Preeclampsia usually occurs in the last trimester of pregnancy and usually resolves after delivery. But preeclampsia can also develop after a baby is born, whether a woman experienced high blood pressure during her pregnancy or not.
Diagnosed: Week 38
Courtney, a mother of two who lives in Northern California, experienced preeclampsia both pre- and post-delivery. Her first son was born about two weeks early due to preeclampsia. Then Courtney developed preeclampsia a few days after he was born. Both experiences served as lessons about the importance of self-advocacy before and after delivery.
“No one mentioned postpartum preeclampsia,” Courtney says. “Maybe it's because my blood pressure went back to normal after delivery. My labs were perfect. But I’ve learned the more you can listen to your body and listen to yourself to advocate for yourself, the better.”
Preeclampsia and related hypertensive disorders of pregnancy impact 13% of all births in the United States, and the incidence of them is rising. These disorders are among the leading causes of maternal mortality, and they are also independent risk factors for future cardiovascular disease. The rate of preeclampsia in the United States has increased 25% in the last two decades. While most women with preeclampsia deliver healthy babies and fully recover, more severe complications can occur.
Caught off guard
Courtney’s experience with preeclampsia started late in her pregnancy. “The pregnancy was going great,” she says. “I was super active. I was working out a few times a week. Every doctor's appointment was like three minutes long cause I didn't really have any questions. And the heartbeat was fine.”
At a routine appointment when Courtney was 38 weeks pregnant, her doctor raised concern about her elevated blood pressure but acknowledged it can be common as a woman gets closer to delivery. With no other signs or symptoms of preeclampsia at the time, Courtney went on her way, not thinking much of it.
However, over the next two days, Courtney didn’t feel well. Her stomach was upset. She developed a headache, a symptom of preeclampsia, and couldn’t sleep. She got ready to attend a friend’s baby shower, and she felt so unwell, she didn’t go. Later that afternoon, she called her doctor, who told her to come in for a well check. Her blood pressure had risen even more and she still had a headache. The doctor told Courtney she was going to be induced into labor. About 36 hours later, she delivered her son.
Four days later, after Courtney had gone home, she started to feel unwell like she did right before she was induced. Not knowing she was at risk of postpartum preeclampsia, Courtney wasn’t sure how to interpret her symptoms.
“When I wasn’t feeling well like I did before, I wasn’t sure what it was,” she says. “Can this happen again? I didn’t know.”
Contrary to common perception, delivery is not the cure for preeclampsia, although it can be a necessary intervention. A woman is at risk for preeclampsia up to six weeks after delivery, although it’s more likely to occur within the first seven days of delivery. Warning signs include stomach pain, nausea, severe headaches, swelling in the hands and face, vision changes and blood pressure at or exceeding 140/90. Postpartum preeclampsia can lead to seizures, stroke, organ damage, and death.
Courtney ended up back in the hospital, was given magnesium and blood pressure medication and underwent lab tests to check for indicators of other complications. After a couple of days, she was able to go home again.
“I definitely felt very caught off guard and it did take me a while to recover. not physically, but mentally reliving a lot of the trauma and the worry,” she remembers.
Improving education about preeclampsia
Courtney’s experiences are reflected in Mirvie’s Future of Pregnancy Health Report, based on a survey of more than 1,000 new and expecting moms. The report revealed education about preeclampsia is not what it should be.
“It’s critical to have a conversation with your doctor or midwife about preeclampsia,” says Dr. Alison Cowan, head of medical affairs for Mirvie. “Every woman should discuss preeclampsia and high blood pressure during pregnancy with their provider. Based on your unique health situation, there might be specific recommendations that they will have for you to reduce your risk. Some women will be told to take a baby aspirin daily depending on their individual risk in pregnancy. And there is some evidence that exercise can reduce the risk of preeclampsia.”
Since her experiences with preeclampsia, Courtney has had another son. Her second delivery was markedly different from her first. Courtney attributes that to becoming better informed about how to prevent preeclampsia. During her second pregnancy, she took baby aspirin and monitored her blood pressure regularly.
“I felt more empowered during my second pregnancy and actually started paying attention to my stats,” she says. “I was very aware at every appointment what my blood pressure was.”
Experience with pregnancy complications like preeclampsia can lead to greater awareness. But what if the risk for pregnancy complications could be detected before they even occur? That’s the promise of the Mirvie RNA platform’s ability to understand the underlying biology of each unique pregnancy. Using a simple blood test, the platform can predict pregnancy complications months before symptoms occur, giving moms and doctors time to prepare and intervene before complications like preeclampsia become a crisis.
One of Mirvie’s founders had a premature baby delivered due to preeclampsia, which makes our mission personal. If we can better predict preeclampsia and other complications for the individual, then moms, doctors and midwives can get the tools they need to personalize their care and prevent preeclampsia from occurring. With more women than ever before experiencing high blood pressure in pregnancy, the need for accurate prediction is urgent.