin, and we knew it was cured by delivery. Preeclampsia is the condition before it gets to the stage of seizures. Today on The Scope we're going to talk about how it's diagnosed, who gets it, and some very recent recommendations, just this week, about how we might prevent it.
So toxemia, preeclampsia, pregnancy induced hypertension, these are all terms used for a condition in the pregnancy that causes high blood pressure and kidney problems and swelling that can progress to seizures, stroke and organ failure. It happens in about 5 to 10% of pregnancies, or about 1 in 15, so it's common and it's treated by delivery and resolves within several weeks after delivery, sometimes within hours after delivery. It's a major cause of premature delivery, because if the mom gets pretty sick and is only going to get sicker and sometimes is very dangerously sick, we have to get her delivered, even if the baby isn't ready.
We don't have great treatments, other than treating the blood pressure problem at the core of the disease, and that doesn't always work, so doctors have been looking for a prevention. It's hard to know a prevention when we barely even know the cause of this ancient and common disease of pregnancy.
So who can get it? Any woman who is pregnant can get and it usually shows up in the second half of pregnancy, mostly in the third trimester. It's more common in first moms and older moms. It's more common in African American moms. It's most common in woman with underlying medical conditions like high blood pressure, diabetes, clotting problems and auto immune disease. It's also more common in women with more than one baby on board or diabetes in pregnancy.
Many preventative treatments have been tried over the years; calcium supplements, low salt diets, blood letting. Didn't they try that on Lady Sybil? Vitamins, none have worked. Recently however, there have been enough studies of low dose aspirin to start at the beginning of pregnancy, to make the suggestion that all women who are at risk of preeclampsia take low dose aspirin after 12 weeks. The U.S. Preventative Services Task Force, the scientific group for all things about medical preventions, has made this recommendation for low dose aspirin, 81 mg, in women at risk, and studies show it decreases the risk of preeclampsia by about 25%. Now that's not perfect, but it's good and it's not risky for the pregnancy, the mom, or the baby or the baby later.
So if all women are at risk and you don't know if you're going to get it until after you've got it, who should start their pregnancy with low dose aspirin? Well women who've had preeclampsia before, women with more than one baby on board, women who have diabetes or blood pressure at conception. Other groups of women may also benefit and those are women with a family history of preeclampsia, women who are obese, women over 35 and African American women.
This is a little bit of good news, and important news. Preeclampsia can be very dangerous for Mom and baby. Keep your OB appointments, they check for this condition every visit with blood pressure check and a urine check. And if you think you're at risk, ask you doctor about low dose aspirin. Thanks for joining us on The Scope.
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