Pregnant women, after 20 weeks of pregnancy, should be alert to the risk of pre-eclampsia, a complication in which the pregnant woman develops high blood pressure, with great risk for the mother and child. Pregnant women at risk deserve specialized care, with strict surveillance during prenatal care. This type of care has been offered to pregnant women in the Metropolitan Region of Campinas for years by Unicamp, through the Specialized Pre-Natal Outpatient Clinic at Hospital da Mulher – Caism. On average, around 30 pregnant women are treated there per day with high-risk conditions for pre-eclampsia, not only pregnant women with chronic hypertension, but also those with a history of pre-eclampsia, kidney disease, autoimmune disease, hemoglobinopathies and neoplasms.
This service has increased due to a set of risk factors that have an impact on pregnant women, including the increasing obesity in the country, later pregnancies, women with more comorbidities and, in addition, better clinical control of many serious diseases, such as kidney disease or sickle cell anemia, which allows for the maintenance of fertility and more pregnancies.
On the 22nd (Tuesday), Unicamp was a voice that joined others to remember World Pre-Eclampsia Day, in its second edition, already incorporated into the calendar of several international organizations. “The idea, when creating this date, was to get the whole world to discuss and publicize the subject because pre-eclampsia is one of the causes of highest mortality and morbidity in pregnancy and postpartum worldwide”, commented the professor at the Caism, obstetrician Maria Laura Costa do Nascimento.
According to the expert, hypertensive complications represent the main cause of maternal death in Brazil. “So addressing the issue and spreading the signs and symptoms of severity is very important for the population, since around the world a woman dies from pre-eclampsia every 20 minutes”, she lamented. “And the saddest thing is that 99% of these deaths occur in low- and middle-income countries.”
Pre-eclampsia today accounts for a large proportion of premature births called therapeutic, that is, induced by doctors to save the lives of mothers or babies. It occurs when high blood pressure during pregnancy is accompanied by loss of protein in the urine (proteinuria) or, in the absence of proteinuria, some sign of severity, which may indicate dysfunction in organs such as the central nervous system, liver and kidneys.
According to Maria Laura, pre-eclampsia most often occurs at the end of pregnancy and there is still no effective way to prevent it or predict which patients will have complications. However, some interventions that produce the most results involve identifying risk factors. These factors are normally associated with women with a history of pre-eclampsia in a previous pregnancy, the presence of chronic high blood pressure and autoimmune diseases such as lupus and obesity.
Some of the possible interventions include the use of aspirin for the highest risk population and replacement with calcium carbonate in populations with low calcium intake [Brazil is known to be a low intake population]. “But the most effective intervention is to make the diagnosis early and monitor the patients to determine the ideal time for the birth to take place, since the only effective treatment is childbirth”, said the doctor.
Caism is currently part of a large multicenter study in Brazil, coordinated by Fiocruz in Rio de Janeiro, called Prepare (Reduction of Prematurity through Pre-Eclampsia Care). This study aims to identify cases that, given the diagnosis of pre-eclampsia, may benefit from expectant management (postponing birth) with the use of biomarkers. "We are testing the collection of factors in the blood (angiogenic and antiangiogenic factors) to check maternal risk. This is a project that is already underway," she informed.
Project Manager
The Prenatal Outpatient Clinic Specializing in Hypertension operates on Wednesdays at Caism. Obstetricians Mary Ângela Parpinelli, Fernanda Surita and Maria Laura are responsible. It is especially aimed at women with chronic hypertension, but also with collagenosis, kidney disease, sickle cell disease and neoplasia. “In this outpatient clinic, we have patients at highest risk of pre-eclampsia”, revealed Maria Laura. She explained that pre-eclampsia is an evolutionary, multisystemic pathology and that, therefore, you never know what condition the patient may present."
According to the professor, there are women who start with very high blood pressure, others show significant kidney changes (with kidney failure), there are those who come to the emergency room with liver failure and there are still others who convulse first (eclampsia).
“If a woman has hypertension with pressure above 140/90 during prenatal care, this needs to be valued and it is essential to investigate pre-eclampsia. If she has a weight gain of more than 500 grams per week; if you notice any significant edema (swelling), especially on the face and hands; and if you start to have stomach pains, nausea or visual changes (seeing everything 'shiny'), all of this is a serious factor that deserves to be evaluated”, she defended. “These signs should put the pregnant woman on alert, because they are not common at the end of pregnancy. Therefore, it is necessary to measure the pressure immediately and seek immediate medical attention.”
On the other hand, pre-eclampsia is the biggest cause of therapeutic prematurity, that is, medically indicated. Therefore, in addition to the maternal risk of severity, there is also the risk it represents for the fetus. Especially in cases of early pre-eclampsia (before 34 weeks), the placenta does not function properly and so the baby may be restricted, smaller than it should be. There is a greater risk of intrauterine suffering and the consequences of prematurity.
"In the long term, mothers who have already had pre-eclampsia have an increased risk, throughout their lives, of having chronic hypertension, cardiovascular disease, kidney disease and progressing to death earlier. Therefore, it is essential that all women who have pre-eclampsia If they had pre-eclampsia, they should undergo specialized prenatal care during their next pregnancy, as they are at risk. It is also desirable that they be monitored from then on by a clinician to control their blood pressure and modifiable factors to avoid cardiovascular disease. These factors involve weight control, the practice of physical activity and pressure control, when they become hypertensive postpartum", highlighted Maria Laura.
