Eclampsia

What Causes Eclampsia?

Scientists don’t know exactly what causes preeclampsia and eclampsia, but the condition seems to be associated with problems in the development and function of blood vessels in the placenta, the organ that nourishes the fetus during pregnancy. When these blood vessels don’t function properly, the resulting elevated blood pressure poses a danger to both the mother and the unborn baby.

The circumstances that trigger abnormal blood-vessel development aren’t known, but several factors can increase a woman’s risk for developing preeclampsia. Possible factors include:

• Chronic high blood pressure
• Age. Women over 35 or under 20 are at increased risk.
• First pregnancy (or first pregnancy with a new partner)
• Pregnancies less than two years or more than ten years apart
• Obesity
• Family history of preeclampsia
• History of heart disease, kidney disease, or diabetes
• Race. Black women are at increased risk.

Is Eclampsia Hereditary?

Many cases of preeclampsia occur in women who have no history of the disorder, suggesting there is no inherited component in these cases. However, people with a family history of preeclampsia are at a significantly higher risk of developing the condition, suggesting genetics play a role in these cases.

Scientists don’t yet know exactly how the risk is passed on, but the risk is higher when there is a family history of the disorder in either the mother’s or the father’s family.

How Is Eclampsia Detected?

Preeclampsia can develop suddenly, and it sometimes produces no noticeable symptoms. Because of this, good prenatal care is essential for spotting the disorder’s warning signs. Doctors will routinely monitor the mother’s blood pressure and test urine samples during pregnancy to identify preeclampsia’s characteristic symptoms.

How Is Eclampsia Diagnosed?

Screening for preeclampsia is a routine part of standard prenatal medical care. Doctors will monitor the mother’s blood pressure and conduct other laboratory tests to look for the signs of developing preeclampsia. Typical diagnostic procedures include:

• Blood pressure monitoring. Readings above 140/90 mm Hg are considered excessive.
• Testing urine for the presence of protein
• Blood tests to look for low platelet count
• Tests of liver function
• Exams to look for the presence of fluid in the lungs (pulmonary edema)
• Fetal ultrasound to assess the baby’s health 

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Eclampsia Treated?

The most effective way to protect the mother and baby from the complications of preeclampsia is to deliver the baby as soon as possible. If the pregnancy is advanced enough, induced labor or delivery through C-section may be an option. If immediate delivery isn’t possible, other treatments may be used to control the disorder until delivery, including:

• Bed rest
• Hospitalization (in severe cases)
• Antihypertensive medications to lower blood pressure
• Corticosteroids to improve liver function and help fetal lung development
• Anticonvulsant drugs to prevent seizures

How Does Eclampsia Progress?

Prompt treatment of preeclampsia is essential for preventing the condition from getting worse and possibly progressing to eclampsia. Severe cases of the disorder can produce life-threatening complications for the mother and baby, including:

• Preterm labor
• Poor fetal growth and low birth weight
• Placental abruption, a condition that can cause bleeding that is life-threatening for mother and baby
• HELLP syndrome, a potentially life-threatening problem with liver function and blood platelet counts
• Damage to kidneys, liver, lungs, heart, or eyes
• Stroke
• Future heart disease

How Is Eclampsia Prevented?

There is no known reliable way to prevent preeclampsia. Some doctors may recommend dietary supplements to reduce risk, but because many supplements are not safe to take during pregnancy, it is crucial that you not take any supplements or medications other than those prescribed by your doctor.

Eclampsia Caregiver Tips

Many people who have had preeclampsia also suffer from other brain issues, a condition called co-morbidity. Here are some of the disorders commonly associated with preeclampsia:

• Women who have had preeclampsia have as much as five times the risk of having a stroke.
• Some studies have linked preeclampsia to later cognitive impairment similar to Alzheimer’s disease and dementia.
• Preeclampsia has also been associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD), autism, and epilepsy in children whose mothers have had the condition.

Eclampsia Brain Science

Scientists don’t yet fully understand how abnormal blood flow in the placenta affects the mother’s brain, but it is clear that the disorder involves the brain even though it is a vascular problem in another part of the body. Not only does eclampsia disrupt brain function and produce seizures during pregnancy, but there is also evidence that preeclampsia can affect the brain long after pregnancy.

Some scientists have theorized that high blood pressure disrupts connections between different parts of the brain. As a result, this condition may lead to poor communication between these areas over the long term. This long-term damage to the brain’s connection could help to explain how preeclampsia can increase the risk of future brain disorders such as dementia.

Eclampsia Research

Title: Aspirin and Preeclampsia

Stage: Recruiting

Contact: Sajid Shahul, MD, PhD

University of Chicago Hospital

Chicago, IL

The primary objective of this trial is to mechanistically compare the effect of postpartum aspirin therapy versus placebo in preeclamptic patients identified as high risk for postpartum cardiac dysfunction using Activin A. The intent is to evaluate the effect of selective treatment based on Activin A status rather than treatment for all postpartum preeclamptic women.

After informed consent, 5cc of blood will be collected from the median cubital vein on antepartum admission to labor and delivery for Activin A screening. The patient will be subjected to a total of 2 such blood draws- a single draw at screening, one at their six-month postpartum visit. The study team member carrying out the blood draw will immediately label the specimen in the presence of the subject, after the collection, and before leaving the patient’s bedside, room, cubicle, or surgical suite. The guidelines from “The University of Chicago Medicine Policy and Procedure Manual – Phlebotomy Service Infection Control 04-26” will be followed for specimen collection and transport. Activin A levels based on our previous data will be classified as elevated if greater than 23.74 ng/ml in the last trimester of pregnancy (4). This threshold was selected based on our prior data suggesting an inflection point in the rate of abnormal GLS postpartum at this concentration. Patients with elevated Activin A levels will be randomized to a placebo group receiving routine postpartum cardiovascular standard of care or an intervention arm with 81 mg daily aspirin therapy added to care at their postpartum delivery stay. The rationale for only randomizing women with elevated Activin A levels is that among women with an elevated Activin A antepartum, 85% developed abnormalities in GLS at one year postpartum versus 25% in women with non-elevated Activin A levels. Women whose Activin A levels are not elevated will receive the same care as that provided to the placebo group and be followed for one year (n=60). All other subjects who meet the criteria of elevated Activin A levels will either be randomized to the aspirin therapy group (N = 60) or a placebo group (N = 60). The investigators choose postpartum Aspirin therapy post-delivery to avoid any immediate delivery or C-section-associated bleeding complications and to coincide with their postpartum well-baby visit.

The investigator will determine the blood Activin A levels at six months after delivery, measured using ELISA. The samples will be assayed for Activin A level using commercially available ELISA kits (Ansh Labs; Webster, TX) following the manufacturer’s recommendations. Each sample will be run in triplicate, and the values averaged. GLS at six months after delivery will be measured using fully automated vendor-independent software that uses a computer learning algorithm to facilitate endocardial border detection.

Mean arterial pressure and other indices of systolic and diastolic function (ejection fraction (EF), early filling/atrial contraction (E/A), deceleration time (DT), mitral annular motion (E’), and left atrial volume index) measured at the baseline and six months postpartum. Transthoracic echocardiograms will be performed and reported according to American Society of Echocardiography guidelines. Ejection fraction and left atrial volume will be calculated using the Simpson’s biplane disc method. Left ventricular mass index (LVMI) will be calculated using the area length method.

Title: Losartan for Improved Vascular Endothelial Function After Preeclampsia (LIVE-PE)

Stage: Recruiting

Principal Investigator: Anna Stanhewicz, PhD

University of Iowa

Iowa City, IA

Women who develop preeclampsia during pregnancy are more likely to develop and die of cardiovascular disease later in life, even if they are otherwise healthy. The reason why this occurs is unclear but may be related to blood vessel damage and increased inflammation that occurs during the preeclamptic pregnancy and persists postpartum. The purpose of this investigation is to determine the mechanisms contributing to this lasting blood vessel damage and to test whether taking a medication that blocks angiotensin II receptors (losartan) decreases these negative effects in women who have had preeclampsia. Identifying these mechanisms and treatment strategies may lead to better clinical management of cardiovascular disease risk in these women.

In this study, we use the blood vessels in the skin as a representative vascular bed. Using a minimally invasive technique (intradermal microdialysis for the local delivery of pharmaceutical agents), researchers examine the blood vessels in a nickel-sized area of the skin in women who have had preeclampsia. We make these measurements after the subjects take a placebo and after taking losartan (an angiotensin II receptor blocker) to test whether this treatment improves vascular function in these women. As a complement to these measurements, researchers also draw blood from the subjects and isolate the inflammatory cells to test how sensitive their inflammatory responses are following the placebo and the losartan treatment.

Title: Preeclampsia And Nonsteroidal Drugs for Analgesia: a Randomized Non Inferiority Trial (PANDA)

Stage: Recruiting

Contact: Jonathan Hirshberg, MD

Barnes Jewish Hospital

Saint Louis, MO

Recently published clinical guidelines for the care of women with hypertensive disorders recommended that nonsteroidal anti-inflammatory drugs (NSAIDs) should be withheld from patients with hypertension that persists for more than one day postpartum (1). This recommendation is based on data from the general medicine literature, which suggests the role of NSAIDs in precipitating hypertension in non-pregnant adults (2,3). It may also draw from previously published case reports of postpartum hypertension that were thought to be NSAID induced (4). There has been a paucity of data from the obstetric literature to support or rebuff this recommendation. As the opioid crisis worsens in the United States, additional attention and resources have focused on limiting the use of narcotic medications. The effective employment of non-opioid analgesics has been shown to reduce narcotic use (5). Ibuprofen and other NSAIDs are the most effective and most commonly prescribed analgesics for postpartum pain, but clinicians now find themselves stuck between these recommendations and their efforts to limit unnecessary opioid prescriptions.

 The investigators propose a randomized controlled non-inferiority trial of women with preeclampsia comparing a postpartum analgesic protocol that includes NSAIDs to one that excludes them. The central hypothesis is that NSAID use does not worsen hypertensive diseases of pregnancy.