Prenatal Health Maintenance
Pre-Eclampsia: A frequent reason Mamas are prescribed bed rest
August 25th, 2010Pre-Eclampsia-Definition and Background
Pre-Eclampsia is a medical condition that only affects women during pregnancy and post partum. It is characterized by 
high blood pressure and protein in the urine, subsequently creating a toxic physical environment for both mother and baby. It is frequently the reason a pregnant woman is prescribed bed rest. While it can occur anytime during pregnancy, it typically occurs after 20 weeks of pregnancy, in the late second or third trimester. Pre-Eclampsia occurs in 5-8% of all pregnancies globally and is the cause of some 76,000 maternal deaths and 500,000 infants annually.
Pre-Eclampsia can rapidly become a serious or even fatal medical condition. Women should know the signs and symptoms of pre-eclampsia and report any signs or symptoms they have to their health care provider immediately.
Major Signs and Symptoms of Pre-Eclampsia
None – The problem with Pre-Eclampsia, much like other hypertensive disorders, is that it often has no symptoms.
Hypertension is known as “the silent killer” and pre-eclampsia is no different. Bed rest has been shown to reduce blood pressure and frequently reduces the signs, symptoms and complications that may arise as a result of pre-eclampsia. Even though bed rest is inconvenient at best and quite uncomfortable and physically challenging at its worst, if your health care provider prescribes bed rest for pre-eclampsia, Please follow his or her directions, even if you feel fine.
Hypertension – Hypertension or high blood pressure is defined as two blood pressure readings over 140/90 at two different times at least six hours apart. However, pregnant women with normally low blood pressure, such as 110/65, may be diagnosed with pre-eclampsia prenatally or in the post partum period when their blood pressure rises to 135/80 and/or they develop signs and symptoms of pre-eclampsia.
In 1990 the National Institutes of Health, National High Blood Pressure Education Program: Working Group Report on High Blood Pressure in Pregnancy issued the following research guidelines:
In the past it has been recommended that an increase of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg. This definition has not been included in our criteria because the only available evidence shows that women in this group are not likely to suffer increased adverse outcomes. Nonetheless, it is the collective clinical opinion of this panel that women who have a rise of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure warrant close observation, especially if proteinuria and hyperuricemia (uric acid [UA] greater than or equal to 6 mg/dL) are also present.
For this reason, it is extremely important that women know what their baseline blood pressure readings are and at each prenatal visit they ask their providers what their blood pressure is. In this way, both health care provider and patient can be on the look out for blood pressure abnormalities and address them as soon as possible.
Swelling (Edema) – Swelling can be an insidious symptom of pre-eclampsia because so many women experience swelling of their hands and/or feet or even their faces when they are pregnant. However, when the swelling is significant enough to change your facial features, you should notify your health care provider immediately, advising them that you believe the swelling has become excessive. You may need to show them a photo of you prior to pregnancy, your driver’s license for example, to prove your point. In any event, if swelling concerns you, make sure it becomes a concern of your health care providers and that it is addressed.
Proteinuria – Proteinuria occurs when proteins, usually filtered by the kidneys and retained in the blood stream, leak into the urine because the small blood vessels in the kidneys have become damaged allowing the proteins to pass through. (This is usually due to your elevated blood pressure. Remember, pre-eclampsia creates a toxic physical environment to both mother and baby!)
Other Common Signs and Symptoms of Pre-Eclampsia
Sudden Weight Gain – Since weight gain is a hallmark of pregnancy, it’s often hard to discern between regular pregnancy weight gain and weight gain associated with Pre-Eclampsia. The rule of thumb is that if you start gaining more than 2 lbs per week or more than 6 lbs in a month, you should consult with your health care provider as this could be an indication of pre-eclampsia.
Headache – Severe, migraine-like headaches which are often one sided and dull and throbbing could be a warning that your blood pressure is dangerously high. Contact your health care provider immediately for evaluation.
Nausea or Vomiting – While nausea and/or vomiting is common in the first trimester, it usually abates during the second and third trimesters. If you have sudden onset of nausea and/or vomiting in the second or third trimester, contact your health care provider immediately for evaluation.
Changes in Vision – If you experience any sudden blurred vision, double vision, flashing spots, or sudden light sensitivity, this is another warning that your blood pressure may be dangerously high. Contact your health care provider immediately for evaluation.
Racing pulse, mental confusion, heightened anxiety, trouble catching your breath – While all of these symptoms can occur in pregnant women, when they suddenly occur from out of the blue and especially if they occur together, this is cause for concern. Contact your health care provider immediately.
Stomach or Right Shoulder Pain – I want to be a bit more specific here. The pain you may be experiencing here is right upper quadrant abdominal pain, specifically, liver pain. The pain may be “radiating” or “referred” to the right shoulder, but its origin is in the liver. This pain requires immediate attention as it is an indication that the liver is under stress and you may be suffering from HELLP (Hemolysis-bursting of red blood cells, Elevated Liver enzymes levels, and Low Platelet count) as serious obstetrical complication. It is imperative that you be evaluated immediately if you have symptoms of HELLP to avoid more serious complications or even death.
Lower back pain - Low back pain is so common in pregnancy that it is difficult to distinguish between the typical low back pain of pregnancy and low back pain associated with pre-eclampsia. If you are unsure, certainly consult your health care provider. But consult with your health care provider immediately if the low back pain is present with right upper quadrant abdominal pain as this may be another sign of pre-eclampsia.
This is a cursory overview of Pre-Eclampsia and we will delve into the subject with more depth in coming blog posts. Just remember that pre-eclampsia can have serious medical consequences for both you and your baby including death, so if you are concerned about symptoms, consult with your health care provider and have an immediate evaluation.
This list of signs and symptoms is edited and reprinted from the list presented on The Pre-Eclampsia Foundation website. This website is a holds a wealth of information on pre-eclampsia; current research and resources for more information and to get more help and/or support.
Did you have pre-eclampsia during your pregnancy? Are you a Mama on Bedrest now for pre-eclampsia? Share your story in our comments section below.
Gestational Diabetes: Often a Recurrent Problem for Mamas on or off Bedrest
August 2nd, 2010In January of this year I wrote “Gestational Diabetes: A Particular Problem for Mamas on Bedrest”. This post provided an overview of Gestational Diabetes, the diagnostic criteria for Gestational Diabetes and the complications and unfortunate outcomes that can occur if Gestational Diabetes is not treated.
What I didn’t mention at that time, and what has just come to my attention, is the fact that once a woman has had Gestational Diabetes in one pregnancy, she is at increased risk for developing Gestational Diabetes in her subsequent pregnancies.
In the July 12, 2010 issue of the American Journal of Obstetrics and Gynecology, lead author Darios Getahun, MD, MPH, from the Kaiser Permanente Southern California Department of Research & Evaluation in Pasadena notes,
“Well-controlled gestational diabetes may prevent complications that result in fetal and maternal morbidity, such as high blood pressure during pregnancy, urinary tract infections, cesarean delivery, big babies, birth trauma, and a variety of other adverse outcomes, including future diabetes. Because of the silent nature of gestational diabetes, it is important to identify early those who are at risk and watch them closely during their prenatal care.”
Dr. Getahun and his colleagues reviewed obstetrical records from Kaiser Permanente in Southern California from 1991 to 2008 in an effort to determine of development of Gestational Diabetes was more prevalent in subsequent pregnancies. They also sought to determine if Gestational Diabetes is more prevalent among women of any particular race.
What Getahun and his colleagues found is that women who had Gestational Diabetes with their first pregnancies and had a second pregnancy had a 41.3% risk of developing Gestational Diabetes with their second pregnancy vs 4.2% risk in women who did not have Gestational Diabetes in their first pregnancies. Women who had Gestational Diabetes in their first two pregnancies had an even higher risk of developing Gestational Diabetes in their third pregnancies.
While the authors note that the study is limitied by the fact that the data used is analyzed retrospectively and there was no note of pre-pregnancy weights, pregnancy weight gain, what if any lifestyle interventions were implented or any other potentially confounding factors, based on the data reviewed, they are confident in reporting that women who develop Gestational Diabetes during their first pregnanies are at increased risk of developing Gestational Diabetes in subsequent pregnancies.
Dr. Getahun and his colleagues also noted that recurrence of Gestational Diabetes is more prevalent in Hispanic women and Asian/Pacific Islander women.
If you develop Gestational Diabetes during your first pregnancy, be sure that you and your obstetrician/midwife implement a plan to screen early in your subsequent pregnancies for Gestational Diabetes. If you do develop Gestational Diabetes in subsequent pregnancies , It is imperative that you Obstetrician/midwife monitor and manage your blood sugars with meticulous care so that you and your babies are at the lowest possible risk for complications.
For more information about Gestational Diabetes, check out our Resource Page. Gestational Diabetes is under the Pregnancy tab.
The full citation of Dr. Getahun’s paper can be found on the American Journal of Obstetrics and Gynecology website.
Please share your comments below.
How the “Affordable Care Act” Could Benefit All Mamas on Bedrest
July 28th, 2010The Affordable Care Act
On June 10, 2010, the Health Resources and Services Administration (HRSA), in collaboration with the Administration for Children and Families (ACF) announced that some $90 million dollars has been allocated for the Affordable Care Act (ACA). ACA provides funding for the Maternal, Infant, and Early Childhood Home Visiting Programs.
I was thrilled that “the powers that be” are recognizing that if effort and energy (as well as funds) are expended preventively to provide care and support to high risk pregnant women and subsequently to families that have infants and children with special needs, then millions of dollars and many maternal, infant and children’s lives can be saved.
Evidence-based research reveals that women who are at risk for preterm labor and families with children with special needs that receive home visits fare better. Maternal and infant morbidity and mortality go down. Other countries have known this and have successful, effective home care programs that have existed for years. Let’s hope that this study will finally bring the United States in line with other countries
High risk pregnacy affects a wide variety of women-regardless of race, socioeconomic status or age. While it is common knowledge that women who don’t receive good prenatal care are at increased risk for pregnancy complications, young women, older women, African American women and women who have utilized assisted reproductive technologies in order to become pregnant are also at increased risk for pregnancy complications, going into preterm labor and delivering premature infants who in turn often have behavioral and developmental problems. Evidence-based research has proven that early intervention, such as home visits and supportive services, improves outcomes. So if pregnant women prescribed bed rest receive home visits and their needs are identified and met, then perhaps we can reduce maternal and infant rates in this country-rates that are higher than in many industrialized and “developing” nations.
African American Women have the highest perinatal mortality rate of all American women, regardless of age, socioeconomic status or prenatal care. According to the California Maternity Quality Care Collaborative, in California alone,
“In 2004, there were 13.6 maternal deaths per 100,000 live births, above the national rate of 13.1 and well above the Healthy People 2010 target of 4.3 maternal deaths per 100,000 live births. Pregnancy-related deaths among African-American women in California were 3 times higher than rates for Whites or Hispanics (37.6 deaths per 100,000 live births for African-Americans versus 12.0 and 11.9 for Whites and Hispanics, respectively). In addition, when researchers examined mortality rates in African American women due to the five major complications of pregnancy, they learned that these complications did not occur at higher rates in this population but African American women were 2-3 times more likely to die from the complications than were White women in the US. (Tucker, AJPH, 2007)”
ACA can provide invaluable services to high risk pregnant African American women, but it may also provide insight into why African American women have such high morbidity and mortality and ways to lower these rates.
The Affordable Care Act is a good thing. It has the potential to lower maternal, infant and child morbidity and mortality in the United States. It has the potential to provide insight into why some women are at increased risk for complications and why others are not. It has the potential to completely change the way high risk pregnant women are managed. If this 5 year program definitively proves that home visits by skilled medical professionals reduces pregnancy complications and lowers maternal and infant mortality, surely home visits will be made available to all high risk American women and new standards of care will be established.
Currently, the funds can only be accessed by federal, state and local agencies, so we here at Mamas on Bedrest & Beyond are busily working to strengthen collaborations and alliances so that we may be able to qualify for these grant and in turn, be able to serve more women. Initial inquiries have been made and we will keep you, our mamas on bedrest, informed.
What do you think of the Affordable Care Act (ACA)? Please add your comments below and share this post with other women who may be affected or assisted by this program.
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