An Integrative Comprehensive Approach to Preeclampsia: Risk Factors and Preventative Lab Testing

Women who suffer from chronic hypertension during pregnancy can be at risk for a complex and potentially life-threatening condition called preeclampsia. Approximately 5% to 8% of pregnancies can develop preeclampsia in the second half of the gestational period. What's most concerning about this condition is that it can occur without warning and harm both the mother and the growing fetus. While science is still putting together the puzzle of what causes preeclampsia, some studies have shed some light as to what is the culprit in some women. This article dives deep into the specifics of preeclampsia, how it can be addressed from both standard medical care and integrative medicine, and the complementary modalities that can assist those at risk of preeclampsia. 

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What is Preeclampsia?

Preeclampsia is characterized by persistent elevated blood pressure that leads to organ dysfunction and potential fetal distress in pregnancy. This typically occurs after the 20-week mark of pregnancy and brings complications for both the mother and baby. While hypertension in pregnancy does not always result in preeclampsia, this complication of hypertension results in kidney and liver damage that leads to protein in the urine, swelling, blurred vision, and headaches in the mother. Preeclampsia also impacts the placenta, which provides nutrients and oxygen to the growing fetus. This can also lead to eclampsia which results in maternal seizures. Prevention of this and direct monitoring of preeclampsia are necessary to ensure healthy development and safe outcome for both mother and baby. 

What Causes Preeclampsia?

There is not a single defined cause of preeclampsia. Rather it's thought to be multifactorial dysfunction that impacts the formation, health, and function of the placenta. The factors that have been investigated include abnormal placenta development, genetics, immune system dysfunction, pre-existing medical conditions, environmental factors, and nutritional implications. 

Abnormal Placenta Development 

Anatomical size, shape, and vascular input have all been correlated to preeclampsia. The microvasculature to the placenta often times presents as diseased due to diabetes or hypertension, with hypoperfusion. There has also been evidence that the maternal blood vessel remodeling that is supposed to connect to the placenta does not properly occur. This can lead to underdeveloped placenta size, which impacts fetal size. Oblong-shaped placentas, rather than circular, have been seen in cases of preeclampsia.  

Genetics

Inherited predispositions can add to preeclampsia risk. Women who inherit genes that negatively impact blood pressure can have higher odds of hypertension during pregnancy. There are dozens of genes that are under investigation for hypertension, placental development, and maternal factors that make women more prone to developing preeclampsia. 

Immune System Dysfunction

Preeclampsia is also a result of an inflammatory process. The culprit is thought to be an immune system dysfunction that impedes the development of the placenta. Science has shown that this, in part, has to do with the improper functioning of Interleukin-10 (IL-10), which normally neutralizes proinflammatory cytokines. In the development of preeclampsia, the decrease in this interleukin leads to a decline in T-cell differentiation. T-cell differentiation is necessary for proper trophoblastic formation, which is the beginning stage of placenta development. 

Medical History

Your overall health leading up to conception can play a role in your pregnancy. A history of hypertension, diabetes, obesity, kidney disease or conditions involving the kidney, and previous pregnancies with preeclampsia are a few contributors to the potential development of preeclampsia. Monitoring, treating, and stabilizing these conditions before becoming pregnant is ideal to minimize your risk. 

Environmental and Lifestyle Factors

What you are exposed to in your daily life can affect many aspects of your health, including pregnancy. Increased exposure to air pollution, which causes inflammation, vascular impairments, and oxidative stress, can negatively affect the development and function of your placenta. Exposure to some heavy metals such as cadmium and lead has been associated with an increased risk of preeclampsia as well. 

Nutrition and Nutrient Depletion

Inflammatory diets low in nutrients can negatively affect your pregnancy. Having a low vitamin D, calcium, and magnesium status has been seen in cases of preeclampsia. Vitamin C and vitamin E deficiency have also been seen in women. Other vitamins provide antioxidative support to our cells. When deficient in these nutrients, there is more oxidative stress which can impact, in this case, profusion to the placenta. Selenium, B12, and folic acid deficiency have been investigated and found to be depleted in preeclampsia development. Overall, your micronutrient status can seemingly put you at a disadvantage, which, when appropriately supported, can potentially change your pregnancy trajectory. 

Preeclampsia Risk Factors

Numerous contributors put a pregnancy at a higher risk of developing preeclampsia. Some of the factors are lifestyle-related, while others, we don't have a solid understanding of why it's occurring. Making sure you are in good health before pregnancy is a key way to support a healthy pregnancy. If you are overweight, have pre-existing high blood pressure, or are managing kidney disease, you are automatically at a higher risk for developing preeclampsia. 

Other risk factors include a family history of preeclampsia, being pregnant with multiples, pregnancies over the age of 40 years old, and being of African American ethnicity. Having one or more of these risk factors does not guarantee that you'll develop preeclampsia, and having no risk factors does not mean you are in the clear of developing it. Being aware of your body and any oddly developing symptoms is the best way to catch the development of preeclampsia early on. 

Preeclampsia Symptoms  

During pregnancy, your body changes, sometimes rapidly. When changes become sudden, drastic, or abnormal, it can be an early warning sign for conditions such as preeclampsia. Common signs and symptoms of preeclampsia are:

• Hypertension
• Swelling
• Headaches
• Blurred vision
• Fatigue
• Nausea
• Vomiting
• Light sensitivity
• Pain in the abdomen
• Shortness of breath
• Easily bruising
• Urinating in small amounts
• Impaired kidney and liver function
• Pain located in the upper right quadrant of the abdomen 
• Sudden weight gain (2 to 5 lbs in a week)
• Protein present in your urine

The Role of Integrative Medicine in Preeclampsia

Taking an integrative medicine approach for preeclampsia can help women before and during pregnancy. The tenants of integrative medicine are the utilization of holistic philosophies and modalities and collaboration with Western medicine practices. It's a patient-centered approach that combines the care of both traditional medical doctors and complementary healthcare practitioners. Evidence-based natural interventions, physical medicine, and lifestyle interventions are a few of the ways in which integrative providers can help support you during your medical care. 

The Importance of Collaborative Care and Multidisciplinary Approach

In the case of preeclampsia, someone who is at risk or receives a diagnosis could consult with both their OB/GYN and an integrative medicine practitioner. The integrative approach could help address areas of nutrition, stress management, environmental exposure mitigation, sleep optimization, and other lifestyle medicine factors. Making sure you have your primary care physician in the loop on what you are incorporating is essential so they understand changes that are helping you or could be impacting your conditions. Integrative medicine providers such as acupuncturists, naturopathic doctors, or functional medicine practitioners are excellent resources for conditions such as hypertension, diabetes, and weight management, which could be a preeclampsia risk factor you are facing.

Functional Medicine Labs That Can Help Individualize Care for Patients at Risk for Preeclampsia

If you are at risk for preeclampsia or you were recently diagnosed, here are six functional medicine tests that could help investigate causative factors and provide guidance for treatment recommendations 

Pregnancy Panel

A comprehensive blood panel prior to the first trimester of pregnancy can provide a baseline of your health status. Access Medical Laboratories has an excellent option for pregnancy called the Obstetric Panel. This can provide information that would indicate disturbances associated with infection and imbalances in the immune system. 

Glucose Testing

If you are diabetic prior to pregnancy, getting an initial glucose testing done can help detect trends that may lead to preeclampsia. Controlling your diabetes during pregnancy can help deter your chances of progressing to preeclampsia.

T-Cell Immune System Testing

T-cell differentiation plays a role in the development of preeclampsia. When T-cells are not properly differentiating, that can lead to a decrease in IL-10, an anti-inflammatory cytokine. Finding clues by diving deeper into the immune system through T-Cell, B-Cell, and Natural Killer Cell Profile could provide insight prior to this occurring.

Environmental Toxins 

What you are exposed to in your environment can impact many areas of your health. From air pollution to groundwater, there are toxins bombarding us daily. Investigating your environmental toxic load may be beneficial, especially if you have known industrial or community-based exposures.

Heavy Metals

Lead and cadmium are two heavy metals you'll want to rule out as contributors to preeclampsia. A comprehensive option would be a toxic metal Hair Elements test by Doctor's Data. Hair analysis can be a great indicator of toxic elements because these metals can be 200 to 300 times present in hair compared to blood or urine.

Micronutrient Testing

Studies have found an association between micronutrient status and the development of preeclampsia. The key vitamins- vitamin C, vitamin D, vitamin E, magnesium, calcium, and iron all have an impact on the pathophysiology of preeclampsia and, therefore, should all be evaluated.

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Conventional Management of Preeclampsia

Western medicine treatment for preeclampsia depends on the severity of the case and how far along you are in pregnancy. The standard of care treatment is to deliver the baby if you are at least 37 weeks pregnant. In earlier stages of pregnancy, your doctor will most likely prescribe bed rest, run blood work and urine tests more often to monitor progression and perform more frequent ultrasounds and heart rate monitoring of the fetus. In severe conditions, medication to control your blood pressure and prevent or treat seizures will be prescribed. Unfortunately, delivery of your baby is the primary treatment, which poses a risk for prematurity. Your doctor weighs the risks based on your presentation and the health risks posed to you and your child. 

Integrative Approach to The Management of Preeclampsia 

Treatment from a holistic perspective is best done when an integrative approach is implemented. Women diagnosed with preeclampsia could greatly benefit from a collaboration of practitioners that are all working in the mother and unborn child's best interest. Here are evidence-based options to consider for a complementary medicine preeclampsia approach.

Nutritional and Dietary Considerations For The Management of Preeclampsia 

Eating well during pregnancy is key for both the mother and the growing baby. Making sure you are getting a balance of macronutrients- healthy fats, proteins, moderate consumption of carbohydrates, and plenty of fruits and vegetables will ensure that you're getting a broad spectrum of nutrients. Foods high in calcium, magnesium, and fatty acids have proven to be beneficial in managing blood pressure and preeclampsia. Focusing on foods rich in these nutrients, such as yogurt, dark leafy green spinach, and fatty fish, such as wild-caught salmon and nuts, can be supportive of your nutritional needs in pregnancy. 

Nutraceuticals For The Management of Preeclampsia 

Working with a skilled holistic practitioner that is well-versed in both pregnancy complications and the use of high-dose nutrient support is necessary when considering this route. While there are no evidence-based herbal medicines safe to use in pregnancy and preeclampsia, there are helpful herbs used to treat hypertension prior to pregnancy.

It's recommended to take a prenatal vitamin for pregnancy which contains the essential micronutrients to support the pregnancy. If additional support is needed for single nutrients, here are some suggested doses based on the information available:

Calcium: >1000mg per day starting before week 34 of pregnancy 

Vitamin D3: biweekly dosing of 50,000 IU or 200 IU daily from weeks 20 to 32 gestation. This should be taken with daily calcium to decrease preeclampsia risk

Selenium: 100 micrograms per day from week 24 until delivery

Lifestyle Modifications and Stress Management For The Management of Preeclampsia 

Implementing lifestyle modifications and techniques to manage stress can be a supportive tool in managing preeclampsia. While these complementary measures are not a cure for preeclampsia, they can help you process and adapt to the detrimental physical, mental, and emotional stressors of this condition. Here are some simple ways to support your health and well-being during pregnancy: rest as much as possible, practice breathing techniques, surround yourself with a support system of family and friends, get outside into nature, and engage in light exercise to support your blood pressure. 

Mind-Body Interventions For The Management of Preeclampsia 

Creating time and space to clear your mind and intentional thoughts regarding your pregnancy can be reassuring and create peace around the unfortunate circumstance of preeclampsia. Some women develop preeclampsia unexpectedly and without a known risk factor. Others may have a predisposing factor such as hypertension but are trying to manage it as best as possible. Regardless of the situation you may find yourself in, incorporating meditation is an excellent way to induce relaxation and calm your mind. Evidence also suggests that practicing meditation can relax the sympathetic nervous system, thus improving blood pressure. Yoga can also be a great addition to reducing hypertension in pregnancy. One randomized controlled trial (RCT) provided excellent insight. In this study, the 30 women in the test group incorporated one hour of yoga three times a week during weeks 12 to 28 of their pregnancy. The control group received standard pregnancy care and implemented walking. The results were impressive, with significantly fewer women experiencing hypertension, preeclampsia, gestational diabetes, or growth complications. This study suggests that weekly yoga can be a great adjunct to your health during pregnancy. 

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Summary

Preeclampsia continues to pose challenging risks to women's health during pregnancy. Managing care from early detection to incorporating collaborative patient care and comprehensive treatment plans can provide timely mitigation and support for the mother and fetus. When it comes to research, investigating all avenues that can lead to prevention, decrease the manifestation of severe preeclampsia, and best course interventions for care should be at the forefront. In integrative medicine, our hope is that we can help women control the controllable- their lifestyle, diet, environmental exposures, stress, etc., while also providing them with complementary medicine tools during a time of need.