Why we need to change the way we talk about pre-eclampsia

Pre-eclampsia affects around 7 per cent of pregnant women, but many don't know much about it.
Pre-eclampsia affects around 7 per cent of pregnant women, but many don't know much about it. Photo: Getty Images

When 42-year-old Marianne Thomson was rushed into surgery for an emergency caesarean at 33 weeks, she had no idea that she had pre-eclampsia, or even that she had been at high risk of developing the condition. 

“I pretty much ticked every box for pre-eclampsia – twins, over 40, first-time mum, IVF and had gestational diabetes – yet was never told about it at any stage,” she says. 

“I only went to hospital because I was having contractions, which they thought was an irritable uterus. I was very nearly discharged!”

Marianne Thomson and her twins now, after developing pre-eclampsia in pregnancy.
Marianne Thomson and her twins now, after developing pre-eclampsia in pregnancy. 

Thomson recalls that at the time of her C-section, no one explained what was happening. “It was only after, when I got even more severe pre-eclampsia once I'd delivered the twins, that I was drip-fed information. Not once were we ever really told what had happened or how serious it was,” she says. 

Pre-eclampsia is thought to affect as many as 7 per cent of pregnancies in Australia. Its symptoms include high blood pressure and swelling that happens suddenly in conjunction with rapid weight gain due to fluid retention. Doctors can also find protein in the urine.

Health professionals have been baffled by the causes of pre-eclampsia for decades, and the reasons why some women develop the condition so suddenly have also evaded them. But a new research paper, co-authored by associate professor Alicia Dennis from the Royal Women's Hospital in Melbourne, may be able to shed some light on it.

“I’ve been interested in pre-eclampsia for quite a long time. When I did my training I was really perplexed about why so many pregnant women developed high blood pressure, and when I looked at the literature there was a lot of disagreement about what was happening in the women’s body to cause high blood pressure,” Dr Dennis says.   

Dr Dennis set out to make observations in pregnant women using cardiac ultrasound (echo-cardiography). “The great thing about that was that pregnant women love ultrasound and it is very safe and non-evasive – we could get a lot of information about heart function,” she says.

The results showed that heart function in women with pre-eclampsia is actually better than the researchers had expected.    

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“We started to ask ‘why would heart function be increased or improved in women with pre-eclampsia?’” she explains. “That got us thinking that maybe the development of high blood pressure is something the woman’s body is trying to do to improve blood flow to her baby.” 

As a result of this finding, Dr Dennis has called for a new framework for healthcare workers to think about and explain this condition. 

“For the first time we have put in context all the observations and created a unified theory about why high blood pressure is occurring in pregnant women. It really helps to explain why a pregnant woman will develop high blood pressure for the first time.” 

This finding is not only significant for midwifes, obstetricians and health professionals, but it is also really important for women to understand what is happening to them. “This new unified theory helps women and their families understand why [pre-eclampsia] has happened to them,” she explains. 

Dr Dennis hopes that the new theory will lead to a de-mystification about pre-eclampsia, and has called for a change in its name. “The name ‘pre-eclampsia’ is very historical and creates a mystery about pregnancy and the condition. But the really fundamental thing about this condition is that high blood pressure can lead to serious complications – it’s a really serious condition – but the name hinders a new way of thinking about it.” 

In the case of Marianne Thomson, Dr Dennis says that had the new framework been in place, the doctors treating her may have been able to better explain what was happening.

“I think that the medics need a huge kick up the butt on their behaviours in this area,” says the now healthy Thomson. 

“Mothers need more education and awareness on how common this is and how awful it is. It is far more common than anyone thinks.”