pre-eclampsia
Mamas on Bedrest: 1st Time Mamas over 45 Can Expect Complications
April 19th, 2011Being an older mama myself, I am always a bit sensitive when I see reports indicating the problems and complications associated with being an older mama. So when I read this Reuter’s Health Report on Medscape my heart went out to older women desiring to and having children.
I want to add that while this report states that pregnancy is more risky for older moms, in this case, having their first child over the age of 45, it’s not impossible. Even if a woman is not able to carry her own child, there are surrogates (women who will donate an egg to a pregnancy and then carry the pregnancy) as well as gestational hosts (women who will carry a child for a couple) and adoption. Older women can have the children their hearts desire.
The study was conducted in Israel and found that pregnancy and childbirth in Israeli women over age 45 has nearly tripled over the last decade. The study looked at 131 mothers ranging in age from 45 to 65 who gave birth between 2004 and 2008. Forty percent developed gestational diabetes and 20% had preeclampsia. One third of the babies were born prematurely and nearly all were delivered by cesarean section. All but 5 of the women had become pregnant with assisted reproductive technologies.
Why is it so much more difficult to have a child, especially a first child, over that age of 45? First and foremost there are the physiological changes going on with a woman. If a woman has never been pregnant, the quality and number of eggs that her ovaries will produce will be lowered. At 45 years old many women are approaching menopause and their bodies are responding to hormonal fluctuations. In particular, she may have uterine changes such that she is unable to sustain a pregnancy. Women are also at risk of having developed hypertension and Type II diabetes by age 45. Researchers in this study recommend counseling against pregnancy if an older woman already has a pre-existing condition.
While the researchers acknowledged the increased risk to older mothers and their babies (increased risk of being born prematurely, at a lower birth weight, requiring intensive care in NICU and having developmental problems) they did not make being over age 45 and absolute contraindication to attempting pregnancy.
I can attest to the fact that the older you are having children, the more risk there is to you and your baby. My first pregnancy at age 35 ended in miscarriage. The second was high risk, fraught with complications and resulted in my daughter being born at 36 weeks and 6 days at 5 lbs 3 oz. I miscarried my 3rd pregnancy at age 38 and had my son, my 4th and last pregnancy at 40 yrs and 4 months. So I was not as old as the women in the study in Israel yet did experience more complications than women say 5-10 years younger than I was at each age. If I had it all to do over again, would I? Absolutely, but I have to admit that I would do it a lot smarter.
Before each pregnancy I would engage in a 3 month pre-conception “conditioning program” where I’d take exquisite care of myself; priming my body with exceptional herbs and supplements, getting lots of rest, making sure that I was at ideal body weight for my height and that I was fibroid free. In preparation for complications, I’d have a support system in place-either my mother, mother in law or friends in the community at the ready and available to assist me with my activities (especially with my second/fourth pregnancy with my son where I had a 3 1/2 year old to take care of as well).
As the saying goes, hindsight is 20/20. I didn’t do any of these things, but I made it my mission to do for other women what I did not do for myself and hence Bedrest Fitness and Mamas on Bedrest & Beyond were created. If you are an older woman and have decided to pursue pregnancy, we would love to support you in your endeavors. So that we can assist you to plan your pregnancy and (hopefully ) avoid bed rest or at the very least, minimize the trauma/drama, sign up for a Complimentary 30 minute Bedrest Breakthrough Session. We’ll go over potential pitfalls of being an older pregnant mama and offer tips to minimize them.To schedule, send an e-mail to info@mamasonbedrest.com.
While complications are expected the older a mama is having her babies, they aren’t mandatory and they don’t have to be horrendous. As researchers in the Israeli study pointed out, “Starting motherhood at an advanced age may carry risks, but they’re not prohibitive risks. People of all ages are interested in having a child and completing their families.”
Bedrest Coach Darline Turner-Lee had her daughter at age 37 and son at age 40.
Mamas on Bedrest: How & Why to Monitor Your Own Blood Pressure
February 25th, 2011Bed rest Coach Darline Turner-Lee reviews the common complications associated with high blood pressure during pregnancy and offers tips on how pregnant women on bed rest can monitor their own blood pressure and share this information with their health care providers.
Mamas on Bedrest: Urine Tests May Predict Pre-Eclampsia
December 6th, 2010The Discovery
Recently, two different groups of researchers identified urine proteins that can detect pre-eclampsia in early pregnancy. Pre-Eclampsia affects 5% of all pregnancies worldwide and is a leading cause of maternal and fetal morbidity and mortality. Symptoms of pre-eclampsia (hypertension, proteinuria and edema) typically manifest late in pregnancy, but the protein markers which the researchers have identified are present by 18 weeks gestation. Researchers theorize that abnormal development and function of the placenta is the central cause of pre-eclampsia. This abnormal development gives rise to certain proteins which can be found in maternal urine. The presence of these proteins can predict whether or not a woman is at risk for, or actually developing pre-eclampsia.
Congo Red Dot Urine Test
The first study was conducted by Irina Buhimschi, MD, Associated Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Yale University and the data was presented in February 2010 at the Society for Maternal and Fetal Medicine 30th Annual Meeting: The Pregnancy Meeting.* Dr. Bahimschi and her colleagues sought to create and confirm the Congo Red Dot Test as a way to assess for pre-eclampsia. Their rationale was that pre-eclampsia is frequently diagnosed and often over treated in the United States, primarily due to litigation fears. Yet pre-eclampsia is often underdiagnosed and undertreated in developing countries due to the lack of diagnostic resources. They chose to use the Congo Red Dot test as a screening test because the test is quick (results are available in 10-15 minutes) and the test does not require any technical equipment so it can be done anywhere. The results of the Congo tests are easy to determine and are based on the percentage of Congo Red Retained in target proteins. The researchers compared Congo Red Retained as a predictor of delivery for pre-eclampsia with two other tests, one for urine protein and another for the ratio of high soluble fms-like tyrosine kinase 1 t placental growth factor (sFlt1/PIGF). Dr. Buhimschi and her colleagues found:
- 61% (211/347) of the subjects had an indicated delivery for pre-eclampsia, with the highest percentages in those with superimposed pre-eclampsia (100%), severe pre-eclampsia (99%), and mild pre-eclampsia (69%); in the control group, the rate was 4%.
- CRR levels were higher in women with mild pre-eclampsia than in those with gestational hypertension, and were even higher in women with severe and superimposed pre-eclampsia.
- 11% (4/35) of the asymptomatic women evaluated longitudinally with Congo Red Dot urine testing had preterm indications for delivery for pre-eclampsia and elevated CRR levels before they developed symptoms.
- CRR levels more accurately predicted and indicated delivery for pre-eclampsia than the more intensive urine protein test (P < .001) and sFlt1/PlGF (P = 0.014).
Urine Test to Detect Pre-Eclampsia in Early Pregnancy
Matt Hall, MBChB, Leicester General Hospital and The University of Leicester in the United Kingdom reported that urine samples obtained before 20 weeks gestation allowed them to identify 5 protein peaks that predict pre-eclampsia with 92% accuracy, 87% sensitivity and 82% specificity for the proteins in question.
Urine samples were obtained from woman at 20 weeks gestation and analyzed the same day using surface enhanced laser desorption/ionization time-of-flight mass spectrometry. The results of the urine samples were compared with the pregnancy outcomes (those who had pre-eclampsia and those who did not) at birth. Pre-Eclampsia was defined by the International society for the Study of Hypertension in Pregnancy, 2001 criteria.
Hall and his colleagues also noted, as did Buhimschi, that because placental development is complete by 18 weeks gestation, urinary protein changes early in pregnancy as a result can be used to predict subsequent development of pre-eclampsia. The findings were presented at the Renal Week 2010: American Society of Nephrology 43rd Annual Meeting.**
Implications for Mamas on Bedrest
Pre-Eclampsia is one of the leading reasons that pregnant women are prescribed bed rest and carries with it significant morbidity and mortality for both mamas and babies. To date, pregnant women diagnosed with pre-eclampsia are prescribed bed rest and their blood pressure is monitored carefully. If their blood pressures remains high, they are often given Magnesium Sulfate to prevent the pre-eclampsia from progressing to eclampsia or HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count) Syndrome. Magnesium Sulfate is also used to prevent women from developing hypertension induced seizures. While Magnesium Sulfate has been used for some 60 years for the treatment of pre-eclampsia, it has some pretty uncomfortable side effects.
- Flushing
- Nausea
- Vomiting
- Palpitations
- Headache
- General muscle weakness
- Lethargy
- Constipation
Magnesium Sulfate can cause these dangerous complications:
- Cardiac arrest
- Pulmonary edema (lungs fill with fluid; can be fatal)
- Chest pain
- Cardiac conduction defects
- Low blood pressure
- Low calcium
- Increased urinary calcium
- Visual disturbances
- Decreased bone density
- Respiratory depression (difficulty breathing)
- Muscular hyperexcitability
Rare, Severe Complications
- Profound muscular paralysis
- Paralytic ileus (intestinal obstruction)
(NOTE: The side effects and complications of Magnesium Sulfate are intensified by kidney failure, a common complication of pre-eclampsia. Your obstetrician should monitor your kidney function carefully if you develop pre-eclampsia, and even more so if you are prescribed Magnesium Sulfate.)
If the urine tests mentioned in the studies could be performed early in pregnancy to detect which women are in imminent danger of developing pre-eclampsia or who may already have the early stages of pre-eclampsia, the prevalence of pre-eclampsia could be significantly reduced. Women experiencing the horrible side effects of pre-eclampsia could be spared the discomfort of treatment and the risk to their lives and the risk to the lives of their babies. These tests could make pre-eclampsia and bed rest for pre-eclampsia a thing of the past-or at the very least, a rare occurrence.
Clearly more research is necessary in order to confirm these study findings. However, the implications of these studies is extremely exciting for mamas on bed rest. Each year thousands of women are prescribed bed rest as part of the treatment for pre-eclampsia, yet there is no documented proof that bed rest aids in the treatment of pre-eclampsia. Additionally as it has been stated here, once a woman begins to exhibit the signs and symptoms of pre-eclampsia, she and her baby are already in danger. If tests could be made available to detect pre-eclampsia early or even before it even develops, thousands, maybe even millions of women and their babies could be spared the trauma of pre-eclampsia and the potentially life threatening treatments and consequences.
* From MedScape Medical News: Congo Red Dot Urine Test Can Predict, Diagnose Pre-Eclampsia.
**From MedScape Medical News: Urine Test Early in Pregnancy Can Predict Pre-Eclampsia.
