Recent research brings good news about preeclampsia, a condition in pregnancy that affects up to a third of moms of multiples. Researchers have identified two proteins produced by the placenta that may be repsonsible for the development of the condition. Because of this discovery, doctors will be better able to predict and perhaps treat the disorder. In 2003, researchers at Boston's Beth Israel Deaconess Medical Center used gene expression profiling to identify the genes in placental cells of pregnant women that produce a high level of protein. A concentration of these proteins narrow blood vessels, raising the mother's blood pressure and impairing the delivery of blood and nutrients to the placenta.
What does this mean for moms of multiples?
Identifying the gene meant that doctors will be better able to rapidly diagnose the condition and develop effective therapy to prevent it. In the past, diagnosis relied on inconclusive symptoms; by the time the symptoms were exhibited, the blood flow to the placenta may already have been reduced by up to 50%.
What is preeclampsia?
Mothers who are pregnant with multiples are at extremely high risk for preeclampsia, also known as Toxemia or Pregnancy Induced Hypertension (PIH). While it is estimated that between 5 and 10% of singleton pregnancies are effected by the condition, one in every three mothers of multiples will exhibit symptoms during her pregnancy.
What are the symptoms?
Symptoms usually develop after the twentieth week of pregnancy and are typically detected during a routine checkup. They include water retention, puffiness in the hands or feet, elevated blood pressure, protein in the urine or a weekly weight gain of more than 2 pounds. More severe symptoms include: agitation or confusion, changes in the mother's mental state, nausea or vomiting, headaches, fatigue, abdominal pain, or shortness of breath. Contact your doctor or caretaker immediately if you experience these symptoms during your pregnancy with twins, triplets or more.
What is the treatment?
Ultimately, the only way to "cure" preeclampsia is to deliver the babies. Doctors have to weigh the impact on the mother's health against the condition of the twins, triplets or multiples. In some cases, the condition can be controlled by moderating the mother's behavior: increasing her water intake, reducing her salt intake, or instituting a routine of bed rest while lying on her left side to limit pressure on major blood vessels. Her caretakers will also likely require more frequent office visits in order to monitor her blood pressure and urine protein levels.
In more severe cases, hospitalization may be required to ensure complete bed rest. Medications such as magnesium sulfate or hydralazine may be administered, although the side effects of these drugs can cause further medical issues. In the most severe cases, labor will be induced or a c-section will be performed.
What are the health effects on the mother?
Once the babies are delivered, the symptoms should subside and the mother's health would no longer be at risk. However, women are at risk for developing eclampsia up to six weeks after delivery of their babies; their doctors will continue to monitor their blood pressure during that postpartum period. If left unchecked, preeclampsia can damage the mother's kidneys, liver and brain. Preeclampsia is responsible for sixteen percent of pregnancy-related deaths in the United States each year; untreated preeclampsia develops into eclampsia, the second leading cause of maternal death in the United States.
What is the impact on the babies?
Because the "cure" for preeclampsia is delivery of the babies, they are at an increased risk for premature birth. While the impact of prematurity presents a variety of complications, remaining in utero presents its own set of risks. When blood flow to the placenta is restricted, the fetuses receive reduced oxygen and nutrients. This may produced babies with IUGR (Intrauterine Growth Retardation), low-birth weights or even stillbirths.
What can moms of multiples do to prevent complications from preeclampsia?
Frequent checkups with your physician or midwife are imperative. Your caretaker should carefully monitor your blood pressure, weight gain, and urine output. Let your doctor know if you have any history of preeclampsia in your family -- including your own past pregnancies. Women who already have hypertension, obesity, diabetes or kidney disease are at increased risk, as well.
Hopefully this new information about the cause of preeclampsia will provide the medical community with tools to limit the impact from the condition. Researchers say the finding c ould provide "an amazing breakthrough," which is good news for the mothers of multiples who are at high risk for this disorder during their pregnancy with twins, triplets or more.
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