Transcription:
Preeclampsia

Melanie Cole (Host): Welcome to Back To Health, your source for the latest in health, wellness, and medical care. Keeping you informed, so you can make informed healthcare choices for yourself and your whole family.

Back To Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. Georges Sylvestre. He's an assistant attending obstetrician-gynecologist at New York Presbyterian Hospital and an Assistant Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medical College Cornell University. And we're here today to talk about preeclampsia awareness.

Dr. Sylvestre, it's a pleasure to have you join us today. Tell us a little bit about preeclampsia for people that don't know what this is or we've heard this term before. What is that?

Dr Georges Sylvestre: Preeclampsia refers to elevation of blood pressure that usually happens towards the end of the pregnancy.

Melanie Cole (Host): So who does this happen to? Who is at risk for this scary complication? I remember a girlfriend of mine had that as well, and it's pretty scary, right? Is there a predictive test? Tell us who's at risk.

Dr Georges Sylvestre: Well, that's what's really interesting, Melanie. If you think about it, let's look at the risk factors for preeclampsia. First, baby is a risk factor for preeclampsia, twins and other multiple gestations, chronic hypertension, diabetes, obesity, and age above 35 just to name a few. If you think about it, Melanie, these risk factors have increased markedly in the last 20, 30 years, meaning a lot more women with risk factors for preeclampsia are pregnant now. So, this is why it's so important to be aware of that condition, because it's one of the major causes of severe maternal complications for people giving birth, not only in the United States, but across the world. It's one of the main three causes of mortality in childbirth and pregnancy.

In terms of predicting for eclampsia, unfortunately, it's been pretty disappointing. We don't have any very specific markers that can predict that preeclampsia is going to happen. That's why it remains a challenge.

Melanie Cole (Host): Wow. This is just so interesting. Now, when you said that it's been on the rise, are we linking or attributing or are there theories that since the obesity epidemic and diabetes has been on the increase and high blood pressure, all of these risk factors that contribute to so many things these days, is that what they're thinking is really causing it and contributing to it?

Dr Georges Sylvestre: Oh, definitely. Women, for many good reasons, are waiting to have their first child more and more. If you think about it in the days that we were born, probably the average age of a woman giving birth to her first child may have been 26. Now in places, especially like New York, the age is in the early to mid-30s to have a first child. So that's one thing.

Women don't have as many children as before, right? So because preeclampsia is a lot more common in first babies, there's a lot more women having first babies now than 30 years ago, if you look at all the pregnancies. And like you said, the rise of obesity across all the world has been contributing majorly. And another thing too is that women that previously were not -- I don't want to use the allowed -- but It was not adviced for them to get pregnant now get pregnant. So think of women were chronic hypertension. In the past, some of these women were told, "Don't get pregnant because you'll get preeclampsia and you could die from it." Now, more and more women can be controlled with medication, safe medications in pregnancy, with chronic hypertension, now attempt pregnancy because it's a very desired stage for a lot of people.

Melanie Cole (Host): So now that we know more about it, doctor, do we do things to hopefully stave it off? If we know that a woman has gestational diabetes or that she had diabetes before she got pregnant, or if we know that she has high blood pressure and it's being checked at her obstetrician visits, are those the kinds of things that we're looking for to hopefully keep a real close watch on it?

Dr Georges Sylvestre: Yeah, just two things that are super important in the management of preeclampsia in preventing and hopefully predict complications. One of the things that we've done and we've tried many medications to prevent preeclampsia and it has been very disappointing. We tried calcium, low salt diet, antihypertensives from the get go for women with normal blood pressure, tons of vitamins, nothing has really worked to prevent it except baby aspirin. A tiny dose of aspirin, very cheap, easy to obtain, can cut down the rate of preeclampsia by about 50%. So that's a huge impact in the world of women at risk for preeclampsia. So, yes, baby aspirin at a dose of 81 milligrams started early in pregnancy between 12 and 36 weeks can cut down the risk of severe preeclampsia, especially by 50%. So that's what we've achieved.

In terms of surveillance for preeclampsia, and we've noticed that in the pandemic, for women particularly at risk of preeclampsia, taking the blood pressure frequently, having home blood pressure monitoring for women when they can't make it to the doctor, especially if you think of the recent pandemic, we would give women blood pressure cuffs. So if preeclampsia were to happen, we will catch it on time because the earlier you recognize it, the less likely you are to have complications. So the last thing we want to do is a patient who has no prenatal care for weeks because of the pandemic or other reasons, and then she walks into your office at 34 weeks with blood pressure that's so severe that it causes stroke or she's at risk of severe complication in herself or her baby. So yes, surveillance is very important.

Melanie Cole (Host): Well, it certainly is. And if you know that a woman is at high risk at some point we've determined that, then what is the process for delivery? Is she considered then high risk and kept in the hospital? What do you do for a woman that now either you've determined has it or is at a high risk during delivery or even right after?

Dr Georges Sylvestre: That's an excellent question, Melanie. And the answer is it all depends on gestational age, how far along the pregnancy is. In other words, if a woman is at full term, 37 or 39 weeks, because it happens often then, the decision is easy. It's just to deliver the baby because, importantly, the treatment for preeclampsia is delivery. Delivery always treats preeclampsia. But sometimes as you can imagine, if preeclampsia happens at an earlier pregnancy stage, say at 28, 30 or 32 weeks, then the baby is still premature and there's still some benefit in keeping the pregnancy going. So when we have a preterm preeclampsia, we call it, we determine how stable or unstable the mother is. And if she is deemed stable with mild preeclampsia, very often we can keep the pregnancy going on the very close check. Sometimes the woman has to be hospitalized, sometimes we can watch it as an outpatient. But importantly, she'll be hooked up to a very, very close monitoring of her blood pressure, some lab work that indicates severe or non-severe preeclampsia and especially the baby's condition. If the baby is growing well, the hypertension is not so severe, then we can keep the pregnancy going until the safest stage.

Melanie Cole (Host): Is that when bed rest might happen?

Dr Georges Sylvestre: Bed rest does not work. It has been very disappointing, but the bed rest to prevent the severity of preeclampsia, to prevent severe complications or to lengthen the pregnancy has not been working. So there's no indications for bed rest in case of preeclampsia.

Melanie Cole (Host): We used to do that, right? That's what they used to think.

Dr Georges Sylvestre: Oh, we used to do that left and right for prevention of preeclampsia, of premature labor, of miscarriage. It all didn't work in any of these cases.

Melanie Cole (Host): Well, that's really good to know because women sometimes think, "Okay, I'm just going to go on bed rest." Now, if she's had preeclampsia in a previous pregnancy, is she then considered high risk for future pregnancies and watched very closely?

Dr Georges Sylvestre: Oh, yeah, her risk of preeclampsia has probably increased by two to three fold. But because she's been identified high risk, like we discussed before, she'll most likely we'll have been placed on baby aspirin and probably have more frequent checkups with the doctor to monitor the blood pressure so that if preeclampsia happens again, we can intervene quickly.

Melanie Cole (Host): Final thoughts, Dr. Sylvestre, I'd love for you to tell women listening that are concerned about this, what you would like them to know about services that you offer at Weill Cornell Medicine and preeclampsia, what you really want them to know.

Dr Georges Sylvestre: If you have pre-existing conditions such as chronic hypertension or diabetes, for instance, it's important that you check up with your doctor before you even try to attempt pregnancy, because sometimes we can fine tune the diabetes or hypertension in a way that makes a woman less at risk of having preeclampsia in a future pregnancy. So that's one thing.

We offer high-risk prenatal care services, so important that you seek the care of a physician who is very comfortable and familiar with preeclampsia and with women at risk for preeclampsia, so that we can intervene early, for you to enjoy safe pregnancy and a healthy baby.

Melanie Cole (Host): And healthy baby, that is what it's about. Thank you so much, doctor. You're just such a wealth of information and a great guest. Thank you again. And Weill Cornell Medicine continues to see our patients in person as well as through video and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back To Health. We'd like to invite our audience to download subscribe, rate, and review Back To Health on Apple Podcasts, Spotify, and Google Podcasts. And for more health tips, please visit weillcornell.org and search podcasts. And parents, don't forget to check out our Kids' Health Cast. Lots of great podcasts there. I'm Melanie Cole.

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