- What causes sudden weight gain
- When to Contact a Medical Professional
- What is Cushing syndrome
- What is Hypothyroidism
- What is Polycystic Ovary Syndrome (PCOS)
- What is Preeclampsia
What causes sudden weight gain
A sudden weight gain or a sudden unexpected change in weight can be a sign of a medical problem or can be due to medicines.
Causes for sudden weight gain can include 1):
- Thyroid problems
- Heart failure
- Kidney disease
- Digestive diseases
- Certain medications
Other things you should consider with your sudden and unexpected weight gain is the speed of onset and the amount of weight gained.
For example, a slow progressive weight gain occurs with pregnancy, whereas a periodic weight gain may occur with menstruation. A rapid weight gain may be a sign of dangerous fluid retention.
Medications that can cause weight gain include corticosteroids and drugs used to treat bipolar disorder, schizophrenia, and depression 2).
- The atypical antipsychotic drugs (clozapine, olanzepine, risperidone and quetiapine) are known to cause marked weight gain 3).
- Antidepressants such as amitriptyline, mirtazapine and some serotonin reuptake inhibitors (SSRIs) also may promote appreciable weight gain 4).
- Weight gain is also observed with mood stabilizers such as lithium, valproic acid and carbamazepine 5).
- Antiepileptic drugs that promote weight gain include valproate, carbamazepine and gabapentin. Lamotrigine is an antiepileptic drug that is weight-neutral, while topiramate and zonisamide may induce weight loss 6).
If you quit smoking, you might gain weight. Most people who quit smoking gain 4 – 10 pounds in the first 6 months after quitting. Some gain as much as 25 – 30 pounds. This weight gain is not simply due to eating more.
Hormone changes can also cause unintentional weight gain. This may be due to:
- Cushing syndrome
- Hypothyroidism (underactive thyroid, or low thyroid)
- Polycystic ovary syndrome
A build up of fluid or bloating or swelling due to a buildup of fluid in the tissues can cause weight gain. This may occur with:
- Heart failure
- Kidney failure,
- Certain medications.
When to Contact a Medical Professional
Contact your health care provider if the following symptoms occur along with the weight gain:
- Excessive weight gain without a known cause
- Hair loss
- Sensitivity to cold
- Swollen feet and shortness of breath
- Uncontrollable hunger accompanied by palpitations, tremor, and sweating
- Vision changes
Your health care provider will perform a physical examination, measure your height and weight to calculate your body mass index (BMI), and ask questions about your weight gain, such as:
- Are you anxious, depressed, or under stress ?
- Did you gain the weight quickly or slowly ?
- Do you have a history of depression ?
- Do you use alcohol or street drugs ?
- Does the weight gain cause you much concern ?
- Has your participation in social activities decreased ?
- Has your physical activity been restricted due to illness or injury ?
- Have there been changes in your diet or appetite ?
- How much weight have you gained ?
- What medications do you take ?
- What other symptoms do you have ?
- When did the weight gain begin ?
Tests that may be done include:
- Blood tests including chemistry profile
- Measurement of hormone levels
- Nutritional assessment
Weight gain caused by emotional problems may require psychological counseling. Talk to your health care provider about an appropriate diet and exercise program and realistic weight loss goals. If weight gain is caused by a physical illness, treatment (if there is any) for the underlying cause will be prescribed.
- Good nutrition and exercise can help you in losing weight. Eating less calories within a well-balanced diet and treating any underlying medical problems can help to lose weight.
If weight continues to be a problem despite diet and exercise, talk with your health care provider about other treatment options, including medications and surgery.
What is Cushing syndrome
Cushing’s syndrome is a rare hormonal disorder, caused by long-term exposure to too much cortisol, a hormone that your adrenal gland makes 7). Some kinds of tumors produce a hormone that can cause your body to make too much cortisol. Cortisol is also sometimes called a “stress hormone” and is a natural steroid hormone that’s like the “cortisone” in some medicines. Cushing’s syndrome can be caused by the body making too much cortisol or it can be caused by taking too much corticosteroid medicines (which contain cortisol).
Some symptoms of Cushing’s syndrome are:
- Fat deposits that form around the abdomen and upper back (a hump often forms between the shoulders)
- Thin arms and legs
- Severe fatigue and muscle weakness
- High blood pressure
- High blood sugar levels
- Easy bruising
- Thinner skin that is easily bruised
- Cuts, scratches and insect bites that take a long time to heal
- Pink or purple stretch marks on your skin (especially the arms, breasts, adbomen and thighs)
- Round and puffy face
- Muscle weakness
- Irregular menstrual periods in women
- Thicker or more visible hair on the face and body (usually more noticeable in women)
- Erectile dysfunction in men
- Osteoporosis (weak and brittle bones)
What causes Cushing’s syndrome ?
The most common cause of Cushing’s syndrome is taking corticosteroids orally (by mouth) every day for weeks to months 8). These medicines are usually prescribed to treat inflammatory disease, such as lupus and rheumatoid arthritis. Prednisone is the most common corticosteroid medicine that’s taken this way. Other medicines include dexamethasone and methylprednisone.
Inhaled steroid medicines for asthma and steroid skin creams for eczema and other skin conditions don’t usually cause Cushing’s syndrome. Even oral medicines taken every day for short periods of time or every other day for longer periods don’t often cause Cushing’s syndrome.
The next most common cause of Cushing’s syndrome is when the body makes too much cortisol. A tumor in the pituitary gland can be one cause of Cushing’s syndrome 9). The pituitary gland is located at the bottom of the brain and controls the body’s production of cortisol. These small tumors can cause the adrenal glands, which are near the kidneys, to make too much cortisol.
The tumors on the pituitary gland in Cushing’s syndrome aren’t usually malignant (cancercous) 10). However, if these tumors get too big, they can cause problems with your eyesight.
How is Cushing’s syndrome diagnosed ?
Your doctor may start by asking you questions about your medical history and doing a physical exam. If the cause is a medicine you are taking, no tests are usually needed. If your doctor thinks that you have Cushing’s syndrome but you are not taking medicines that can cause it, you may need to have some blood and urine tests. These tests measure the amount of cortisol in your body.
You may be asked to collect your urine for 24 hours. You may also be given a medicine called dexamethasone before your blood or urine is collected. This tests your body’s response to steroids.
At some point, you may need a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan. These tests take a picture of your insides. Looking at these pictures, your doctor will be able to tell whether there are tumors on the pituitary gland or in other parts of your body that may be causing Cushing’s syndrome.
How are Cushing’s disease and syndrome treated ?
If a coritcosteroid medicine is causing Cushing’s syndrome, your doctor will gradually lower your dose over time. Abruptly stopping a corticosteroid can cause a dangerous drop in your cortisol levels, so you should never stop taking these medicines without your doctor’s approval. Your doctor may also prescribe a noncorticosteroid medicine to replace the corticosteroid that was causing Cushing’s syndrome.
If a tumor is causing Cushing’s syndrome, your doctor will surgically remove it from your pituitary gland. This type of surgery is usually successful. Radiation treatments are sometimes used after surgery to lower the risk that the tumor will come back. You’ll need to take a cortisol replacement medicine after the tumor is removed because it will take your body some time before it starts producing normal amounts of cortisol. Most people only need to take the cortisol replacement medicine for a few months, but it could take up to year. In rare cases, people who have had surgery to remove a tumor that was causing Cushing’s syndrome never regain normal cortisol levels and must therefore continue to take the cortisol replacement medicine.
What is Hypothyroidism
Hypothyroidism, or low thyroid activity, means your thyroid gland is not making enough hormones 11). The thyroid gland is located in the front of your neck, just below your Adam’s apple. It makes hormones that control metabolism. Metabolism is the pace of your body’s processes and includes things like your heart rate and how quickly you burn calories. Women, especially those older than 50 years of age, are more likely to have hypothyroidism than men are. If left untreated, hypothyroidism can cause obesity, joint pain, infertility and heart disease.
What are the symptoms of hypothyroidism ?
The symptoms of hypothyroidism tend to develop slowly. They can be different from case to case. Initial symptoms include slight fatigue and sluggishness. As your metabolism slows, you may develop other symptoms 12):
- Increased sensitivity to cold
- Pale, dry skin
- Puffy face
- Hoarse voice
- Elevated blood cholesterol
- Unexpected weight gain
- Muscle aches, cramps, tenderness or stiffness
- Pain, stiffness or swelling in your joints
- Heavier than normal menstrual periods in women
- Visibly enlarged thyroid
- Brittle hair and fingernails
What are the symptoms of hypothyroidism in children ?
Anyone can develop the condition, including infants and teenagers 13).
Babies born without a thyroid gland or with a thyroid that doesn’t work properly don’t have many symptoms at first. They may have yellowing of the skin and the whites of their eyes (jaundice), a puffy face, frequent choking and a large tongue that sticks out slightly. As the disease progresses, infants may have trouble feeding and may not grow and develop normally. They may also be constipated, have poor muscle tone or be very sleepy. If it is not treated, hypothyroidism in infants can lead to physical and mental retardation. In the United States, newborn infants are screened for hypothyroidism before leaving the hospital.
Children and teens who develop hypothyroidism have the same symptoms as adults, but they may also experience:
- Very slow growth
- Delayed development of permanent teeth
- Delayed puberty
- Slow mental development
What causes hypothyroidism ?
The most common cause of hypothyroidism is an autoimmune disease called Hashimoto’s thyroiditis 14). Normally, antibodies produced by the immune system help protect the body against viruses, bacteria and other foreign substances. An autoimmune disease is when your immune system produces antibodies that attack your body’s tissues and/or organs. With Hashimoto’s thyroiditis, antibodies attack the thyroid and keep it from producing enough hormones.
Other common causes of hypothyroidism include:
- Treatment for hyperthyroidism. People who produce too much thyroid hormone (hyperthyroidism) are often treated with radioactive iodine or anti-thyroid medications to reduce and normalize their thyroid function. However, in some cases, treatment of hyperthyroidism can result in permanent hypothyroidism.
- Thyroid surgery. Removing all or a large portion of your thyroid gland can diminish or halt hormone production. In that case, you’ll need to take thyroid hormone for life.
- Radiation therapy. Radiation used to treat cancers of the head and neck can affect your thyroid gland and may lead to hypothyroidism.
- Medications. A number of medications can contribute to hypothyroidism. One such medication is lithium, which is used to treat certain psychiatric disorders. If you’re taking medication, ask your doctor about its effect on your thyroid gland.
- Have a close relative who has an autoimmune disease
- Have been treated with radioactive iodine or anti-thyroid medicines
- Have received radiation therapy to your neck or upper chest
- Have had thyroid surgery in the past
Some less common causes of hypothyroidism include:
Less often, hypothyroidism may result from one of the following:
- Congenital disease: About 1 in 3,000 infants in the United States are born with a defective thyroid or no thyroid at all, in most cases, the thyroid gland didn’t develop normally for unknown reasons, but some children have an inherited form of the disorder. Often, infants with congenital hypothyroidism appear normal at birth. That’s one reason why most states now require doctors to screen newborns for thyroid problems.
- Pituitary disorder: A relatively rare cause of hypothyroidism is the failure of the pituitary gland to produce enough thyroid-stimulating hormone (TSH) — usually because of a benign tumor of the pituitary gland. The pituitary gland produces a thyroid-stimulating hormone (TSH), which tells the thyroid gland how much thyroid hormone to produce. A pituitary disorder may keep the pituitary gland from producing the right amount of thyroid-stimulating hormone.
- Pregnancy: Some women develop hypothyroidism during or after pregnancy because their bodies produce antibodies that attack the thyroid gland. If it is not treated, hypothyroidism increases the risk of miscarriage, premature delivery and preeclampsia — a condition that causes a significant rise in a woman’s blood pressure during the last three months of pregnancy. It can also seriously affect the developing fetus.
- Iodine deficiency: The trace mineral iodine — found primarily in seafood, seaweed, plants grown in iodine-rich soil and iodized salt — is essential for the production of thyroid hormones. Iodine deficiency can keep the body from being able to make enough thyroid hormone. In the United States, table salt has iodine added to it to make sure everyone gets enough. Conversely, taking in too much iodine can cause hypothyroidism.
How is hypothyroidism diagnosed ?
If you have symptoms of an underactive thyroid, your doctor will do tests to measure the levels of thyroid hormone and thyroid-stimulating hormone in your blood.
Some doctors recommend screening older women for hypothyroidism during routine physical examinations. Some also recommend screening pregnant women and women who are thinking about becoming pregnant.
How is hypothyroidism treated ?
Treatment for hypothyroidism is a synthetic thyroid hormone taken daily in pill form. This medicine will regulate hormone levels and shift your metabolism back to normal. It will also lower your LDL cholesterol and may help reverse weight gain. It may take a few tries to get the right dose of synthetic thyroid hormone. If you are not taking enough, you may continue to experience symptoms of hypothyroidism. If you are taking too much, you may have symptoms similar to those of hyperthyroidism (overactive thyroid disease). Your doctor can tell if you are taking the right dose of thyroid hormone based on how you feel, by examination and by blood testing.
Some medicines, supplements and foods may affect your body’s ability to absorb the synthetic thyroid hormone. Tell your doctor if you eat large amounts of soy products, are on a high-fiber diet or take other medicines such as iron supplements, calcium supplements, cholestyramine or aluminum hydroxide (found in some antacids).
Complications of hypothyroidism
If it is not treated, hypothyroidism can lead to other health problems. These include:
- Goiter: Hypothyroidism can cause your thyroid to become larger, creating a swollen lump on your neck called a goiter. A goiter can affect your appearance and can even make it hard for you to swallow or eat.
- An increased risk of heart disease: An underactive thyroid causes high levels of “bad” (LDL) cholesterol.
- Mental health issues: Depression that occurs with hypothyroidism can become worse over time, especially if left untreated.
- Myxedema: A rare, life-threatening condition characterized by intense sensitivity to cold, drowsiness followed by severe sluggishness, leading to unconsciousness and even coma.
- Birth defects: Babies born to women who have untreated hypothyroidism may have birth defects.
- Infertility: Low hormone levels can make it difficult for a woman who has hypothyroidism to become pregnant.
- Peripheral neuropathy. Long-term uncontrolled hypothyroidism can cause damage to your peripheral nerves — the nerves that carry information from your brain and spinal cord to the rest of your body, for example, your arms and legs. Signs and symptoms of peripheral neuropathy may include pain, numbness and tingling in the area affected by the nerve damage. It may also cause muscle weakness or loss of muscle control.
What is Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a condition that occurs when an imbalance of hormone levels in a woman’s body causes cysts to form in the ovaries 15). The cysts are like tiny, fluid-filled balloons.
Polycystic ovary syndrome is the most common endocrinopathy among reproductive-aged women in the United States, affecting approximately 7% of female patients 16).
Polycystic ovary syndrome can cause changes in a woman’s menstrual cycles, fertility, hormone levels, heart and blood vessels, and appearance.
Women can develop polycystic ovary syndrome during their teenage or childbearing years.
What are the symptoms of polycystic ovary syndrome ?
Usually, women who have polycystic ovary syndrome have irregular, infrequent or no menstrual periods. They may also have trouble getting pregnant. Some women who have polycystic ovary syndrome do not experience any symptoms.
Other signs and symptoms of polycystic ovary syndrome may include:
- Overweight and obesity
- Excessive hair growth on the face, nipple area, chest, lower abdomen and thighs
- Thinning hair or bald spots
- Dark patches of skin
- Anxiety or depression
- Pelvic pain
Women who have polycystic ovary syndrome are also more likely to have type 2 diabetes, high blood pressure and high cholesterol and triglycerides. Together with obesity, these conditions are known as the “metabolic syndrome.”
What causes polycystic ovary syndrome ?
Doctors do not know exactly what causes polycystic ovary syndrome. If you have polycystic ovary syndrome, you have a hormone imbalance. Your ovaries make too much of one type of hormone (called androgens). You may also have too much insulin, which regulates your blood sugar levels. These hormone problems cause the symptoms of polycystic ovary syndrome.
What are the risk factors for polycystic ovary syndrome ?
You are more likely to have polycystic ovary syndrome if your mother or sister has polycystic ovary syndrome.
Complications of polycystic ovary syndrome
Complications of polycystic ovary syndrome can include:
- Gestational diabetes or pregnancy-induced high blood pressure
- Miscarriage or premature birth
- Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver
- Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease
- Type 2 diabetes or prediabetes
- Sleep apnea
- Depression, anxiety and eating disorders
- Abnormal uterine bleeding
- Cancer of the uterine lining (endometrial cancer)
Obesity is associated with polycystic ovary syndrome and can worsen complications of the disorder.
If you have polycystic ovary syndrome, you are more likely to develop high blood pressure, high cholesterol or type 2 diabetes. This means you have a greater risk for strokes and heart attacks.
Problems with menstrual periods may also cause women who have polycystic ovary syndrome to be infertile (unable to get pregnant). They may also have a higher risk for cancer of the uterus or breast.
Women who have polycystic ovary syndrome are also more likely to have anxiety or depression. If you are feeling anxious or depressed, talk to your doctor. Treatment is available.
Diagnosis of polycystic ovary syndrome
There’s no test to definitively diagnose polycystic ovary syndrome. Your doctor is likely to start with a discussion of your medical history, including your menstrual periods and weight changes. A physical exam will include checking for signs of excess hair growth, insulin resistance and acne.
Your doctor might then recommend:
- A pelvic exam. The doctor visually and manually inspects your reproductive organs for masses, growths or other abnormalities.
- Blood tests. Your blood may be analyzed to measure hormone levels. This testing can exclude possible causes of menstrual abnormalities or androgen excess that mimics polycystic ovary syndrome. You might have additional blood testing to measure glucose tolerance and fasting cholesterol and triglyceride levels.
- An ultrasound. Your doctor checks the appearance of your ovaries and the thickness of the lining of your uterus. A wandlike device (transducer) is placed in your vagina (transvaginal ultrasound). The transducer emits sound waves that are translated into images on a computer screen. An ultrasound exam can show if you have cysts on your ovaries.
If you have a diagnosis of polycystic ovary syndrome, your doctor might recommend additional tests for complications. Those tests can include:
- Periodic checks of blood pressure, glucose tolerance, and cholesterol and triglyceride levels
- Screening for depression and anxiety
- Screening for obstructive sleep apnea
How is polycystic ovary syndrome treated ?
Treatment for polycystic ovary syndrome focuses on managing the symptoms. You might need to lose weight. Eating healthy and getting plenty of exercise can help manage polycystic ovary syndrome.
Medicine can help regulate your menstrual cycle and reduce abnormal hair growth and acne. Birth control pills (for women not trying to have a baby) and metformin are 2 prescription medicines that are often helpful. If you have diabetes or high blood pressure, those conditions also need treatment. If you want to have a baby, there are medicines that may help you get pregnant.
What is Preeclampsia
Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys 17). Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal. Even a slight rise in blood pressure may be a sign of preeclampsia.
Left untreated, preeclampsia can lead to serious — even fatal — complications for both you and your baby. If you have preeclampsia, the only cure is delivery of your baby.
If you’re diagnosed with preeclampsia too early in your pregnancy to deliver your baby, you and your doctor face a challenging task. Your baby needs more time to mature, but you need to avoid putting yourself or your baby at risk of serious complications.
Symptoms of Preeclampsia
Preeclampsia sometimes develops without any symptoms. High blood pressure may develop slowly, or it may have a sudden onset. Monitoring your blood pressure is an important part of prenatal care because the first sign of preeclampsia is commonly a rise in blood pressure. Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) or greater — documented on two occasions, at least four hours apart — is abnormal.
Other signs and symptoms of preeclampsia may include:
- Excess protein in your urine (proteinuria) or additional signs of kidney problems
- Severe headaches
- Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
- Upper abdominal pain, usually under your ribs on the right side
- Nausea or vomiting
- Decreased urine output
- Decreased levels of platelets in your blood (thrombocytopenia)
- Impaired liver function
- Shortness of breath, caused by fluid in your lungs
Sudden weight gain and swelling (edema) — particularly in your face and hands — may occur with preeclampsia. But these also occur in many normal pregnancies, so they’re not considered reliable signs of preeclampsia.
What causes preeclampsia
The exact cause of preeclampsia involves several factors. Experts believe it begins in the placenta — the organ that nourishes the fetus throughout pregnancy. Early in pregnancy, new blood vessels develop and evolve to efficiently send blood to the placenta.
In women with preeclampsia, these blood vessels don’t seem to develop or function properly. They’re narrower than normal blood vessels and react differently to hormonal signaling, which limits the amount of blood that can flow through them.
Causes of this abnormal development may include:
- Insufficient blood flow to the uterus
- Damage to the blood vessels
- A problem with the immune system
- Certain genes
Other high blood pressure disorders during pregnancy
Preeclampsia is classified as one of four high blood pressure disorders that can occur during pregnancy. The other three are:
- Gestational hypertension. Women with gestational hypertension have high blood pressure but no excess protein in their urine or other signs of organ damage. Some women with gestational hypertension eventually develop preeclampsia.
- Chronic hypertension. Chronic hypertension is high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy. But because high blood pressure usually doesn’t have symptoms, it may be hard to determine when it began.
- Chronic hypertension with superimposed preeclampsia. This condition occurs in women who have been diagnosed with chronic high blood pressure before pregnancy, but then develop worsening high blood pressure and protein in the urine or other health complications during pregnancy.
Risk factors for Preeclampsia
Preeclampsia develops only as a complication of pregnancy. Risk factors include:
- History of preeclampsia. A personal or family history of preeclampsia significantly raises your risk of preeclampsia.
- Chronic hypertension. If you already have chronic hypertension, you have a higher risk of developing preeclampsia.
- First pregnancy. The risk of developing preeclampsia is highest during your first pregnancy.
- New paternity. Each pregnancy with a new partner increases the risk of preeclampsia more than does a second or third pregnancy with the same partner.
- Age. The risk of preeclampsia is higher for very young pregnant women as well as pregnant women older than 40.
- Obesity. The risk of preeclampsia is higher if you’re obese.
- Multiple pregnancy. Preeclampsia is more common in women who are carrying twins, triplets or other multiples.
- Interval between pregnancies. Having babies less than two years or more than 10 years apart leads to a higher risk of preeclampsia.
- History of certain conditions. Having certain conditions before you become pregnant — such as chronic high blood pressure, migraines, type 1 or type 2 diabetes, kidney disease, a tendency to develop blood clots, or lupus — increases your risk of preeclampsia.
- In vitro fertilization. Your risk of preeclampsia is increased if your baby was conceived with in vitro fertilization.
Complications of Preeclampsia
The more severe your preeclampsia and the earlier it occurs in your pregnancy, the greater the risks for you and your baby. Preeclampsia may require induced labor and delivery.
Delivery by cesarean delivery (C-section) may be necessary if there are clinical or obstetric conditions that require a speedy delivery. Your obstetric provider will assist you in deciding what type of delivery is correct for your condition.
Complications of preeclampsia may include:
- Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn’t get enough blood, your baby may receive inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction, low birth weight or preterm birth.
- Preterm birth. If you have preeclampsia with severe features, you may need to be delivered early, to save the life of you and your baby. Prematurity can lead to breathing and other problems for your baby. Your health care provider will help you understand when is the ideal time for your delivery.
- Placental abruption. Preeclampsia increases your risk of placental abruption, a condition in which the placenta separates from the inner wall of your uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both you and your baby.
- HELLP syndrome. HELLP — which stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count — syndrome is a more severe form of preeclampsia, and can rapidly become life-threatening for both you and your baby. Symptoms of HELLP syndrome include nausea and vomiting, headache, and upper right abdominal pain. HELLP syndrome is particularly dangerous because it represents damage to several organ systems. On occasion, it may develop suddenly, even before high blood pressure is detected or it may develop without any symptoms at all.
- Eclampsia. When preeclampsia isn’t controlled, eclampsia — which is essentially preeclampsia plus seizures — can develop. It is very difficult to predict which patients will have preeclampsia that is severe enough to result in eclampsia. Often, there are no symptoms or warning signs to predict eclampsia. Because eclampsia can have serious consequences for both mom and baby, delivery becomes necessary, regardless of how far along the pregnancy is.
- Other organ damage. Preeclampsia may result in kidney, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on the severity of preeclampsia.
- Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease. The risk is even greater if you’ve had preeclampsia more than once or you’ve had a preterm delivery. To minimize this risk, after delivery try to maintain your ideal weight, eat a variety of fruits and vegetables, exercise regularly, and don’t smoke.
Prevention of Preeclampsia
Researchers continue to study ways to prevent preeclampsia, but so far, no clear strategies have emerged. Eating less salt, changing your activities, restricting calories, or consuming garlic or fish oil doesn’t reduce your risk. Increasing your intake of vitamins C and E hasn’t been shown to have a benefit.
Some studies have reported an association between vitamin D deficiency and an increased risk of preeclampsia. But while some studies have shown an association between taking vitamin D supplements and a lower risk of preeclampsia, others have failed to make the connection.
In certain cases, however, you may be able to reduce your risk of preeclampsia with:
- Low-dose aspirin. If you meet certain risk factors, including a history of preeclampsia with severe features, preeclampsia resulting in a preterm delivery, chronic hypertension or a history of kidney disease, your doctor may recommend a daily low-dose aspirin — between 60 and 81 milligrams — beginning late in your first trimester.
- Calcium supplements. In some populations, women who have calcium deficiency before pregnancy — and who don’t get enough calcium during pregnancy through their diets — might benefit from calcium supplements to prevent preeclampsia. However, it’s unlikely that women from the United States or other developed countries would have calcium deficiency to the degree that calcium supplements would benefit them.
It’s important that you don’t take any medications, vitamins or supplements without first talking to your doctor.
Before you become pregnant, especially if you’ve had preeclampsia before, it’s a good idea to be as healthy as you can be. Lose weight if you need to, and make sure other conditions, such as diabetes, are well-managed.
Once you’re pregnant, take care of yourself — and your baby — through early and regular prenatal care. If preeclampsia is detected early, you and your doctor can work together to prevent complications and make the best choices for you and your baby.
Diagnosis of preeclampsia
To diagnose preeclampsia, you have to have high blood pressure and one or more of the following complications after the 20th week of pregnancy:
- Protein in your urine (proteinuria)
- A low platelet count
- Impaired liver function
- Signs of kidney trouble other than protein in the urine
- Fluid in the lungs (pulmonary edema)
- New-onset headaches or visual disturbances
Previously, preeclampsia was only diagnosed if high blood pressure and protein in the urine were present. However, experts now know that it’s possible to have preeclampsia, yet never have protein in the urine.
A blood pressure reading in excess of 140/90 mm Hg is abnormal in pregnancy. However, a single high blood pressure reading doesn’t mean you have preeclampsia. If you have one reading in the abnormal range — or a reading that’s substantially higher than your usual blood pressure — your doctor will closely observe your numbers.
Having a second abnormal blood pressure reading four hours after the first may confirm your doctor’s suspicion of preeclampsia. Your doctor may have you come in for additional blood pressure readings and blood and urine tests.
Tests that may be needed
If your doctor suspects preeclampsia, you may need certain tests, including:
- Blood tests. Your doctor will order liver function tests, kidney function tests and also measure your platelets — the cells that help blood clot.
- Urine analysis. Your doctor will ask you to collect your urine for 24 hours, for measurement of the amount of protein in your urine. A single urine sample that measures the ratio of protein to creatinine — a chemical that’s always present in the urine — also may be used to make the diagnosis.
- Fetal ultrasound. Your doctor may also recommend close monitoring of your baby’s growth, typically through ultrasound. The images of your baby created during the ultrasound exam allow your doctor to estimate fetal weight and the amount of fluid in the uterus (amniotic fluid).
- Nonstress test or biophysical profile. A nonstress test is a simple procedure that checks how your baby’s heart rate reacts when your baby moves. A biophysical profile uses an ultrasound to measure your baby’s breathing, muscle tone, movement and the volume of amniotic fluid in your uterus.
Treatment for preeclampsia
The only cure for preeclampsia is delivery. You’re at increased risk of seizures, placental abruption, stroke and possibly severe bleeding until your blood pressure decreases. Of course, if it’s too early in your pregnancy, delivery may not be the best thing for your baby.
If you’re diagnosed with preeclampsia, your doctor will let you know how often you’ll need to come in for prenatal visits — likely more frequently than what’s typically recommended for pregnancy. You’ll also need more frequent blood tests, ultrasounds and nonstress tests than would be expected in an uncomplicated pregnancy.
Medications for preeclampsia
Possible treatment for preeclampsia may include:
Medications to lower blood pressure. These medications, called antihypertensives, are used to lower your blood pressure if it’s dangerously high. Blood pressure in the 140/90 millimeters of mercury (mm Hg) range generally isn’t treated.
Although there are many different types of antihypertensive medications, a number of them aren’t safe to use during pregnancy. Discuss with your doctor whether you need to use an antihypertensive medicine in your situation to control your blood pressure.
Corticosteroids. If you have severe preeclampsia or HELLP syndrome, corticosteroid medications can temporarily improve liver and platelet function to help prolong your pregnancy. Corticosteroids can also help your baby’s lungs become more mature in as little as 48 hours — an important step in preparing a premature baby for life outside the womb.
Anticonvulsant medications. If your preeclampsia is severe, your doctor may prescribe an anticonvulsant medication, such as magnesium sulfate, to prevent a first seizure.
Bed rest used to be routinely recommended for women with preeclampsia. But research hasn’t shown a benefit from this practice, and it can increase your risk of blood clots, as well as impact your economic and social lives. For most women, bed rest is no longer recommended.
Severe preeclampsia may require that you be hospitalized. In the hospital, your doctor may perform regular nonstress tests or biophysical profiles to monitor your baby’s well-being and measure the volume of amniotic fluid. A lack of amniotic fluid is a sign of poor blood supply to the baby.
If you’re diagnosed with preeclampsia near the end of your pregnancy, your doctor may recommend inducing labor right away. The readiness of your cervix — whether it’s beginning to open (dilate), thin (efface) and soften (ripen) — also may be a factor in determining whether or when labor will be induced.
In severe cases, it may not be possible to consider your baby’s gestational age or the readiness of your cervix. If it’s not possible to wait, your doctor may induce labor or schedule a C-section right away. During delivery, you may be given magnesium sulfate intravenously to prevent seizures.
- If you need pain-relieving medication after your delivery, ask your doctor what you should take. NSAIDs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), can increase your blood pressure.
References [ + ]
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