Women who experience chronic hypertension during pregnancy may be at risk for a complex condition known as preeclampsia. Approximately 5% to 8% of pregnancies may develop preeclampsia in the second half of the gestational period. This condition can occur without warning and may affect both the mother and the growing fetus. While the exact causes of preeclampsia are still being studied, some research has provided insights into potential contributing factors. This article explores the specifics of preeclampsia, how it can be addressed through standard medical care and integrative approaches, and the complementary modalities that may assist those at risk of preeclampsia.
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What is Preeclampsia?
Preeclampsia is characterized by persistent elevated blood pressure that may lead to organ dysfunction and potential fetal distress during pregnancy. This typically occurs after the 20-week mark of pregnancy and can bring complications for both the mother and baby. While hypertension in pregnancy does not always result in preeclampsia, this complication of hypertension may lead to kidney and liver issues, resulting in protein in the urine, swelling, blurred vision, and headaches in the mother. Preeclampsia also affects the placenta, which provides nutrients and oxygen to the growing fetus. This can also lead to eclampsia, which may result in maternal seizures. Monitoring and managing preeclampsia are important to support healthy development and outcomes for both mother and baby.
What Causes Preeclampsia?
There is no single defined cause of preeclampsia. It is thought to be a multifactorial condition that affects the formation, health, and function of the placenta. The factors that have been investigated include abnormal placenta development, genetics, immune system function, pre-existing medical conditions, environmental factors, and nutritional implications.
Abnormal Placenta Development
Anatomical size, shape, and vascular input have all been correlated with preeclampsia. The microvasculature to the placenta may present as compromised due to conditions like diabetes or hypertension, with reduced blood flow. There is also evidence that the maternal blood vessel remodeling that is supposed to connect to the placenta may not occur properly. This can lead to underdeveloped placenta size, which may impact fetal size. Oblong-shaped placentas, rather than circular, have been observed in cases of preeclampsia.
Genetics
Inherited predispositions may contribute to preeclampsia risk. Women who inherit genes that affect blood pressure may have higher odds of hypertension during pregnancy. There are numerous genes under investigation for their roles in hypertension, placental development, and maternal factors that may make women more prone to developing preeclampsia.
Immune System Function
Preeclampsia is also associated with an inflammatory process. It is thought that immune system function may play a role in the development of the placenta. Research suggests that this may involve the functioning of Interleukin-10 (IL-10), which normally helps manage proinflammatory cytokines. In preeclampsia, a decrease in this interleukin may lead to changes in T-cell differentiation, which is necessary for proper trophoblastic formation, an early stage of placenta development.
Medical History
Your overall health leading up to conception can play a role in your pregnancy. A history of hypertension, diabetes, obesity, kidney disease, or previous pregnancies with preeclampsia are a few factors that may contribute to the potential development of preeclampsia. Monitoring and managing these conditions before becoming pregnant may help minimize your risk.
Environmental and Lifestyle Factors
What you are exposed to in your daily life can affect many aspects of your health, including pregnancy. Increased exposure to air pollution, which may cause inflammation, vascular changes, and oxidative stress, can affect the development and function of your placenta. Exposure to some heavy metals such as cadmium and lead has been associated with an increased risk of preeclampsia as well.
Nutrition and Nutrient Status
Diets low in nutrients may affect your pregnancy. Low levels of vitamin D, calcium, and magnesium have been observed in cases of preeclampsia. Vitamin C and vitamin E deficiency have also been noted. Other vitamins provide antioxidative support to our cells. When deficient in these nutrients, there may be more oxidative stress, which can impact, in this case, blood flow to the placenta. Selenium, B12, and folic acid deficiency have been investigated and found to be depleted in preeclampsia development. Supporting your micronutrient status may potentially influence your pregnancy trajectory.
Preeclampsia Risk Factors
Numerous factors may put a pregnancy at a higher risk of developing preeclampsia. Some of these factors are lifestyle-related, while others are not fully understood. Ensuring good health before pregnancy is a key way to support a healthy pregnancy. If you are overweight, have pre-existing high blood pressure, or are managing kidney disease, you may be at a higher risk for developing preeclampsia.
Other risk factors include a family history of preeclampsia, being pregnant with multiples, pregnancies over the age of 40 years old, and being of African American ethnicity. Having one or more of these risk factors does not guarantee that you'll develop preeclampsia, and having no risk factors does not mean you are free from the possibility of developing it. Being aware of your body and any unusual symptoms is important for early detection of preeclampsia.
Preeclampsia Symptoms
During pregnancy, your body changes, sometimes rapidly. When changes become sudden, drastic, or unusual, it may be an early warning sign for conditions such as preeclampsia. Common signs and symptoms of preeclampsia are:
- Hypertension
- Swelling
- Headaches
- Blurred vision
- Fatigue
- Nausea
- Vomiting
- Light sensitivity
- Pain in the abdomen
- Shortness of breath
- Easily bruising
- Urinating in small amounts
- Impaired kidney and liver function
- Pain located in the upper right quadrant of the abdomen
- Sudden weight gain (2 to 5 lbs in a week)
- Protein present in your urine
The Role of Integrative Medicine in Preeclampsia
Taking an integrative medicine approach for preeclampsia may help women before and during pregnancy. The principles of integrative medicine include the use of holistic philosophies and modalities and collaboration with Western medicine practices. It's a patient-centered approach that combines the care of both traditional medical doctors and complementary healthcare practitioners. Evidence-based natural interventions, physical medicine, and lifestyle interventions are a few of the ways in which integrative providers may support you during your medical care.
The Importance of Collaborative Care and Multidisciplinary Approach
In the case of preeclampsia, someone who is at risk or receives a diagnosis could consult with both their OB/GYN and an integrative medicine practitioner. The integrative approach may help address areas of nutrition, stress management, environmental exposure mitigation, sleep optimization, and other lifestyle medicine factors. Making sure you have your primary care physician in the loop on what you are incorporating is essential so they understand changes that are helping you or could be impacting your conditions. Integrative medicine providers such as acupuncturists, naturopathic doctors, or functional medicine practitioners can be excellent resources for conditions such as hypertension, diabetes, and weight management, which could be a preeclampsia risk factor you are facing.
Functional Medicine Labs That Can Help Individualize Care for Patients at Risk for Preeclampsia
If you are at risk for preeclampsia or you were recently diagnosed, here are six functional medicine tests that could help investigate contributing factors and provide guidance for care
Pregnancy Panel
A comprehensive blood panel prior to the first trimester of pregnancy can provide a baseline of your health status. Access Medical Laboratories offers an option for pregnancy called the Obstetric Panel. This can provide information that may indicate disturbances associated with infection and imbalances in the immune system.
Glucose Testing
If you are diabetic prior to pregnancy, getting an initial glucose testing done can help detect trends that may lead to preeclampsia. Managing your diabetes during pregnancy may help reduce your chances of progressing to preeclampsia.
T-Cell Immune System Testing
T-cell differentiation plays a role in the development of preeclampsia. When T-cells are not properly differentiating, that can lead to a decrease in IL-10, an anti-inflammatory cytokine. Finding clues by diving deeper into the immune system through T-Cell, B-Cell, and Natural Killer Cell Profile could provide insight prior to this occurring.
Environmental Toxins
What you are exposed to in your environment can impact many areas of your health. From air pollution to groundwater, there are toxins bombarding us daily. Investigating your environmental toxic load may be beneficial, especially if you have known industrial or community-based exposures.
Heavy Metals
Lead and cadmium are two heavy metals you'll want to rule out as contributors to preeclampsia. A comprehensive option would be a toxic metal Hair Elements test by Doctor's Data. Hair analysis can be a great indicator of toxic elements because these metals can be 200 to 300 times present in hair compared to blood or urine.
Micronutrient Testing
Studies have found an association between micronutrient status and the development of preeclampsia. The key vitamins- vitamin C, vitamin D, vitamin E, magnesium, calcium, and iron all have an impact on the pathophysiology of preeclampsia and, therefore, should all be evaluated.
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Conventional Management of Preeclampsia
Western medicine treatment for preeclampsia depends on the severity of the case and how far along you are in pregnancy. The standard of care treatment is to deliver the baby if you are at least 37 weeks pregnant. In earlier stages of pregnancy, your doctor may prescribe bed rest, run blood work and urine tests more often to monitor progression, and perform more frequent ultrasounds and heart rate monitoring of the fetus. In severe conditions, medication to manage your blood pressure and prevent or treat seizures may be prescribed. Unfortunately, delivery of your baby is the primary treatment, which poses a risk for prematurity. Your doctor weighs the risks based on your presentation and the health risks posed to you and your child.
Integrative Approach to The Management of Preeclampsia
Management from a holistic perspective is best done when an integrative approach is implemented. Women diagnosed with preeclampsia may benefit from a collaboration of practitioners that are all working in the mother and unborn child's best interest. Here are evidence-based options to consider for a complementary medicine preeclampsia approach.
Nutritional and Dietary Considerations For The Management of Preeclampsia
Eating well during pregnancy is important for both the mother and the growing baby. Ensuring a balance of macronutrients—healthy fats, proteins, moderate consumption of carbohydrates, and plenty of fruits and vegetables—can help provide a broad spectrum of nutrients. Foods high in calcium, magnesium, and fatty acids may be beneficial in managing blood pressure and preeclampsia. Focusing on foods rich in these nutrients, such as yogurt, dark leafy greens like spinach, and fatty fish such as wild-caught salmon and nuts, can support your nutritional needs in pregnancy.
Nutraceuticals For The Management of Preeclampsia
Working with a skilled holistic practitioner who is knowledgeable in both pregnancy complications and the use of high-dose nutrient support is important when considering this route. While there are no evidence-based herbal medicines proven safe to use in pregnancy and preeclampsia, there are helpful herbs used to manage hypertension prior to pregnancy.
It's generally suggested to take a prenatal vitamin during pregnancy, which contains essential micronutrients to support the pregnancy. If additional support is needed for single nutrients, here are some suggested doses based on available information:
Calcium: >1000mg per day starting before week 34 of pregnancy
Vitamin D3: biweekly dosing of 50,000 IU or 200 IU daily from weeks 20 to 32 gestation. This should be taken with daily calcium to support preeclampsia risk management
Selenium: 100 micrograms per day from week 24 until delivery
Lifestyle Modifications and Stress Management For The Management of Preeclampsia
Implementing lifestyle modifications and techniques to manage stress can be a supportive tool in managing preeclampsia. While these complementary measures are not a cure for preeclampsia, they may help you process and adapt to the physical, mental, and emotional stressors of this condition. Here are some simple ways to support your health and well-being during pregnancy: rest as much as possible, practice breathing techniques, surround yourself with a support system of family and friends, get outside into nature, and engage in light exercise to support your blood pressure.
Mind-Body Interventions For The Management of Preeclampsia
Creating time and space to clear your mind and focus on positive thoughts regarding your pregnancy can be reassuring and create peace around the circumstance of preeclampsia. Some women develop preeclampsia unexpectedly and without a known risk factor. Others may have a predisposing factor such as hypertension but are trying to manage it as best as possible. Regardless of the situation you may find yourself in, incorporating meditation is an excellent way to induce relaxation and calm your mind. Evidence also suggests that practicing meditation can relax the sympathetic nervous system, thus supporting blood pressure management. Yoga can also be a great addition to reducing hypertension in pregnancy. One randomized controlled trial (RCT) provided excellent insight. In this study, the 30 women in the test group incorporated one hour of yoga three times a week during weeks 12 to 28 of their pregnancy. The control group received standard pregnancy care and implemented walking. The results were impressive, with significantly fewer women experiencing hypertension, preeclampsia, gestational diabetes, or growth complications. This study suggests that weekly yoga can be a great adjunct to your health during pregnancy.
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Summary
Preeclampsia continues to pose challenging risks to women's health during pregnancy. Managing care from early detection to incorporating collaborative patient care and comprehensive treatment plans can provide timely support for the mother and fetus. When it comes to research, investigating all avenues that can lead to prevention, decrease the manifestation of severe preeclampsia, and best course interventions for care should be at the forefront. In integrative medicine, our hope is that we can help women manage controllable factors—such as lifestyle, diet, environmental exposures, and stress—while also providing them with complementary medicine tools during a time of need.
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