You’ve Been Diagnosed with Preeclampsia: Now What?

Q&A with Dr. Emma Rodriguez, maternal fetal medicine specialist

Preeclampsia is a serious health problem for pregnant women around the world. It is one of the more common pregnancy complications, affecting about 5 to 8 percent of pregnant women in the U.S. It is also the leading cause of premature birth, contributing to 15 percent of all premature deliveries in the U.S.

The disease is sometimes referred to as a silent killer because most pregnant women can’t “feel” their blood pressure going up. As a result, patient awareness of the early warning signs is one of the most important tools around to successfully help pregnant women receive the immediate care they need.

So, what exactly is preeclampsia, and how can it be managed effectively? We recently sat down with Dr. Emma Rodriguez to talk about preeclampsia and what women need to know.

Dr. Emma Rodriguez is a maternal fetal medicine specialist with The Children’s Hospital of San Antonio. She helps her patients manage high-risk pregnancies when they develop conditions like preeclampsia.

What is preeclampsia? What symptoms should I be looking out for?
Preeclampsia is a serious medical condition characterized by high blood pressure that can happen after the 20^th week of pregnancy or after giving birth (called postpartum preeclampsia). Symptoms include high blood pressure, protein in urine, swelling, headaches and blurred vision. This condition needs to be treated by a health-care provider. If left untreated, preeclampsia can endanger the health of the mom and her unborn baby. In the most severe cases, preeclampsia can cause organ failure and even death.

How is preeclampsia diagnosed?
Preeclampsia is diagnosed by measuring a woman’s blood pressure and conducting routine urine tests during prenatal visits. The purpose of the urine test is to see if there is protein in the urine, which can indicate a kidney problem. If the blood pressure reading is high (more than 140/90), especially after the 20^th week of pregnancy, and there is protein in the urine, a diagnosis of preeclampsia is made. To determine the severity of the diagnosis, more extensive lab tests may be ordered, including blood tests to evaluate the level of platelets in the blood and to test for abnormally high levels of serum creatinine and liver enzymes in the blood that may suggest impaired kidney and liver function.

Pulmonary edema (excess fluid in the lungs) is another symptom of severe preeclampsia that may present as shortness of breath.

What is the typical medication/treatment for a pregnant woman with preeclampsia?
Treatment during pregnancy will depend on the severity of a patient’s high blood pressure and the health of her and her unborn baby. In general, prenatal care may include frequent prenatal visits, close monitoring of blood pressure, adjustments to blood pressure medications as needed, and regular maternal blood testing to check for signs of the condition worsening. In mild cases, patients are monitored more closely as previously mentioned.  In severe cases of preeclampsia, treatment may include giving anticonvulsant medications to prevent seizures, corticosteroids to speed up the baby’s lung development and early delivery may be indicated.

What are some common risk factors associated with preeclampsia?
There are certain risk factors that predispose a woman to develop preeclampsia. First, if you had it before with another pregnancy, the likelihood of you developing it again is greater. Also, if you have chronic (pre-existing) hypertension, are pregnant with more than one baby, or have underlying health conditions like type 1 or type 2 diabetes, kidney disease or certain autoimmune diseases, you may be at higher-than-average risk for preeclampsia during pregnancy. Other risk factors include being African American, having a family history of preeclampsia, or having a body mass index (BMI) of 30 or higher.

How can you prevent and/or reduce your risk of developing this condition?
As with most pregnancy-related complications, the best way to prevent preeclampsia is to keep up on all your prenatal appointments, and let your doctor know if you are experiencing any unusual symptoms that need attention. Other ways to decrease your preeclampsia risk is to eat healthy, exercise, and maintain a healthy weight. That means staying away from sugary and processed foods and eating more nutrient dense foods including high-fiber fruits and vegetables, lean proteins, whole grains and dairy. Also, incorporating exercise into your daily routine, like taking a 30-minute walk during the day, will also help. You should consult your doctor about how much exercise you should be getting. For high-risk women, taking a low-dose aspirin (81 mg) daily after 12 weeks of pregnancy may reduce their risk of preeclampsia. Before taking any medications during your pregnancy, check with your doctor first.

What causes preeclampsia?
No one knows for sure what causes preeclampsia, although experts believe it begins in the placenta as your body amps up your blood production to support your growing baby. A decreased blood supply to the placenta in some women may lead to preeclampsia. The genetic makeup of a fetus could predispose a pregnancy to preeclampsia. Because a family history also increases the risk, your own genetics may play a role as well. 

How can you manage preeclampsia during pregnancy?
If a woman has been diagnosed with preeclampsia, it is important for them to get plenty of rest and to take prescribed medications to manage their blood pressure. It’s also important to go to regular prenatal visits for close blood pressure monitoring and weekly labs to make sure the preeclampsia hasn’t gotten any worse. Frequent ultrasounds to monitor amniotic fluid and baby’s growth are also very important. Slow fetal growth is often associated with preeclampsia.  

How does preeclampsia affect pregnancy and the baby?
Preeclampsia is one of the most common causes of premature births. Unmanaged preeclampsia can prevent a developing fetus from getting enough blood and oxygen and damage a mother’s liver and kidneys. In rare cases, untreated preeclampsia can progress to eclampsia, a much more serious condition involving seizures, or HELLP syndrome, another serious condition that can lead to liver damage and other complications. Additionally, if the condition is not monitored closely and treated promptly, it can also cause the placenta to suddenly separate from the uterus (called placental abruption), which can lead to serious pregnancy complications and death.

If you have preeclampsia, can you carry your baby to full term?
It depends. Your doctor will determine when to deliver based on how far along your baby is, how well your baby is doing in your womb, and the severity of your preeclampsia. If your baby has developed well and preeclampsia is mild, delivery at 37 weeks is recommended.  In severe cases of preeclampsia, or if there is evidence of worsening disease, preterm delivery may be indicated. Your doctor may want to induce labor or do a cesarean section to keep preeclampsia from getting worse. The only cure for preeclampsia is to give birth.

Do preeclampsia symptoms go away after your baby is born?
The symptoms of preeclampsia usually go away within six weeks after delivery. In some women, the symptoms stop almost immediately after birth. However, in others, high blood pressure sometimes gets worse the first few days after delivery. Even if you were not diagnosed with preeclampsia before delivery, you are still at risk for preeclampsia for up to six weeks after delivery.

In a previous blog, expectant mom Vanessa shared her experience with preeclampsia that led to the premature birth of her daughter Luna.

Xochitl Scott developed preeclampsia during her pregnancy. She and her husband leaned on their faith and the expertise of doctors at The Children’s Hospital of San Antonio. Xochitl shared her story with us in January 2022.

If you have received a diagnosis of preeclampsia and would like to make an appointment with one of our high-risk pregnancy experts, please visit: Center for Maternal and Fetal Care.

Defying Medicine. Defining Hope.

Xochitl and Brian Scott were looking forward to adding to their growing family. The couple had children from previous relationships but not one together, so they were overjoyed when they learned Xochitl was pregnant.

“I had done everything under the moon and stars to get pregnant. It was so surreal for me that it was really happening,” remembers Xochitl.

Because she had experienced two previous miscarriages, Xochitl was understandably nervous during her first trimester. As a paramedic, she found herself overly anxious because she had witnessed countless times how quickly life could change.

“I was just so worried and prayed a lot and I cried over everything,” said Xochitl. “I even cried over a bag of Doritos. And, my cravings were crazy. I had to have Texas BBQ which was not something I was a fan of before at all.”

To help keep things in check, her doctors put Xochitl on a weekly dose of progesterone, which seemed to work until Xochitl began experiencing excruciating abdominal pains one day. The progesterone pills affected her kidneys so that her blood was not being filtered. Her body had become toxic.

She was about 17 weeks along at this point and was worried that if she continued taking the progesterone pills, she would lose her baby. Xochitl and Brian hoped and prayed for the best. Their prayers were answered as things progressed, and the fear of miscarriage slowly dissipated.

The couple’s dream of having a child together began to take more shape until they hit another bump in the road. Xochitl learned she had both gestational diabetes and was high blood pressure.

Wondering how these two conditions might affect her pregnancy, Xochitl had an ultrasound when she was about 20 weeks along. After having her test done, she left, and within 30 minutes, her doctor called and asked her to come back to the office.

Xochitl worked as a paramedic up until the 30th week of her pregnancy. She was ordered to go on bed rest due to complications from high blood pressure.

“My heart stopped. I was terrified. I thought they were going to tell me that I had lost my baby or that they couldn’t find the baby’s heartbeat,” said Xochitl.

It turned out to be none of those things. Instead, Xochitl and Brian’s baby had a condition known as omphalocele, a congenital disability of the abdominal wall. It’s when an infant’s intestines, liver, or other organs protrude outside of the belly through the belly button. Xochitl immediately began questioning whether she had done something to cause this.

“The paramedic in me came out. I’m supposed to make everything okay; my job is to make everyone feel better. I felt like I had failed,” said Xochitl.

She was referred to Dr. Theresa Stewart, a high-risk OB at the Center for Maternal and Fetal Care – New Braunfels, which is part of The Children’s Hospital of San Antonio.  

“She was such an amazing person and made sure that I did everything I was supposed to do,” said Xochitl. “She was on top of everything and made me feel so wonderful and gave me lots of hope. The whole staff are so dear to my heart from the desk office to the ladies that would to the sonogram. They became like a family to me.”

Xochitl’s diagnosis of gestational diabetes and hypertension, in addition to the baby’s condition, was just too much to bear. So much was happening that they did not find out until the second ultrasound if they were having a boy or a girl.

“At that point, I didn’t care if the baby was a boy or a girl,” said Xochitl. “I just wanted the baby to be as healthy as possible.”

As it turns out, Xochitl was pregnant with a little girl they would name Lilly.

Dr. Stewart told Xochitl that she would need to arrange to deliver at a children’s hospital because of baby Lilly’s omphalocele. Xochitl knew exactly where they wanted to go: The Children’s Hospital of San Antonio (CHofSA.) Soon after birth, Lilly would need multiple surgeries to correct the omphalocele and access to a neonatal intensive care unit (NICU).

Xochitl and Brian were excited to welcome a new baby into their family. Xochitl experienced several setbacks to her own health during her pregnancy and also learned the baby would need surgery soon after delivery.

During her third trimester, Xochitl began going to specialists weekly to have her blood sugar levels checked. One day at work, when she was about 30 weeks along, Xochitl didn’t feel right and thought it would be wise to take her blood pressure. It was sky high. The next thing she remembers, doctors and nurses were swarming around her, and transported her to the hospital.

Dr. Stewart determined Xochitl had preeclampsia, a condition in pregnant women marked by high blood pressure that can damage the liver and kidneys.

Despite everything swirling around them, Xochitl and Brian remained strong in their faith and counted their blessings.

“We tried to focus on the positive and surrounded ourselves with our other children,” said Brian. “They brought us lots of laughter and a ton of love. That helped.”

The diagnosis of preeclampsia called for strict orders for Xochitl to go on bed rest, which proved to be quite challenging for the active mom, but she knew what she had to do for Lilly. She and Brian took a short vacation, and she also stopped working – all steps to ensure Lilly had the best possible outcome. That was the middle of August.

On September 15, Xochitl had what she thought would be a regular appointment with a specialist, but she was experiencing painful contractions and was bleeding. At 37 weeks, Xochitl was going into labor, which she was unprepared for, and began panicking.

“I kept thinking this is way too early for her – she hasn’t fully developed yet. I knew she needed to be in the womb as long as possible to help her recuperate from her surgery and only have minimal complications. I wasn’t ready,” said Xochitl.

Ready or not, though, baby Lilly was coming. Xochitl was prepped for a C-section that same day, and Lilly made her arrival into the world.  

At just 1-day-old, Lilly underwent surgery to correct a condition known as omphalocele that caused her organs to protrude through her umbilical cord.

In addition to the omphalocele, Lilly was born with a few other complications. Her left arm did not fully grow and was underdeveloped, and she didn’t have a pinkie or thumb. One side of her mouth drooped because a tendon was missing.

It felt like an eternity between the time Xochitl gave birth to when she got to see Lilly. And when she did get to see her finally, Xochitl was heartbroken. Watching her newborn with a central line and IVs was difficult to see.

Because Lilly’s lungs were in good condition and her stomach was intact, the doctors at CHofSA were planning to do surgery on September 16 – the day after she was born.

“I was happy because my baby was born. At the same time, I was nervous about what was happening with my baby and feeling scared, too,” recalls Xochitl.

Dr. Katherine Barness, who serves as Chief of Surgery at CHofSA, did the surgery and afterward shared the amazing news with Xochitl and Brian: Lilly’s surgery was successful – so successful that she would only need one surgery instead of multiple ones to correct the omphalocele. At the beginning of their journey, Xochitl and Brian were told that there was only about a 5% chance of this happening.

From there, Lilly made an amazing recovery. Soon after her surgery, Lilly started eating – something entirely unexpected. Her heart looked good, her oxygen levels were up, and she rapidly began to gain weight. When they first started on their journey, Xochitl and Brian were prepared for Lilly to spend two and a half months in the NICU, but as it turned out, she was only there for two weeks.

“We weren’t quite prepared to go home so soon. Sometimes babies with omphalocele require special equipment designed just for them like cribs, chairs, and car seats,” said Brian. “She ended up not needing any of it.”

In Xochitl’s mind, Lilly defied medicine and defines hope.

Today, Lilly is doing well and is showered with love and attention by her siblings. She eats regularly, likes to swing, and loves cuddle time. Xochitl is so grateful to her friends and family who provided tremendous support during her journey.

Baby Lilly is thriving after her surgery and enjoys getting lots of attention from her older siblings.

“Lilly is hope, Hope that miracles can happen. She inspires us and shows us that the impossible can be conquered. I stare at her and realize we are so blessed. We are thankful and so grateful to all the NICU nurses that took care of Lilly, especially Dr. Katherine Barness and Dr. Maria Pierce,” said Xochitl. “We would have been lost without their kindness, care, support, and wonderful sense of humor. I wish I could take what I have in my heart and physically show how thankful we are. I don’t think words can express what we feel. They have made a difference and changed more than one life. Thank you for giving us our miracle and for giving my family our Lilly,” she said.

To learn more about the NICU at The Children’s Hospital of San Antonio, please visit our webpage: https://www.christushealth.org/childrens/services-treatments/nicu