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Catching COVID-19 during pregnancy significantly raises the risk of the blood-pressure disorder preeclampsia — but getting vaccinated protects against this serious pregnancy complication, new research finds. Studies have consistently shown that COVID-19 can worsen pregnancy outcomes. The new findings suggest that, during the pandemic, the coronavirus infection raised the risk of preeclampsia by 45% among pregnant women who caught it, compared to those who did not……….Continue reading….

By Gabriela Galvin

Source: Live Science

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Critics:

Edema (especially in the hands and face) was originally considered an important sign for a diagnosis of pre-eclampsia. However, because edema is a common occurrence in pregnancy, its utility as a distinguishing factor in pre-eclampsia is not high. Pitting edema (unusual swelling, particularly of the hands, feet, or face, notable by leaving an indentation when pressed on) can be significant, and should be reported to a healthcare provider.

Further, a symptom such as epigastric pain may be misinterpreted as heartburn. Standard features of pre-eclampsia, which are screened for during prenatal visits, include elevated blood pressure and excess protein in the urine. Additionally, some women may develop severe headaches as a sign of pre-eclampsia. In general, none of the signs of pre-eclampsia are specific, and even convulsions in pregnancy are more likely to have causes other than eclampsia in modern practice.

Diagnosis depends on finding a coincidence of several pre-eclamptic features, the final proof being their regression within the days and weeks after delivery. The cause of preeclampsia is not fully understood. It is likely related to factors such as:

• Abnormal placentation (formation and development of the placenta)
• Immunologic factors
• Prior or existing maternal pathology – pre-eclampsia is seen more at a higher incidence in individuals with pre-existing hypertension, obesity, or antiphospholipid antibody syndrome, or those with a history of pre-eclampsia
• Dietary factors, e.g., calcium supplementation in areas where dietary calcium intake is low, have been shown to reduce the risk of pre-eclampsia
• Environmental factors, e.g. air pollution
• Infection (for which there is much evidence), including at the time of conception.

Those with long-term high blood pressure have a 7 to 8 times higher risk than those without. Physiologically, research has linked pre-eclampsia to the following physiologic changes: alterations in the interaction between the maternal immune response and the placenta, placental injury, endothelial cell injury, altered vascular reactivity, oxidative stress, imbalance among vasoactive substances, decreased intravascular volume, and disseminated intravascular coagulation.

While the exact cause of pre-eclampsia remains unclear, there is strong evidence that a major cause predisposing a susceptible woman to pre-eclampsia is an abnormally implanted placenta.^[2][16] This abnormally implanted placenta may result in poor uterine and placental perfusion, yielding a state of hypoxia and increased oxidative stress and the release of anti-angiogenic proteins along with inflammatory mediators into the maternal plasma.

A major consequence of this sequence of events is generalized endothelial dysfunction. The abnormal implantation may stem from the maternal immune system’s response to the placenta, specifically a lack of established immunological tolerance in pregnancy. Endothelial dysfunction results in hypertension and many of the other symptoms and complications associated with pre-eclampsia.

When pre-eclampsia develops in the last weeks of pregnancy or a multiple pregnancy, the causation may, in some cases, partly be due to a large placenta outgrowing the capacity of the uterus, eventually leading to the symptoms of pre-eclampsia. Abnormal chromosome 19 microRNA cluster (C19MC) impairs extravillus trophoblast cell invasion to the spiral arteries, causing high resistance, low blood flow, and low nutrient supply to the fetus. Pre-eclampsia is diagnosed when a pregnant woman develops:

• Blood pressure ≥140 mmHg systolic or ≥90 mmHg diastolic on two separate readings taken at least four to six hours apart after 20 weeks of gestation in an individual with previously normal blood pressure.
• In a woman with essential hypertension beginning before 20 weeks of gestational age, the diagnostic criteria are an increase in systolic blood pressure (SBP) of ≥30 mmHg or an increase in diastolic blood pressure (DBP) of ≥15 mmHg.
• Proteinuria ≥ 0.3 grams (300 mg) or more of protein in a 24-hour urine sample or a SPOT urinary protein to creatinine ratio ≥0.3 or a urine dipstick reading of 1+ or greater (dipstick reading should only be used if other quantitative methods are not available).^[3]

Suspicion for pre-eclampsia should be maintained in any pregnancy complicated by elevated blood pressure, even in the absence of proteinuria. Ten percent of individuals with other signs and symptoms of pre-eclampsia and 20% of individuals diagnosed with eclampsia show no evidence of proteinuria. In the absence of proteinuria, the presence of new-onset hypertension (elevated blood pressure) and the new onset of one or more of the following is suggestive of the diagnosis of pre-eclampsia:

• Evidence of kidney dysfunction (oliguria, elevated creatinine levels)
• Impaired liver function (noted by liver function tests)
• Thrombocytopenia (platelet count <100,000/microliter)
• Pulmonary edema
• Ankle edema (pitting type)
• Cerebral or visual disturbances

Pre-eclampsia is a progressive disorder, and these signs of organ dysfunction are indicative of severe pre-eclampsia. A systolic blood pressure ≥160 or diastolic blood pressure ≥110 and/or proteinuria >5g in 24 hours is also indicative of severe pre-eclampsia. Clinically, individuals with severe pre-eclampsia may also present epigastric/right upper quadrant abdominal pain, headaches, and vomiting. Severe pre-eclampsia is a significant risk factor for intrauterine fetal death.

A rise in baseline blood pressure (BP) of 30 mmHg systolic or 15 mmHg diastolic, while not meeting the absolute criteria of 140/90, is important to note but is not considered diagnostic. Supplementation with a balanced protein and energy diet does not appear to reduce the risk of pre-eclampsia. Further, no evidence suggests that changing salt intake has an effect.

Supplementation with antioxidants such as vitamin C, D and E has no effect on pre-eclampsia incidence; therefore, supplementation with vitamins C, E, and D is not recommended for reducing the risk of pre-eclampsia. Previous guidelines, including the WHO 2011 recommendation, suggested that calcium supplementation of at least 1 gram per day during pregnancy could help prevent pre-eclampsia, particularly in women with low dietary calcium intake or those at high risk. 

However, updated evidence indicates that calcium supplements may have little or no effect on preventing pre-eclampsia or related complications for mothers or babies. Most studies started supplementation in the second trimester, so the effectiveness of earlier supplementation remains unclear. Higher selenium level is associated with a lower incidence of pre-eclampsia. Higher cadmium level is associated with higher incidence of pre-eclampsia.

“Preeclampsia 

“A brief overview of preeclampsia”.  

“Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy”

“Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015”. 

Pre-eclampsia: pathogenesis, novel diagnostics and therapies”. 

Hypertension in pregnancy.

“A brief overview of preeclampsia”.

Role of B1 and B2 lymphocytes in placental ischemia-induced hypertension”.  

“Trusted Health Sites Spread Myths About a Deadly Pregnancy Complication”.  . 

“The Last Person You’d Expect to Die in Childbirth”.

“Pre-eclampsia rates in the United States, 1980–2010: age-period-cohort analysis”.

“Definition of ECLAMPSIA”.  

Advanced Therapy in Hypertension and Vascular Disease.

Toxemia of pregnancy | medical disorder”. 

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