The Concept of Preeclampsia

Preeclampsia is a condition characterized by hypertension, excessive quantity of protein in urine and swelling in legs and feet (Suhonen et al., 1993). Lewis et al. (2014) defined preeclampsia as a hypertensive condition of pregnancy diagnosed when a woman with no history of hypertension develops hypertension and proteinuria after 20 weeks of gestation. According to WHO (2011), it was found to be the major condition among the hypertensive disorders for its impact on maternal and neonatal health. It is one of the leading causes of maternal and perinatal mortality and morbidity worldwide. The rate of having preeclampsia has increased by 40% between 1990 and 1999, particularly in developed countries ((Shamsi et al., 2010). It affects multiple maternal organs including the liver, brain, and kidneys (Lewis et al., 2014) however, the etiology of preeclampsia is only partially understood.

The onset of hypertension during pregnancy (with persistent diastolic blood pressure >90 mm Hg) with the occurrence of substantial proteinuria (>0.3 g/24 h) can be used as criteria for identifying preeclampsia. Although pathophysiological changes (e.g. inadequate placentation) exist from very early stages of the pregnancy, hypertension and proteinuria usually become apparent in the second half of pregnancy and are present in 2%–8% of all pregnancies overall (WHO, 2011). Obese pregnant women (BMI >30kg/m²) experience a nearly three-fold increase in developing preeclampsia compared to women of normal weight (BMI 18.5-<25.0 kg/m2) (Lewis et al., 2014).

Preeclampsia is usually classified as mild or severe. Severe hypertension, heavy proteinuria substantial maternal organ dysfunction, early onset (before 32–34 weeks of pregnancy) of preeclampsia or fetal morbidity can be considered in the category of severe preeclampsia in many parts of the world. The progression from mild to severe can be rapid and unexpected, resulting in maternal deaths (WHO, 2011). Preeclampsia has many consequences including impaired fetal growth, premature birth, and death. It may also lead to eclampsia - the onset of seizures related only to a preeclampsia diagnosis (Lewis et al., 2014).

The author identified significant and independent relationship between preeclampsia and GDM. Diabetic pregnancies along with preeclampsia can become worsen due to adverse perinatal consequences (Crowther et al., 2005). Therefore, the National Collaborating Centre for Women’s and Children’s Health (NCCWCH) has presented the guidelines for routine prenatal care recommending that at the first visit, a woman’s level of risk for preeclampsia should be evaluated by identifying the series of maternal characteristics including maternal age, body mass index and previous and family history of preeclampsia, so that a plan for her prenatal visits can be formulated. This will allow intensive maternal and fetal monitoring, leading to an earlier diagnosis of preeclampsia with the potential for extenuating an adverse outcome (Akolekar et al., 2011).