Episode 201 - Preeclampsia: Red Flags, Risk Factors, and Reducing Your Chances
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey.
[0:25] Welcome to today's episode of the Great Birth Rebellion podcast. If you are new to the podcast, welcome to the Great Birth Rebellion family. In this podcast, I use my clinical and research expertise to bring you as much unbiased information about a topic as I can so that you feel prepared to make your own decisions through your pregnancy, birth and postpartum period. Today, I'm going to talk about preeclampsia. But before we start, this episode is sponsored by my dear friend and birth prep extraordinaire, Poppy Child from Pop That Mama. She's a doula and hypnobirthing practitioner and her online hypnobirthing course called The Birth Box has already helped thousands of women get ready for labor. Listen to this recent review of The Birth Box. The woman says, I'm a first time mom and I gave birth to my beautiful baby boy yesterday. day. I've been listening to the birth box on repeat for the past few months, including the day in which I went into labor. And I had the most empowering birth experience. And I can honestly say that listening to the birth box was a huge part of this success.
[1:36] Reframing the pain that you experience during labor can be a purposeful pain instead of a harmful pain. And that really helped me to know that. And just being able to surrender to the wild ride that birth is and let my body take over was the most incredible thing. And this is coming from a pelvic floor physiotherapist based here in Australia. She says, I will recommend it to all my patients. And you know me, I'm so picky about what I will endorse, but I do get behind the work that Poppy is doing. And in the birth box, you'll learn tools to help you manage pain and how to stay steady when labor gets intense. It's all about giving you knowledge, confidence, and a mindset that actually works when the big day comes and for the big days that will follow.
[2:26] Birth Box is rated five stars across the board. And with my code, Melanie, you'll get 25% off. So if you're preparing for birth, go to the checkout. You'll be so glad you did. The link is in the show notes. Use the code Melanie to get your 25% off. I'm also going to draw your attention to the event of the year,
[2:49] the Convergence of Rebellious Midwives. Don't let the name deter you. everyone is welcome to attend the convergence to experience some of the most cutting edge and rebellious speakers of our generation all the details for ticket sales are in the show notes get your friends to come along converge and come party with the rebels at the convergence of rebellious midwives okay right today i'm going to talk to you about preeclampsia It's a complex topic, and I will say straight up that preeclampsia management is not really completely within the midwifery scope. We're midwives. We can definitely identify preeclampsia, but in terms of management, it's not our comfort zone. So midwives do have a role to play across the spectrum of detection.
[3:50] Diagnosis, treatment, and supervision of management and seeing about the success of the treatment.
[4:00] But really, preeclampsia should be managed in collaboration with a medical team because we all have unique and important contributions to make in order to optimize women's care. And preeclampsia is one of the scenarios where outcomes are better if we embrace medical management of this condition. So if you are out there as a midwife or a woman thinking that you can manage preeclampsia on your own, I would caution you against that. And, you know, for longtime listeners of this podcast, you will know that I have a definite preference for physiological birth. I have full faith in women's bodies to function and birth, but this preeclampsia is pathology. So I would caution you against thinking that we can manage preeclampsia on our own as midwives or women if you've decided not to engage a clinician.
[5:00] I would suggest that you listen to this whole episode so that you fully understand what you're getting into. And I know for lots of episodes, I say that women and midwives are capable of managing many scenarios without medical input, but preeclampsia is not one of those. And I know I speak a lot in this podcast about avoiding unnecessary screening and testing and procedures in pregnancy. But in the case of preeclampsia, my professional understanding and opinion is that this is a necessary time to engage with medical care. Preeclampsia always needs treatment, management and monitoring. It doesn't go away by itself. It's not really either a wait-and-see condition, it requires close observation by engaged care providers. So, part of the care for women who have preeclampsia is within the scope and capacity of midwives, but medical practitioners have an important place and a role when a woman gets preeclampsia.
[6:03] And this is the time where I welcome medical intervention, and I'm so grateful for medicine and highly skilled clinicians. So it is our job as midwives to be able to identify when a woman is healthy
[6:16] and also to recognize when she is no longer well and give her timely advice about what to do next. So this is a kind of a break from great birth rebellion tradition because today we're talking about pathology, not so much about physiology. We're talking about when things aren't right and your body becomes unwell with preeclampsia. And when you've got preeclampsia, your pregnancy has become complicated.
[6:44] Now, I don't want to frighten you. It's not like preeclampsia. It's lurking around every corner. In Australia, we actually don't collect exact statistics on preeclampsia, but we do have rates that tell us about the hypertensive disorder rates. So preeclampsia is a hypertension disorder. And from the 2024 Mothers and Babies report, we know that the rates of women who experience pregnancy-related high blood pressure, and that includes preeclampsia, is around 3% to 4% of women. So a large proportion of that statistic will have just an increase in blood pressure, not preeclampsia. But the women who get preeclampsia are within that 3% to 4% statistic. So that's kind of the incidence, the number of women who might experience preeclampsia. It's different all over the world. It's also different depending on race and ethnicity. So in some countries and cultural groups, ethnic groups, it's as low as 2% incidence, but in others it's as high as 8% or 9%. So, Don't be frightened by what I'm saying here today, but definitely the messaging is going to be different in this episode to other episodes, but it's highly unlikely that preeclampsia is going to happen to you.
[8:09] However, even if you don't think you're going to get preeclampsia, I think this is a good episode to listen to because you don't know if you're going to be the one to get it. If it happens to you, there isn't really a lot of time to be learning about it in the moment. What we know about women who are experiencing preeclampsia or are given a diagnosis of preeclampsia is that it feels like a confusing time with conflicting information. There's multiple tests and locations where they might occur. You're engaging with multiple different care providers depending on the care model that you're in and things feel like they're going really fast. So women sort of feel like they get hijacked by a diagnosis of preeclampsia and don't really have a lot of time to be navigating their options and considering second opinions, for example. So understanding just a little bit about preeclampsia before you're in that scenario might just be the thing that helps you if you are one of those two to 8% of women.
[9:14] And the same goes for midwives and birth workers and health professionals that are listening. This is a bit of a primer for you, an update for you in your alertness to preeclampsia to keep you sharp for when and if you do need to act. So this kind of thing can creep up on you as a clinician. You know, you might just be sitting in your appointment and it's time to take the woman's blood pressure and, you know, it's high, higher than you were expecting. Then you might ask about her symptoms and within that minute, you need to collect all that information and make a decision about next steps. And if you're not alert to the fact that this could be preeclampsia, you might miss it. So this episode is a bit of a moment to help you sharpen, help you identify if and when you need to act because you won't have days or weeks to consider your strategy. You'll need to get the ball rolling in that moment and a lot of hospital-based midwives will have a strategy for this and access to potentially quicker options but private midwives and people working out in the community, they need to be thinking on their feet about the quickest pathways that women can access higher acuity care and testing.
[10:32] Now preeclampsia is a big topic even for me so I'm going to do this over two
[10:38] episodes because of the sheer complexity and volume of information that's out there. There is a broad range of information and controversies around preeclampsia diagnosis and treatment so although I'm going to give you some information here I cannot do justice to it all in detail but I've included a range of research papers and resources in the resource folder. So if you are one of the people who've signed up for the podcast mailing list, which is easy to do, all the details are in the show notes below, you'll know that you have access to the podcast resource folder. And in there is pages of links and resources that I've used to curate every single podcast episode. And we have a back catalog of every episode. So if you want to sign up for that mailing list and get access to the resource folder, just have a look in the show notes below and you can do that. You'll get access to all of the resources from today's episode too, as well as the previous ones.
[11:40] So today, in this episode, this is more if you are, I mean, it's for everybody, but it's the first step. So we'll talk about what preeclampsia is, the diagnostic criteria, how do you know if you've got it, what tests will you be sent for, the pathology of why it develops, and I'll explain the risk factors, so who's more likely to get it than others, and then I'll also share some strategies on how to prevent it. So if you think you might be at risk or if you feel like you could be somebody who's going to get preeclampsia, a little bit of a taste of things that you can do to help prevent it from happening from the beginning. And in next week's episode, that's all going to be from the point of diagnosis onward. So what are the next steps? If you are diagnosed with preeclampsia, what happens now? So that's going to be next week's episode. This week, we're going to do all of the pre stuff leading up to your diagnosis. So let's get started. What is preeclampsia? So preeclampsia is a collection of symptoms and diagnosable chemical and physical changes in a pregnant woman's body. And all of these symptoms and diagnosable changes point to the development of a condition called eclampsia. And there's other complexities that can occur when you have eclampsia called HELP syndrome, H-E-L-L-P syndrome.
[13:10] So preeclampsia describes the pre-symptoms and warning signs that eclampsia is on its way. So eclampsia can progress rapidly or slowly. So practitioners don't really mess around. If they suspect that you have pre-eclampsia, the pre-symptoms for eclampsia, we don't really know if you are going to progress quickly from pre-eclampsia into eclampsia. We don't know what that point is. So we act on it in the moment and we respond to your symptoms. It's not really a wait and see thing. Let's see if this thing settles down. It's not that kind of circumstance. If we suspect that you have preeclampsia, we will always check and monitor you closely. So preeclampsia is a collection of symptoms and pathological test results that together indicate that your body is in a state of preeclampsia. So the most common things that we look for but not all of them are always present with the diagnosis of preeclampsia it's a bit of a investigative journey for the clinician we're trying to work out if you are preeclampic or not not all the symptoms are always there so we're piecing together a puzzle.
[14:30] It's not one blood test and you go, yep, you've definitely got preeclampsia. So to start with, the most common things that we look for is, is your blood pressure starting to increase, which would be detected in an antenatal appointment. And this is often what happens is a woman presents for her appointment and her blood pressure is high. So if it's above 140 on 90, this should trigger some further blood tests at least. But also if you have a client who is has typically got a lower blood pressure so say it's normally 90 on 50 and then you check it and it's 135 on 85 for example you know some say if it's 20 points above the usual then this could also be an early warning sign and it wouldn't be unreasonable to do some checks to see that it's not preeclampsia or something brewing there is a situation called called gestational hypertension, so just high blood pressure of pregnancy. So one thing we're also trying to do here is see, is this just gestational hypertension on its own, just high blood pressure in pregnancy, or are there other clinical factors that are pointing to preeclampsia? So even if you feel well, then we will still start checking that are we dealing with gestational or hypertension, or is this preeclampsia?
[15:57] Some of the other symptoms that you might feel as a woman is that your face, hands and feet become unusually puffy and swollen. And sometimes people in your life will say, well, what's happened to your face? Oh, wow, you're really swollen today. There is kind of usual pregnancy swelling. And the typical pattern of that is you'll get sort of more and more swollen through the day. And then as you lie down at night, it all kind of settles and you wake up less swollen. That's a pretty normal pattern but if you've got swelling that you wake up with or that it doesn't settle over it after a night's sleep that's a little bit more unusual and something that should trigger a thought process about if this is preeclampsia or not. The other common symptom but again not always is a frontal headache and visual disturbances or changes so frontal you know being sort of they usually describe it as being over their forehead or behind their eyes And the other thing to factor in is how many weeks pregnant you are. So usually preeclampsia is a disorder of later pregnancy, usually after 30 weeks. But early onset is possible. It's much, much more rare.
[17:10] So, you know, just also considering what gestation am I? How serious is this? So these are some early warning signs, but they definitely need to be acted upon. So if a woman presents to you as a clinician with this symptom picture, don't delay in getting a diagnosis or referring on to a medical professional as soon as possible. So as midwives and primary care providers for pregnant women...
[17:39] Our job is to identify when things are deviating from normal and act. So this is one of those times. And another top tip with preeclampsia is that a preeclampsic headache, that frontal headache, usually cannot be relieved by the usual over-the-counter pain medications.
[17:59] So if a pregnant woman has got a headache and it's unresponsive to over-the-counter medications for headache, then this is another red flag that you need to keep searching for answers for her. And if you're a woman out there and you're thinking, well, I've had this headache for three days and Panadol's not working, you need to be in touch with your care provider because you could be experiencing a preeclastic headache.
[18:21] And one of the challenges with today's maternity care system is care providers are short on time. Often services are not suited to sort of out of hours or you know unplanned appointments so if you are between midwifery or doctor's appointments and you develop any of these symptoms that won't go away and can't be relieved then this is the time to contact your care provider or the hospital that you're giving birth at possibly the birth unit you know sort of take it to the top and if they don't take you seriously just don't take no for an answer no I'm actually really concerned that I could have pre-eclampsia you can use these words and then that can just trigger things for your care provider too it could be absolutely nothing and you've overreacted but that's okay it might not be pre-eclampsia but it's always worth checking and also for for those playing at home, just a caution with the automatic blood pressure cuffs. So sometimes women have got family members who have those automatic sort of self-testing blood pressure cuffs that you put on and then you push the button and it inflates and then it gives you a blood pressure reading.
[19:31] They're generally not accurate in pregnancy. You have to use a manual one and I've had women contact me before after using someone else's electronic blood
[19:41] pressure cuff telling me, oh my gosh, my blood pressure's high. And then obviously, you know, I think, well, we can't let this slide. I go out and check on them. And invariably it's because they were using an electronic blood pressure cuff and also it's poorly fitted. So the bigger the arm, the bigger the cuff you need. If it's the not the right size, it's not going to give you an accurate blood pressure.
[20:05] So anyway, these external and measurable things can be felt by the woman and noticed by a midwife or doctor. And they are just signals that there's some internal things that are going on. So our next step after a woman presents with these sort of symptoms is to send a woman for a blood test, a urine screen, and something called a blood pressure profile, which, I mean, that's what we call it here in Australia. And you can go in and have it done at a day stay unit or HNAD award. So they might be called something different where you are. But basically, a blood pressure profile, they do hourly blood pressure checks and urine checks. And they might also do another blood test.
[20:50] And they see the pattern of blood pressure and protein in urine over time. And they pair that with your symptoms and your blood results to see if they can give you a diagnosis. Is this just a benign increase in blood pressure or are you showing signs of preeclampsia? So all of those results together, the results of the pathology tests, help build a picture and they provide some more certainty for a preeclampsia diagnosis. So preeclampsia is a whole symptom picture. It's not just a single test or a single symptom. Sometimes it takes multiple checks and procedures to get all the information to make a formal diagnosis. So there's this time between testing and it's a bit of a slow process to get a diagnosis. When I say slow, it means you might have multiple stops at different healthcare providers or pathology collectors or at the hospital or all kinds of things before somebody can look at all of those results and say, yes, you have preeclampsia. And this is what can be confusing and a little bit stressful for women is this weird time of uncertainty. So what we'll do next then is get a urine screen and check if there's protein in it and how much. And also for practitioners who are potentially working outside of a facility and thinking, what else do I add to the results? When you're doing a urine screen, also ask for a protein-creatinine ratio.
[22:20] And there's cutoffs and diagnoses of the protein-creatinine ratio that can help give a bit more of an accurate diagnosis for preeclampsia. So then you're going to offer women the option for the urine screen and a blood test. And the blood test would include a full blood count because platelet counts are important when we're looking at preeclampsia diagnosis and preeclampsia progression. One of the complications of preeclampsia can be a reduction in platelets, and we would find that in the full blood count. So that's particularly what you're going to be looking for from that. A kidney function test and a liver function test. So preeclampsia is considered a multi-organ or a multi-system disorder. And each little piece of the puzzle tells you if there's an issue with platelets, is there protein in the urine? Is kidney function struggling? Is liver function struggling? Is the blood pressure increasing? Is the woman feeling those external symptoms? So over time, you're building a picture of are we...
[23:29] Preeclampsia. So preeclampsia also has a neurological element, which explains the visual disturbance and the headache. And if it goes undiagnosed, preeclampsia can progress to seizures and stroke, coma. And so a doctor would check also a woman's reflexes. I don't know how they do that. We don't get taught. There might be some midwives who know how to check a woman's reflexes to help with a preeclampsia diagnosis, but I haven't done that. Certainly a doctor would do that in this process. So, so far, if you're a clinician, there's a woman in front of you. She has a headache maybe. Her blood pressure is elevated above 140 or 90 or significantly higher than her usual blood pressure. She may have some visual disturbance, unusual swelling of hands, feet, and face. So you've sent her for blood tests and we're going to do a full blood count, liver function tests, kidney function tests, check her urine for protein, but we're also interested in the protein creatinine ratio.
[24:34] So this is step one. And in the meantime, you may also like to arrange for a formal blood pressure profile to be done at the hospital that she's giving birth at.
[24:45] Just gather more information, more pieces of the puzzle. So by now you'll see that preeclampsia is more like a collection of circumstances and symptoms and pathological results that tell us that your body is preeclamptic and heading for eclampsia. And there's various complications that can come with eclampsia. And it's not a single thing that's happening in your body. It's multiple things. Consider it a multi-organ cascade of events that are occurring. They've been triggered off and you are now in a pre-eclamptic state. And if it goes on for too long, it actually can start to deteriorate and impact a woman's body with kidney and liver issues. So in the later stages, we're looking at multi-organ failure.
[25:32] Seizures, possible strokes. The impact on your baby is reduced blood flow through the placenta. And this can also cause something called a placental abruption where the placenta attaches from the uterus. So there is a huge spectrum of preeclampsia. It can range from mild to severe. So not everyone who has preeclampsia is going to progress to eclampsia. In fact, in a well-resourced country, we are very well equipped to diagnose preeclampsia and offer you treatment in enough time to prevent it from moving to eclampsia. Very few women in a well-resourced country where women have access to healthcare. Do we see women become eclamptic because we are very serious about preeclampsia diagnoses?
[26:21] So it can be mild and progress slowly or it can be severe and come on suddenly and progress suddenly. Not everyone will have severe preeclampsia or progress to eclampsia, but we always check and keep an eye on it so that we can detect early if a woman's condition is deteriorating. So for women out there thinking what will happen to me if I have preeclampsia there is constant checking and monitoring to see if things are stable or if they're getting worse and there's this tricky balance of trying to keep the baby in as long as possible because we want it to be as grown and mature as possible but also balancing that with how well the woman is and working out the optimal time to get the baby out if the woman's condition deteriorates with preeclampsia. So the late or emergency management of preeclampsia is actually to give birth and get the baby out. So if you've got preeclampsia and it appears to be progressing quickly, then your clinician might say we actually, the only option here is to get the baby out either through induction if you're well enough and if your baby's well enough or a cesarean section.
[27:38] And so it's this balancing act of when do we get the baby out while everybody's well and healthy or do we continue to wait for the woman to deteriorate in order to give the baby more time to grow and mature. So we're balancing the risks of preeclampsia against the risks of preterm birth and the complications that can happen with that for the baby.
[27:59] Fortunately, later term preeclampsia is more common than very early term before 30 week preeclampsia. So the baby would be preterm in that scenario, but very likely to be well and recover. So just a reminder that not all the symptoms need to be present in order to be diagnosed with preeclampsia, but that decision and the details of that should
[28:24] be managed by your care team. So someone individually or collectively, a team, will assess your results together and offer a diagnosis, but it's not always a clear picture. So that's the diagnostic picture of preeclampsia. That's what we're looking for as a clinician. That's what you might feel as a woman. But what's the cause of preeclampsia? Why does it develop? Now, knowing why it develops is a little bit important because we might be able to prevent it from happening altogether and know the right kind of treatment that we can give you if we know what causes it. So, the causes of preeclampsia are only really becoming better known over the last 50 years or so.
[29:07] And I will explain a physiology of how it happens, but it doesn't appear to be sort of a lifestyle disease. So there are controllable factors that women can do to perhaps reduce their chances of getting it. You know, some illnesses are caused by things that people do or put in their bodies that gradually deteriorate their health. Preeclampsia is not really one of those things, but there are things that you can do to prevent or avoid it. And we'll talk about that later. but please don't be thinking that preeclampsia just happens to people who aren't well or who don't look after themselves. This is not really necessarily one of those things.
[29:46] So preeclampsia has been recognized in 2000 year old texts and it has been part of pregnancy as far back as we can see. It's actually only yet really becoming better known in the last 50 or so years. It actually used to be called toxemia of pregnancy because there was a belief that there was some kind of toxin in the body, a buildup of toxins that potentially causes. And so you might see older texts or maybe even your relatives talking about toxemia of pregnancy. They're talking about preeclampsia. And this was before they started to understand it better. And, you know, I want to acknowledge that some people are probably yelling down the podcast at the moment saying that actually there are some nutritional reasons for preeclampsia. There are things that maybe women haven't done that are contributing to preeclampsia.
[30:41] And I think this stems from a few places, but there is a resource that, And it was created by Dr. Thomas Brewer, who wrote about the Brewer's diet. And he published a book called Toxemia of Pregnancy. So that gives you a sign of when it was written. He wrote in about around the 1960s. And he came up with this particular diet that he believed could prevent and sometimes treat preeclampsia. It's still all on the internet, actually, his website. and I've put the name and title of his book in the resource folder and also the links to his website in the resource folder. More so for you to go and have a look to get a full picture of what I'm talking about in this podcast. Obviously, I don't endorse or encourage anything in particular. This is all just for your own information and investigation process if you're somebody who's really looking deep into preeclampsia.
[31:40] So Dr Brewer proposed many things and one of these things is that he believed that the root of preeclampsia is malnutrition and he offers the Brewer's diet as a possible preventative option for preeclampsia and I'll speak about this a little bit later. As I said I've listed the things in the resource folder for you to go and have a look at personally he does have a list of resources and research that he's used to inform his opinions full disclosure I have not looked into every single one of his research papers so if this is something that is of interest to you it's it's you're gonna have to go off and do that little deep dive into the brewer's diet and I will say that there are nutritional and dietary changes or supplements that you could use.
[32:31] When used early in pregnancy and over a sustained period of time, they're showing promising results for preeclampsia prevention, which I will also discuss later in this episode. So anyway, what do we know about why and how it develops? And please know this is an evolving science. There is still a lot not known about preeclampsia, but this is the widely understood cause. So it actually starts right at the beginning of your pregnancy, usually before you even know you're pregnant. So it starts with the implantation of the placenta. So once the egg is fertilized with sperm, the fertilized egg floats down into your uterus through your fallopian tubes and the baby looks for a place to latch on to your uterus. And once it finds its spot, it goes about making a placenta that implants into the side of your uterus. So the baby makes a placenta, it's responsible for the job of that.
[33:29] Now, it's believed that a malfunction in this implantation is the root cause of what will later cause preeclampsia to develop. So the issue is there from the very beginning of pregnancy, but the consequences don't manifest until later in the pregnancy when you discover that preeclampsia is ultimately developing. But not all women with this impaired placentation will develop preeclampsia. So we do have some testing options that can indicate if this might be happening for you. You know, people might be asking, gosh, if it's early on, right at the beginning when the placenta implants, is there any way we can know which woman's placenta is not well implanted and which one is? Well, there is. So there's a blood test that's done with the nuchal translucency ultrasound that's done between 12 and 14 weeks and that's the one where they check for down syndrome and a few other genetic things there's an ultrasound and a blood test that goes with it and the blood test has a result called a pap a and that is a placental hormone and low pap a can indicate that there's been impaired placentation and implantation.
[34:54] So what happens next is because of this impaired placentation or implantation of the placenta, there's a gradual and progressive reduction in blood flow through the placenta and to the baby. So the placenta becomes periodically through the pregnancy less perfused with blood as the pregnancy progresses.
[35:16] And one of the risks of this is poor placental perfusion, which is indicated by a low pap A, is that the baby is at risk of being smaller than expected or growth restricted. And the reduction in placental blood flow could explain that scenario. So the state of placental hypoxia, so gradual placental oxygen deprivation, triggers off a series of chemical, hormonal, oxidative, immune, and inflammatory reactions within the mother's body. Now, I really simplified that process into one single sentence, but it is a whole cascade of reactions that occur from this placental oxygen deprivation. So it's essentially the hypoxic stress that the placenta is under which triggers the cascade that progressively results in preeclampsia and for those of you who are really interested in the science and detail of this there are a number of research papers in the resource folder that have provided some really great detailed diagrams of this process and explain every single element and the cascading event that lead to the next. So feel free if you want to do a deep dive, go in and have a look at the resources and you'll see that all of the things that are affected.
[36:41] But for our purposes today, for the intention of the podcast, just know that the placental hypoxia and inflammatory and immune responses in the mother's body triggers a series of events that starts to impact the liver, the woman's liver, kidney function, and these changes are the ones that we detect in the blood test and this is what causes the protein in the urine. So it will show, your blood test will show deranged liver and kidney function and protein in the urine and these things will develop further and we'll see a change in blood pressure, cardiac function, platelet count in the mother's blood.
[37:20] And this will then cascade in the later signs of eclampsia, which can result in stroke, seizure, multi-organ failure, coma. This is what makes eclampsia so serious. And this is why we're so interested in diagnosing pre-eclampsia. So now I'm hearing your next question, and that is, is there anything that can be done to prevent this poor implantation in the first place? Maybe if we can prevent poor implantation and placentation, then we can prevent the cascade that occurs towards preeclampsia from happening. The answer is yes. There are some things that can prevent the cascade and potentially prevent this poor implantation.
[38:09] But first, let's understand who in the population, which pregnant women, are at more chance of having preeclampsia and which aren't. Because if you have risk factors that are going to predispose you to preeclampsia, then you do have lots of options and things that you can do before you get pregnant and in your early pregnancy to reduce the likelihood that you will have it.
[38:32] Now, I've had clients with preeclampsia, and I can tell you after them having preeclampsia once, they are interested in trying anything they can to prevent getting it again. So what are the risk factors, and who's more likely to get it than not? So if you've got a family history of preeclampsia, if your sisters or mother had preeclampsia, And interestingly, if your partner, the father of the baby, if his mom had preeclampsia, that can increase your chance of getting preeclampsia. The paternal factors, the genetic paternal factors are actually quite significant in the development of preeclampsia. So it's not just you, actually the genetics of the baby impact your chances of getting preeclampsia because remember, preeclampsia is a placental issue and the baby makes the placenta. And so there's this interaction of experiences that happen in order for you to get preeclampsia. So a family history or the paternal side has a history.
[39:42] Then you can also detect do you have low pap A is it possible that your placenta has not implanted adequately then potentially you're at higher risk of preeclampsia or hypertensive disorders if this is your first pregnancy you're at more risk than if it's a subsequent pregnancy now interestingly one of the risk factors for preeclampsia is if you are pregnant from a new sexual partner. Now, let's unpack this. There is some evidence that if a woman has reduced exposure to the ejaculate or sperm of the male parent, either through use of long-term barrier contraceptives, if it's a new partner, or if you're pregnant with a sperm donor, then there can be an immune sensitivity towards the sperm. It actually reduces over time from repeated exposure. So they say that exposure to the paternal antigen in ejaculate and sperm is actually protective against preeclampsia. So it's like if you are presented with foreign sperm or sperm that your body doesn't recognize, there could be an immune response to that, which could actually increase your chances of preeclampsia.
[41:01] But I'm trying to work out an easy way to say this. A repeated exposure reduces the immune response that may be associated, partly associated with preeclampsia. And this is similar. There's a higher risk if you've used reproductive technologies.
[41:19] Women who have larger placentas, for example, when you're pregnant with multiple babies, the bigger your placenta, the higher the chance of preeclampsia. Women who have pre-existing cardiac conditions or high blood pressure or kidney issues or autoimmune diseases.
[41:36] Women who are considered bigger, so, you know, the literature would say obese women are considered to be at higher risk of preeclampsia. Women who are less physically active and black women and women from disadvantaged ethnicities. And this comes with nuance because what we know is that these women are confronted with lots of challenges within the healthcare system. So it may not be that their bodies are more likely to become preeclamptic, but that through a series of events and differences in care, they're at more risk. So that's a bit of a rundown of women who are at more risk of preeclampsia than not.
[42:15] And so let's talk about some strategies on how to prevent it. Are you getting ready to have a baby? And if you are, what are you going to do about the pain of contractions? There are lots of things you can do. In fact, I'm going to tell you about them because I've been watching women give birth without pain relief for over 18 years. I'm Dr. Melanie Jackson and I'm a home birth midwife. I had my own babies at home without pain relief and I've been helping other women do the same for my entire career. If you want the top tips and tricks that I recommend to help women give birth without pain medication, it's all here in the link below in my guide to giving birth without pain relief. You can do it. Give it a go. Why not just prepare?
[43:01] This is not going to be intensely detailed because each one of these points could be its own podcast episode altogether and possibly I'll get to that. But this is to kick you off on the journey. If you are in the category of women that desperately wants to avoid preeclampsia, if you've been there before, you've got an increased risk, if you've got a family history, if you've seen someone struggle with this or you've noticed that actually you've got multiple risk factors, maybe you've got low papay. You might be particularly interested in exploring as many preventative options as possible. So I'm going to more so list it out and briefly describe them so that you've got an opportunity to direct your efforts and thoughts.
[43:46] So I'll mention it straight up. We did an episode early in the podcast. It was about sex in pregnancy. And as I was researching for that podcast episode, it kept coming up with research papers about maternal exposure to the male partner's sperm or ejaculate as a protective factor against preeclampsia. So I'm going to mention it here because there's actually been a significant amount of research about it and I've put all the papers in the resource folder for you to have a good look but you know unfortunately some of the papers really focus on the idea of exposure through oral sex, but the exposure vaginally is just as exposing to our bodies. And so, yeah, it seems as though.
[44:41] The more exposure that we have to the sperm of the father of your baby reduces the chance of preeclampsia, enough so that there are a number of papers that all seem to have the same finding. The cynical ones around that think maybe males did all this research and are quite happy with those results might say, well, yeah, that's because of that. But anyway, I'll leave you to read the papers. That's one thing.
[45:07] So if you think that you might be at risk of preeclampsia, you may consider getting the nuchal translucency test. Unfortunately, it's all bundled up with the nuchal translucency ultrasound, but potentially you could negotiate with your care provider to maybe just get the blood test to check for PAP-A. Now, the current focus around medical management of preventing preeclampsia is the focus on low dose aspirin and the dosage is approximately 100 to 150 milligrams a day it's considered low dose aspirin again the research on this could take up an entire episode so I'm not going to go into a lot of detail but low dose aspirin is showing promising results for women who might be considered at high risk for preeclampsia. There's no reason to give it to everybody. And certainly just a diagnosis of low PAP-A might not be a reason to go on low-dose aspirin. However, this is being done, so don't discount it. It certainly depends on where you sit in the category of how desperate you are to prevent preeclampsia. It won't prevent every case, of course. It's not 100% efficient like that. But low-dose aspirin commenced before 16 weeks of pregnancy.
[46:31] Seems to reduce the chances of you getting preeclampsia. They believe that the anti-inflammatory effect of aspirin has an effect on not triggering off that cascade that I mentioned. So the abnormal placentation happens and at some point a inflammatory immunological, you know, chemical cascade occurs as a result of the hypoxia that triggers off the eclamptic circumstance. It's thought that aspirin interrupts that process and prevents the inflammatory response, but also increases blood flow through that not as optimally implanted placenta. So maybe that also delays the onset of preeclampsia. So consider aspirin. Again, the information on this could take up an entire episode. Hopefully I'll have a chance to do that soon.
[47:28] The other thing that's showing promising results is calcium supplementation. Now again there's papers in the resource folder around 2,000 milligrams or two grams of calcium supplement taken for women who are considered at higher risk of preeclampsia has shown promising results in reducing the incidence. Now as a naturopath I was previously a naturopath in my other clinical life I no longer work as a naturopath. But something we learned way back then, 20 odd years ago, is that calcium and magnesium compete for...
[48:06] Absorption in the gut and that they should be given in a two-to-one ratio.
[48:12] So then I went ahead and had a look to see if there was any research around magnesium supplementation for preeclampsia. Turns out yes, magnesium is also showing some clinical results for the prevention of preeclampsia. So in this circumstance, it makes sense to dose with a two-to-one ratio of calcium magnesium throughout your pregnancy in the interest of potentially preventing preeclampsia. There are similar studies that focus on essential fatty acid supplementation for the prevention of preeclampsia. Again, the research papers on each of these could take up an entire episode. So I'm just giving you a direction to look in regarding dosage and possible chances of reducing preeclampsia so that you can go on your own journey with this.
[49:04] I'm not able to give enough information to kind of give you a treatment protocol if you know what I mean and as I mentioned earlier you can look into the brewer's diet see if that feels right for you it's very tricky because all of that brewer's diet stuff was sort of developed in the 1960s There's been some updates. As I tried to look into the research around this, I feel as though there's potentially been some censorship because I could find very little regarding the total brewer's diet. The little elements of it, you can find research papers that break down all the little elements. But.
[49:45] The Brewer's Diet focuses heavily on adequate protein consumption, salt and electrolyte consumption, and he's got them drinking lots of milk, which maybe is the calcium supplementation factor.
[50:01] So that's a little bit of a direction that you can go in if you're concerned about preeclampsia. Maybe you've got a diagnosis of low PAPA or significant risk factors, or you've had it before, this could start you on your journey to potentially preventing preeclampsia again. But just know that preeclampsia doesn't just suddenly come on. There is a journey. It starts from the beginning with placentation and implantation of the placenta and over time develops into preeclampsia.
[50:36] Now, if you're a clinician out there, I hope you've got enough information to make you a lot more confident in identifying preeclampsia for your clients and for women out there if you're feeling any of those symptoms please don't delay really make sure that your care team is responsive to your needs in that moment so nothing is missed. Now next episode we are going to talk about what next if they've done all of these tests and they've put all of the results together, and they've said, yes, you do have preeclampsia. What happens for you next? That's going to be the next episode of The Great Birth Rebellion. To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com. And to support the work of this podcast, wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanieTheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
This transcript was produced by ai technology and may contain errors.
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