Dr. Mills describes the risk factors associated with preeclampsia and shares the research being conducted on this topic.
Read the full transcript »
Well the risk factors are several; younger women under age 15, women who are older, over age 35, women who have multiple gestations so twins, triplets, quadruplets, all are at risk, women who have a history of preeclampsia with previous pregnancies, particularly if that preeclampsia was more severe or occurred earlier in the pregnancy. Women who have medical conditions that we mentioned earlier, chronic high blood pressure, autoimmune disorders like lupus, mixed connective tissue disorder, rheumatoid arthritis, diabetes, those conditions all carry an increased risk. Interestingly, women who have either their mother or have siblings who developed preeclampsia appear to be at greater risk as well. That certainly suggests that there are some element of a genetic component to this condition, but we have not at this point been able to identify any particular like way to describe or define that. There have been, over the years, studies to look at and assess women who may be at greater risk or something called a rollover test where women lye on their back, they take their blood pressure, roll up to their side; if the blood pressure increases they may be at risk. Probably more important is if it doesn’t increase their risk may be less and in general, the risk factor, while looking at those studies that try to predict which women may be at risk for preeclampsia were probably better at predicting who is not as likely to get it than we are at predicting who will get it when any of those tests are positive. Additional tests that have been looked, have been looked at, blood flow early in the pregnancy, blood flow through the uterine artery. There’s a characteristic notching that if it occurs those women may have an increased risk, but that risk may predict only as many as 20 to 25% of women at risk. If the notching is not present then it’s much less likely that that woman would develop preeclampsia. There are some studies that are looking at compounds that affect the blood vessels from how the placenta attaches to the uterus and blood vessels really affect the flow of blood to the placenta. These, again, are very intriguing and I think are leading us in the right direction, but still to date have not fully identified those women that are at risk that we can sufficiently predict who is going to be affected. It would be our advantage or the advantage to the patient to be able to do that also if we also knew a way to try and reduce that risk, which currently we do not have effective ways to do that. Things that have been tried in the past has been a variety of vitamin supplementations, which now have been shown not to be as effective; low dose aspirin or 81 mg of baby aspirin a day in most populations have not been shown to be effective and those at the highest risk, women with chronic hypertension, diabetes, there still may be a trend to benefit so that is something that is often talked about and considered useful. There have been studies that have looked at blood clotting disorders, what we call thrombophilias, and at one time felt that these conditions were linked to preeclampsia in some form. More recent studies and reports have not linked as tightly the occurrence of preeclampsia with these conditions as well. So we still are looking for the test to try and help us understand who is at risk and we still are struggling to try and determine who may benefit. There is research at this point looking at omega-3 fatty acids and its role in modifying the risk of preeclampsia, but to date that is still uncertain so there is a lot of research that is going on in this field, but still with no clear direction and clear answers. I think in general, putting the research together, it has to do as much with maintaining a healthy placenta, and when we look at some of the conditions that influence placental health or the amount of placenta multiples, generally we think are a risk because there are so much placental tissue there that there is a greater ris