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My dear sister-in-law gave birth to her third child through a planned c-section in the 28th week. This was followed by nerve-wracking weeks in the incubator, daily milk pumps and only hourly visits to the premature center of the maternity clinic, which was an hour from her place of residence. All this happened because the gestosis, also called preeclampsia, of my sister-in-law was recognized far too late.
In retrospect, she could certainly have done many things differently and, above all, be able to extend the important time that the child spent in the womb.
When my sister-in-law thinks back, she is sure that she already had an unrecognized gestosis with her first two children.
The second youngest child was born one month early, very small and a very fast birth. My sister-in-law was also accompanied by hypertension, water retention and extreme tiredness in these pregnancies.
Unfortunately, the diagnosis was missing.
Because I don't want that to happen to you I want explain what a gestosis / preeclampsia is about. So, that you can correctly interpret the symptoms and your gynecologist can specifically address it.
What are the symptoms, causes and how can you treat a gestosis?
My sister-in-law now gets her fourth child and is much better prepared for her pregnancy with the knowledge of her illness.
However, to be clear, even today there is no safe therapy for a gestosis other than the (premature) birth of the child, yet you can prevent and reduce the course by various means.
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Medical Disclaimer: I am not a doctor, a psychologist, nor do I have any other medical training that motivates me to make recommendations.
The content presented here is therefore for neutral information and general training only.
They do not constitute a recommendation or application of the diagnostic methods, treatments or medicines described or mentioned above. The text neither claims to be complete nor can it guarantee the topicality, correctness and balance of the information provided, even if I have spent a lot of time in the research and writing. Please always consult your doctor, if you experience any symptoms.
1 What is gestosis?
The often used term “pregnancy toxemia” is actually not correct, because the disease is not a real toxemia, a poisoning of the blood of the pregnant woman.
The more correct term “gestosis” is a generic term for similar illnesses during pregnancy and can also be called “expanded toxemia syndrome”
However, the term “pregnancy toxemia” has become naturalized and I use it synonymously with the correct term “gestosis”.
Gestosis means something like “disturbed pregnancy”. The collective term for this is called today “Hypertensive gestational diseases”.
In general the gestosis can be divided into early and late pregnancy toxemia.
- The early pregnancy toxemia refers to the disease in the first trimester.
- One speaks of a late pregnancy toxemia (“EPH-gestosis”), with symptoms in the third trimester.
- The second trimester is generally unaffected.
Other terms that you may have heard about pregnancy include pre-eclampsia, eclampsia, and the HELLP syndrome.
They all name different manifestations or symptoms of a gestosis, which I will discuss below.
Early Gestosis / Pregnancy Toxemia
The symptoms of early pregnancy toxemia usually occur in the second to fourth month of pregnancy.
The pregnant woman often experiences severe nausea and vomiting (hyperemesis gravidarum) even at night or on an empty stomach.
A decline is often expected only from the 14th week of pregnancy.
A normal progress of pregnancy with mild nausea or vomiting between the third and twelfth week is no cause for concern. However, if the vomiting does not stop and there is no relief, it can be a sign of an early gestosis.
A superimposed gestosis exists when symptoms of pre-eclampsia (see chapter “Pre-eclampsia”) were present before pregnancy (e.g. hypertension, water retention / edema) and are now more pronounced during pregnancy.
Pre-eclampsia is diagnosed when a third-trimester pregnant woman has high blood pressure, edema and protein in her urine. (see Symptoms)
Pre-eclampsia is the actual late gestosis and usually occurs after the 20th week of pregnancy.
It represents the strongest expression of the gestosis. When one speaks of pregnancy toxemia, it is usually meant pre-eclampsia.
This article therefore mainly treats pre-eclampsia, the late gestosis.
Eclampsia occurs in association with a (often untreated) pre-eclampsia.
Eclampsia are seizures that, if not treated promptly, can be fatal.
Symptoms of eclampsia can be:
- Strong headache
- Eyes flicker
- General malaise
An eclampsia is an emergency and must be treated immediately in the hospital!
In most cases, the pregnancy is then stopped by a cesarean section.
The abbreviation HELLP consists of the abbreviations of the main symptoms:
- H Hemolysis = blood breakdown
- EL Elevated liver enzymes = elevated liver values
- LP Low Platelet count = platelet count lower than 100,000 / ml
HELLP syndrome is not always but often associated with severe pre-eclampsia and results from a weakened liver function.
It can also occur suddenly and without previous symptoms.
In addition to the symptoms of pre-eclampsia sufferers usually complain of upper abdominal pain in the region of the liver (often radiating) sometimes accompanied by nausea, diarrhea and vomiting.
On the basis of the laboratory values (liver, platelet count) and the analysis of the fetus (small, changed cardiac activity) the HELLP syndrome can be diagnosed.
It is interesting that the HELLP syndrome can occur a few days after the birth of the child, whereas a pre-eclampsia usually cures shortly after the birth of the child.
The three main symptoms of pre-eclampsia are:
1) High Blood Pressure (more than 140 to 90 mmHg)
2) Protein Excretion via the urine (proteinuria)
3) Water retention (edema), thereby swelling of the face, hands and feet
In addition, the following additional side effects can occur:
- Visual issues (eye flicker)
- Hypereflexia (increased reflexes)
- Increased liver test values
Severe headaches and eye flicker can be an indication of eclampsia and must be clarified. High liver values indicate the HELLP syndrome.
3 Who is affected by gestosis?
Gestosis affects on average 3-7% of all pregnancies.
The exact reason for gestosis and why some women are affected and others are not, is still not fully understood.
The causes are therefore sought in the similarities of those affected (see Causes).
4 How dangerous is gestosis?
Of course I do not want to stir up fears here, but you just have to face the facts:
Gestosis can be a danger to the mother and child. In particular, pre-eclampsia must be treated and monitored as it can result in eclampsia.
These seizures usually end in death if left untreated. In fact, 20-25% of all birth deaths are due to pre-eclampsia.
However, according to the“Leitlinie: Diagnostik und Therapie hypertensiver Schwangerschaftserkrankungen”, 90% of these cases are preventable in Europe. And that is exactly the content of this blog post.
A bit off topic: If you know the series Downton Abbey, there the young Sybil dies at the birth of her child at a late recognized eclampsia.
It is reassuring to note that eclampsia is less common today, less than 1 in about 2,500 – 3,000 pregnancies.
Of course, as already mentioned, there are different degrees of severity of the gestosis. In any case, you should examine your symptoms closely and consolidate the gynecologist on suspicion.
With a light gestosis bed rest is often sufficient. With a severe pre-eclampsia, worse can often only be prevented by initiating childbirth.
As mentioned earlier, the exact causes are still unknown, but it turns out that women are more likely to be affected, bringing along a combination of some of the following characteristics:
- Pregnant for the first time
- Multiple pregnancy
- Already had a pre-eclampsia in a previous pregnancy
- Having relatives with pre-eclampsia
- To suffer from obesity
- To suffer from diabetes
- Having a high blood pressure or blood vessel disease before pregnancy
- To suffer from a blood coagulation disorder
- Under 17 years or over 35 years old
- Diseases of the kidneys and the vascular system
- To suffer from magnesium deficiency
It is now believed that the main symptoms of gestosis (edema, high blood pressure, protein in urine) are mainly due to an acute nutritional deficiency.
This can also be genetic, which explains the often present familial frequency of gestosis.
Science is making progress in root cause research, unfortunately the breakthrough is still missing.There are hypotheses in which a malfunctioning, abnomal placenta plays a crucial role. To say it very simple: Mother and fetus have a conflict of interest about nutrients and blood flow, which, among other things, results in a lack of nutrients.
6 How is the course of gestosis?
A gestosis can proceed very different in pregnant women. Which symptoms appear first is not always the same, and the timing of the first symptoms is also very different.
In the case of pre-eclampsia, the first symptoms may appear around the 20th week of pregnancy.
However, if you are disadvantaged (genetic, health), high blood pressure and headaches can already occur at the beginning of pregnancy.
A mild pre-eclampsia may also occur in the 34th week at the first time or later with only minor symptoms.
An occurrence AFTER the birth has already been reported. E.g. in this case the water retention may increase again after birth.
The earlier a pre-eclampsia occurs during pregnancy, the more severe is usually the course.
Pre-eclampsia generally worsens the health of pregnant women as pregnancy progresses and gradually affects the unborn child.
Severe pre-eclampsia can therefore lead to growth disorders in the child and almost always to premature births.
The unborn children are often under-supplied which often makes a planned termination of birth necessary.
A severe pre-eclampsia is a danger to mother and child. Therefore, after the diagnosis closely medical checks, usually in-patient stay, the mother (blood pressure, urine) and the child (Doppler ultrasound, CTG) are necessary.
In most cases, all the mother's complaints are cured after birth.
Further observations on one to two days after birth is still advisable. Likewise, an consultation and the mediation of auxiliary groups such as the “Arbeitsgemeinschaft Gestose-Betroffene e.V.” here in Germany.
7 How is gestosis treated?
If the suspicion of a gestosis is found, then, especially in pre-eclampsia, close monitoring of the blood pressure and urine of the pregnant woman is necessary.
If the blood pressure exceeds 150/100 mmHg, the pregnant woman is usually admitted to a hospital for further monitoring and treatment.
Almost always a pregnancy toxemia can be terminated by birth, usually initiated or by c-section. The symptoms of pre-eclampsia then disappear within hours or a few days.
In most cases, the doctor will administer antihypertensive medications. Unfortunately, this medication is often the only thing the patient gets.
In all diseases associated with high blood pressure, I think it is important to understand what the causes of hypertension are. In the case of gestosis this may be e.g. favored by the increased water retention.
Since overweight women are often affected, it is not uncommon for them to go into pregnancy with high blood pressure.
Therefore, the body must be considered holistically.
A pure symptom treatment can even have a negative effect on the care of the unborn child.
Since many gynecologists are often not very well versed in the disease, usually not all possibilities of treatment and especially prevention are exhausted.
Much too late is often reacted and usually more is monitored than treated. In many cases, the pregnancy is terminated early (caesarean section) and thus the disease is interrupted.
After birth, magnesium sulfate is used to prevent eclampsia.
Therefore, it is advisable to visit a gestosis expert in case of suspicion or diagnosis. For more see the chapter Preeclampsia Foundation.
The earlier a gestosis is detected, the more likely it is to influence the course and prevent it from developing more severely (see Prevention).
8 How can I prevent gestosis?
If you already know that you have an increased risk of pre-eclampsia because you already showed appropriate symptoms in your last pregnancy, then the most important thing is to take precautionary measures.
Recommended is a change in diet according to a special nutritional plan, which is designed for a sugar-free, salt-, protein- and nutrient-rich supply of pregnant women.
The earlier you start with it, the better the chance to postpone or generally weaken a pre-eclampsia (e.g. > 37th week of pregnancy).
Since it is suspected that affected women may not be able to absorb nutrients as well, it is advisable, as with “normal” pregnant women too, to pay attention to the increased need for various nutrients.
For the prevention of a gestosis, the following nutrients are particularly important:
- Vitamin D3 together with K2
- B vitamins (especially B12, B6)
- especially magnesium
If you already had a pregnancy toxemia in a previous pregnancy, it is recommended to start with a change in diet and the dietary supplements as soon as you plan to have your next child.
My sister-in-law, e.g. got a nutrition plan from the German “Gestose Frauen”. This is based on a lot of salt and protein by dairy products (for me as a vegan rather not so nice, but there are also vegetable protein) and lots of fruit and vegetables.
Why salt and protein are so important, you will learn in the next chapter.
Acetylsalicylic Acid (ASA, Aspirin)
Risk women also have the possibility of preventing pre-eclampsia with acetylsalicylic acid therapy. Therefore ASA is administered daily in small doses (75-150 mg / day).
Treatment must begin before the 16th week of gestation and can last until week 34 + 0. Current research recommends taking 150 mg of acetylsalicylic acid in the evening.
As research in this field is still quite young, there will certainly be further insights and adaptations of these recommendations in the next few years.
If you are affected, talk to your doctor. He can advise you.
Another way to reduce the development of the gestosis is the additional administration of heparin beginning in the 20th week of pregnancy.
Heparin must be prescribed by the specialist and can be given as a syringe.
Both ASA and heparin are blood-diluting. Heparin serves to prevent blood clotting. As a result of both drugs, the blood pressure drops and the clinical picture is weakened in most cases.
As far as we are aware, the three methods described (diet, ASA and heparin) are the only known measures to prevent pre-eclampsia.
Unfortunately, a drug that prevents 100% of severe gestosis is not known yet.
In any case, an affected pregnant woman should treat herself to a lot of rest. Above all, stress can have a negative effect on a pre-eclampsia. Many bed rest and relaxation is therefore advisable.
A diet with plenty of salt is rather unusual for a “normal” person and contradicts the usual recommendations.
That was also the reason why in the past a low-salt diet (even worse: along with rice diets) was recommended to pregnant and gestosis patients.
As we know today unfortunately exactly the wrong recommendation, as you can read here.
For the pregnancy and especially for the case of pregnancy toxemia, salt is even more important, because the body in this case often accumulates and stores a lot of water and has a generally higher nutrient consumption, since it has to serve two circuits.
It is important to know that salt binds water. This means that if more water is present in the body, more salt (and also protein) is bound, which is thus no longer available for the organism.
An increase in the supply of these substances is therefore necessary to continue to provide adequate care for mother and child.
The thing with the salt and the water you know certainly from the chemistry or biology class:
A) If there is more salt in the tissue than in the blood vessels, the water is bound and stored in the tissue = edema develops.
B) If there is more salt in the vessels, i.e. the bloodstream, the water is also drawn out of the tissue and released into the vessels = edema becomes less.
C) The kidneys divert the excess water to the outside via the urinary tract.
It is therefore no coincidence that women with gestosis often also have kidney problems and vascular diseases that disturb the salt-water balance and the removal of water.
Interestingly, protein deficiency is often the cause of water retention (edema) and increased water retention is the cause of lack of nutrients and minerals (and salt and protein).
The edema increases the elasticity of the vessel walls, which in turn leads to more protein leaving the body. A vicious circle.
As in the previous chapters, it becomes clear that it is important to look at the body holistically and not just to treat symptoms.
Incidentally, the basic protein requirement is 70 grams per day. 20-30 grams per child are additionally needed. A whole lot.
The additional need for salt in a gestosis is increased depending on the body weight. Here is an overview taken from hebamme4u.net:
- Women up to 75 kg take 4 – 6 grams of pure salt (without iodine and fluoride) and 2 – 4 grams of baking soda daily (roughly equivalent to a heaped teaspoon).
- Up to 85 kg daily 8 – 12 grams of pure salt and 4 – 8 grams of baking soda (equivalent to about two heaped teaspoons)
- From 85 kg daily, 12 – 18 grams of salt and 6 – 12 grams of baking soda (equivalent to about three heaped teaspoons).
It has been proven in a medical examination that even pregnant women without gestosis have an increased salt requirement and that the salt can lower the blood pressure during pregnancy.
If you can not make the above recommendations for salt intake with a pre-eclampsia of 1 to 2 teaspoons, you can also switch to salt tablets. These are easier to take. You should take tablets well distributed through the day and not all at once.
In any case, talk to your doctor about the additional intake of salt during pregnancy.
10 What are the consequences of gestosis?
The immediate consequences of (especially untreated / unrecognized) gestosis for the mother may include:
- High blood pressure
- Kidney and especially liver damage
- Disorders of blood clotting
- In extreme cases, liver failure
The immediate consequences for the child can be summarized as follows:
- Circulatory disorders of the placenta
- Less supply with less growth
- In extreme cases death of the child
Depending on the severity of the gestosis and the affected organs, it may lead to impairment or permanent damage to the organs.
However, it is partially unclear whether the impairment is the result of the gestosis, or whether it already existed before the disease that triggers the gestosis. The research is not far enough here.
It's a bit of a chicken-and-egg question.
In onlie forums women, some women still complain about water retention or pain even months after delivery. If you observe this with you, you should definitely consult a doctor.
There is a suspicion that affected women can not absorb certain nutrients as well as “normal” women, which can lead to the formation of a form of edema.
Therefore, you should check for certain nutrients such as magnesium, calcium, vitamin D and the B vitamins even after the gestosis.
Another long-term consequence is the increased risk of getting pregnancy toxemia again in the next pregnancy.
My sister-in-law found that pre-eclampsia was a bit more severe each time.
Even further, the daughters of gestosis women also have an increased risk of developing a pre-eclampsia. With this knowledge, the daughter of a gestosis mother can make an early test and start early with the prevention.
An important point at the end. In Germany there is the “Arbeitsgemeinschaft Gestose-Betroffene e.V.” also called “Gestose Frauen”, which dealt intensively with the topic of late gestosis (pre-eclampsia) and the HELLP syndrome. In the US there is something equal with the “Preeclampsia Foundation”.
I am sure you will find similar organisations in your country where you can address all your further questions.
If you have been diagnosed with pre-eclampsia, your second way, after going to the doctor, should be the call to an organization like the “Arbeitsgemeinschaft Gestose-Betroffene e.V.” .
Especially in prevention, the experienced staff can advise you well and suggest you a nutrition plan and possible treatments, which you can then tackle together with your doctor.
Also I can recommend you the forum of the “Gestose Frauen”.
There is a lively exchange of affected women who also like to help and advise you.
There is also a forum in the US for women who suffer from gestosis. But unfortunately this is locked since 2017. You can still read all posts, but commenting and creating new posts is not allowed any more.
Maybe there is a forum or an active group in the place where you live. Talking to women that made the same experiences can be really helpful.
If you've read all the way through, you'll know that the topic of gestosis is very complex. The treatment and therapy is unfortunately still in its infancy, despite numerous cases.
If you are affected, however, you can, in contrast to the women of the last centuries, already do a lot for prevention, which has turned out “recently”.
The most important thing in a gestosis is the early detection, the knowledge of the symptoms and the knowledge of the possible preventive measures.
Then nothing prevents a birth after the 37th week of pregnancy 😉
Because the goal is to push the birth back as far as possible to prolong the important time in the womb of the child.
I sincerely hope that I have been able to share some important facts about pregnancy toxemia and give you some new information to help you have a nice pregnancy.
If you liked this article, you may also like my article on the 3 only books that you must have read during pregnancy.
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