Featured articles edition 7
Pre-eclampsia is a condition that affects some pregnant women, most commonly in the second half of pregnancy (usually after 20 weeks) or sometimes immediately after the birth of the baby.
It is a potentially dangerous complication of pregnancy which includes the development of high blood pressure, protein in the urine and fluid retention (oedema).
Pre-eclampsia is thought to occur when there is a problem with the placenta (the organ which supplies oxygen and nutrients to the growing baby), although the exact cause is still unknown. We do know however, that women with certain health conditions such as diabetes or high blood pressure, prior to or in early pregnancy, are more likely to develop pre-eclampsia.
Signs and symptoms
The early signs of pre-eclampsia include high blood pressure and protein in the urine. At this stage, many women still feel well, and may not realise they are developing pre-eclampsia. During pregnancy, your pregnancy team will keep a close eye on blood pressure and regularly check the urine for signs of protein. They will also look for signs of swelling at each visit in the later stages of pregnancy.
While some fluid retention may occur in pregnancy, if swelling of the feet, ankles, face and hands occurs suddenly, this could be a sign of pre-eclampsia.
As pre-eclampsia progresses, it may also cause severe headaches, vision changes (such as flashing lights), dizziness, shortness of breath, abdominal pain (just below the ribs), nausea and vomiting. While these symptoms may have other causes, they should never be ignored during pregnancy. Pre-eclampsia can worsen very quickly, so these symptoms need immediate medical attention.
Risks to mother and baby
Pre-eclampsia can cause health problems in both mother and baby. In the mother, it can result in high blood pressure, as well as liver and kidney problems. Occasionally, pre-eclampsia can lead to convulsions (fits), a serious complication known as eclampsia. Women who have had pre-eclampsia are at increased risk of high blood pressure and heart disease later in life.
Pre-eclampsia can cause problems for the baby’s growth due to poor blood supply through the placenta to the baby. This is a common cause of premature birth, which itself increases the risk of complications for the baby.
Women who have a higher risk of developing pre-eclampsia may be advised by their pregnancy specialists to take low-dose aspirin from early pregnancy to reduce the risk. In women with diabetes, well managed blood glucose levels before and throughout pregnancy can also reduce the risk of pre-eclampsia, but not fully prevent it.
In some hospitals screening tests in early pregnancy to predict pre-eclampsia are now being offered to pregnant women. Find out more.
Mild pre-eclampsia may be treated with medication to lower blood pressure and manage symptoms. Women with pre-eclampsia will be monitored closely through the rest of the pregnancy and in the week or so following delivery. Some women may need to be admitted to hospital for monitoring. Early delivery of the baby may be required.
While pre-eclampsia occurs more often in first pregnancies, there is a risk of developing it again in a future pregnancy. The risk of pre-eclampsia is higher in women with diabetes, or other medical conditions, such as high blood pressure or kidney disease.
Regular antenatal check-ups will help with early detection and monitoring of pre-eclampsia. Talk to your doctor, diabetes in pregnancy specialists or obstetrician for more information.
A survey of Australian women with diabetes has looked at the factors associated with attending pre-pregnancy care and reasons why women don’t attend. The study, just published in the journal Diabetes Research and Clinical Practice surveyed more than 400 women with type 1 or type 2 diabetes.
Women were more likely to attend diabetes specific pre-pregnancy care if they had type 1 diabetes, were university educated, married or employed. Of those who didn’t attend for pre-pregnancy care, the main reasons for not attending included not knowing that pre-pregnancy care was available (48%), pregnancy not being planned (47%) and already knowing what to do to prepare for pregnancy (20%).
Most women indicated a willingness to attend pre-pregnancy care if available, although less than half were aware of what was available to them locally.
The authors concluded that more needed to be done to encourage all women with diabetes to plan and prepare for pregnancy, promote the availability of pre-pregnancy care to women with diabetes and increase awareness about the risks of unplanned pregnancy.
Diabetes Australia is seeking expression of interest from women with diabetes to provide input into a checklist of ‘what to pack for hospital when you are having a baby’ for the NDSS pregnancy and diabetes e-newsletter. Participants* who assist will receive a $25 gift voucher as a token of appreciation. Email - Mel Morrison for more information.
*Note that a limited number of consumers are being sought to complete this review, so not everyone who contacts us may be able to participate. Participants will be sent a $25 Coles or Woolworths shopping voucher as a token of appreciation once feedback has been received.
Insulin pump therapy is becoming increasingly popular with women with type 1 diabetes.
Insulin pumps can be used safely and successfully during pregnancy. Some women find that using a pump makes it easier to achieve blood glucose levels in the target range.
Insulin pumps offer the advantage of being able to make very small insulin dose adjustments which can help you with managing your blood glucose levels during pregnancy. This may be particularly useful as your pregnancy progresses, with changing hormone levels and changes to your insulin requirements.
One of the risks of an insulin pump during pregnancy is that if any problems occur that disrupt the delivery of insulin, high blood glucose levels can result very quickly. This can increase the risk of diabetic ketoacidosis which can be very dangerous during pregnancy. Frequent blood glucose monitoring and identifying any problems quickly can reduce these risks.
Insulin pumps can be expensive. Private health insurance may cover the cost of the pump, but this depends on your health fund and level of cover. There also may be a waiting period if you are a new fund member or upgrading your policy. Insulin pump consumables are available through the NDSS and usually cost about $30 a month.
Some women choose to start on an insulin pump in the lead-up to pregnancy, however many other women choose to continue with insulin injections and are still able to manage their diabetes successfully throughout pregnancy. Talk to your diabetes health professionals for more information and to discuss the best options for your individual needs.