PREECLAMPSIA, ECLAMPSIA, HELLP SYNDROME - RESEARCH LINKS

Preeclampsia is a serious blood pressure disorder that can affect all organs in a woman’s body. A woman has preeclampsia when she has high blood pressure and other signs that her organ systems are not working normally. One of these signs is ***proteinuria ***(an abnormal amount of protein in the urine). Though proteinuria is not required for a diagnosis of Preeclampsia, at least one other symptom in addition to high blood pressure is required. A woman with preeclampsia whose condition is worsening will develop other signs and symptoms known as “severe features.” These include a low number of ***platelets ***in the blood, abnormal kidney or liver function, pain over the upper abdomen, vision changes, fluid in the lungs, or a severe headache. A very high blood pressure reading also is considered a severe feature. Resouce: https://www.acog.org/womens-health/faqs/preeclampsia-and-high-blood-pressure-during-pregnancy?fbclid=IwAR3mlr4_-T-_axbziQFsu4VUenFvvLlBuYUho3hanQfiKCTxnylfNJZ6egs#is

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Definition of Preeclampsia and Chronic HypertensionWhat is HELLP Syndrome?Current Management & Care Standards for Hypertensive Pregnancies: ACOG Working ReportThe New Yorker ArticleWhy Pregnancy is a biological warfare between mother & babyHypertension guidelines beofre 20 weeks of pregnancy and preconceptionProtein no longer needed for diagnosis of preeclampsia-1Protein no longer needed for Diagnosis of Preeclampsia-2Preeclampsia: A complex and variable disease

"From what we can tell, in both PE and HELLP pregnancies levels of sFlt and sEng are elevated dramatically above the levels in a normal pregnancy. In PE the absolute value of sFlt is elevated above the absolute value of sEng; in HELLP it's the other way around. And in all women there's some threshold above which she will develop both complications regardless of which of the two is more elevated."

https://www.acog.org/Patients/FAQs/Preeclampsia-and-High-Blood-Pressure-During-Pregnancy?IsMobileSet=false

https://www.acog.org/Resources%20And%20Publications/Task%20Force%20and%20Work%20Group%20Reports/Hypertension%20in%20Pregnancy.aspx

http://www.newyorker.com/magazine/2006/07/24/the-preeclampsia-puzzle

HELLP Signs and Symptoms Upper right quadrant pain (under the rib cage, possibly radiating to right shoulder). Sudden vomiting after first trimester. Severe nausea after first trimester. Unrelenting heartburn. Preeclampsia Signs and Symptoms (after 20 weeks) New blood pressure readings with systolic 140 or higher OR diastolic 90 or higher, OR 30/15 points over baseline if your baseline is very low. (Elevated BP before 20 weeks is considered chronic hypertension. If you are a chronic hypertensive, you may be allowed to run higher, but for chronic or gestational hypertension, BP that isn't controlled by meds or a doctor-prescribed increase in meds warrants a call to your doctor for evaluation for preeclampsia.) Headache that is not relieved by ususal measures (such as acetominophen, fluids, electrolytes, sleep, caffeine). Vision changes such as blurry vision, tunnel vision, black spots in the vision. Sudden weight gain over a few pounds per week. Swelling of hands beyond not being able to wear rings or swelling of face (especially around lips and eyelids). Decrease in urine output when compared with fluid intake, especially if accompanied by swelling. Foamy or cola-colored urine. Nausea or vomiting after first trimester. Upper right quadrant pain (under the rib cage, possibly radiating to right shoulder). Shortness of breath. Hyperreflexia, noticed as anxious feeling. General sense of feeling unwell, confusion, or sense of “impending doom,” in conjunction with other symptoms. Seizures - a symptom of Eclampsia. Preeclampsa, Eclampsia, HELLP Syndrome Survivors Support Group Discussions on what are normal pregnancy symptoms and what are concerning: Headaches: https://www.facebook.com/groups/preeclampsia/permalink/10160740659560006/ Swelling: https://www.facebook.com/groups/preeclampsia/permalink/10160281715300006/ Coming soon: Visual disturbances Upper right side pain Blood pressure Protein

http://www.mayoclinic.org/diseases-conditions/preeclampsia/manage/ptc-20316176

https://healthmetrics.heart.org/wp-content/uploads/2017/11/Highlights-from-the-2017-Guideline.pdf

https://www.preeclampsia.org/the-news/138-latest-news/688-hospital-guidelines-and-the-preeclampsia-patients%E2%80%99-bill-of-rights

Australia & New Zealand Queensland Canadian Working Group Report & Canadian 2018 Guidelines Germany Japan Phillippines United Kingdom USA ** World Health Organization *** The FIGO Textbook of Pregnancy Hypertension

"Therapeutic" bed rest in pregnancy: unethical and unsupported by data Mayo Clinic on Bedrest To Bedrest or Not to Bedrest ACOG on bedrest Harpers Magazine: The Bed-Rest Hoax

DOES DIET HAVE ANY EFFECT? NO: Calorie & Protein intake Brewer Diet Preeclampsia Foundation Discussion on Brewer Diet Antioxidants: Vitamin C & E Cod liver oil Calcium: Supplementation pre-pregnancy or early pregnancy (newest) Trial of Calcium to prevent Preeclampsia USDA Calcium supplementation and reduction of hypertensive disorders Vitamin D: Vitamin D for prevention of Preeclampsia Vitamin D supplementation may make asthma worse Unclear if Vitamin D helps First trimester Serum Vitamin D Levels Magnesium supplements (not the same as magnesium sulfate): Magnesium Supplementation in Pregnancy Folic Acid Folic acid to prevent preeclampsia: After 1224 studies, "...Whether folic acid supplementation in pregnancy can prevent the occurrence of gestational hypertension/preeclampsia remains uncertain." Methylfolate vs Folic Acid MTHFR polymorphism Cleveland Clinic on MTHFR testing MTHFR Exploitation by Supplement Industry American College of Medical Genetics & Genomics - Lack of Evidence for MTHFR testing MTHFR differences in preeclamptic patients vs non-preeclamptic Patients Dr. Lynch, pseudoscience, and Integrative medicine in MTHFR MTHFR genetic testing: Controversy and clinical implications Preeclampsia Foundation: The useful thing here is the math: "Second, the effect of MTHFR to increase the risk of preeclampsia is small. In analyses of available studies, the increased risk is 20 percent to 30 percent (compared to 300 percent with obesity)." Background population risk is 5%, or 1 in 20 pregnancies. An increase of 30% raises that to a little more than 6% (multiply .05x.3 and add that to .05.). Professional explainer on the genetics

The Magpie Trial: a randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for women at 2 years What is Magnesium Sulfate Better Fetal Outcomes Antepartum Magnesium Sulfate use for Neuroprotection of Preterm Infants Mechanism & Management of Seizures in Preeclamptics

Fetal DNA Fathers role: Because most women get PE only once, it's thought that first time around Mom's immune system overreacts to the foreign DNA (Dad's) in the baby. Second time around, she recognizes and accepts it. IF this is the reason you got PE, changing fathers would raise your risk because new, unrecognized DNA. However, PE is multi-causal. We've found a genetic link, and it's really complex, *thousands* of genes involved. Some men have a lot of "bad" DNA and would father a PE pregnancy no matter who the mother is. Some couples have enough genes together to trigger it, but would do better with another partner, assuming that partner had fewer "bad" genes. IF this is the reason you had PE, changing fathers would actually lower your risk. And some women would have PE no matter who the father is, either because they have enough bad genes on their own or because they have some other trigger going on, so changing or keeping fathers doesn't make a difference. It's nearly impossible to figure out which scenarios apply to which couples, so changing partners is counted as a risk factor even though it might not be in a particular case.

Prediction and prevention of recurrent preeclampsia Risk in chronics (25% if well controlled before pregnancy) Reduced risk in subsequent pregnancies Prevention of Preeclampsia“17. Conclusions: Interventions such as rest, exercise, reduced salt intake, garlic, marine oil, antioxidants, progesterone, diuretics, and nitric oxide showed insufficient evidence to be recommended as preventive measurements for PE. On the other hand, low-dose aspirin especially when initiated before 16 weeks in high-risk groups, and calcium especially in low-intake populations show promise in the prevention of PE. The results of large clinical trials in high-risk populations selected during the first trimester of pregnancy are keenly awaited." Closely spaced pregnancies show less risk than farther spaced pregnancies FIND A MFM (High Risk OB) When you should see an MFM Depth of implantation correlated with gestational age at onset of preeclampsia /hellp? No! Oddly enough, no. Some of the time, the mother's immune system and that outer layer of the placenta, the trophoblastic cells that are controlled by the father's genes, manage to work together even in the case of a really awful initial implantation. Some of the time, there's no indication of shallow implantation until right before the placenta abrupts because those sets of genes just CANNOT work together any longer and the maternal tolerance for an implanted placenta is gone, abruptly. There's a strong connection to an initial failure of implantation, but there are exceptions where the ability of the placenta to stay implanted for the entire term is the real problem, in other words. Put another way - this could be like transplant rejection, where the mother's body rejects the grafted organ, or it could be graft vs host disease, where the grafted organ rejects the mother's body. Either way, the problem is that implantation isn't proceeding normally and continuing normally; that tolerance for a foreign body is failing/has failed. They settled on using "preeclampsia" as an umbrella term to try to catch all of the ways in which this can happen, because the important part is that we get *appropriate care* when this happens, and we don't want care providers dithering over whether or not this is the right metaphysics for preeclampsia. We just want them to be empiricists and respond to the sick pregnant woman.

Aspirin inhibits expression of sFLT1 Preconception low-dose aspirin and pregnancy loss Aspirin in chronic hypertensives Aspirin reduces preterm preeclampsia but not term preeclampsia Aspirin helps in 2-5% of pregnancies A primer on the 2-5% prevention rate with low dose aspirin (81mg): The overall recurrence rate for PE is 20%. That means if you grabbed a random sample of survivors who had a second pregnancy, around 20 would get it again and 80 would not. If you put a random group of 100 on aspirin, only 15-18 would get it and 82-85 would not. 80 would be fine with or without aspirin, 15-18 would get sick with or without, 2-5 were helped. But we have no way of knowing ahead of time who are the lucky 2-5, so many of us choose to take it just in case. We also don't know after the fact who were the lucky ones. If you took aspirin and had a normal pregnancy, was it because of aspirin or would you have been fine regardless? Aspirin in Antiphospholipis Antibody Syndrome Prophylatic use of aspirin in pregnant populations 150mg aspirin in prevention of preeclampsia Safety of preconception low dose aspirin for mother & baby LDA Clinical Guidance Committee Opinions (no you don’t have to stop it prior to delivery) Aspirin FAQ Discussion in our support group: https://www.facebook.com/groups/preeclampsia/permalink/10160569407840006/

Developmental Origins of Health and Disease Cardiovascular Health 2017 hypertension guidelines Heart Disease & Stroke Preeclampsia and future cardiovascular risk Pre-eclampsia and cardiovascular disease Info Graphic on Cardiovascular Disease Brain Changes Cognitive changes after preeclampsia Cerebrovascular Dysfunction in Preeclamptic Pregnancies Preeclampsia and cognitive impairment later in life The presence of brain white matter lesions in relation to preeclampsia and migraine Cerebral White Matter Lesions after preeclampsia Long-term cerebral white and gray matter changes after preeclampsia Postpartum Depression Treatment Programs & Specialists Does Magnesium Sulfate cause memory loss?A *lot* of us have PTSD after traumatic pregnancies. Researchers think that if we're having memory trouble, PTSD is why. Connection to Autism in children Antibodies as Mediators of Brain Pathology Autism-specific maternal anti-fetal brain autoantibodies Autism & Developmental Delay