Chapter One: Introduction to Pre-Eclampsia Study
Chapter One: Introduction to Pre-Eclampsia Study
As one of the leading global causes of maternal mortality, pre-eclampsia and related conditions have a remarkably wide impact (Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012). Diseases like pre-eclampsia can strike women of any age and with any socioeconomic background. The issues associated with pre-eclampsia are global, but there are certain populations that are more heavily impacted than others—and these populations are the ones that require investigation (Sibai, Dekker & Kupferminc, 2005). Pre-eclampsia is a condition that is associated with high maternal blood pressure and protein in maternal urine, but it is a complex constellation of symptoms that precludes any one definition (Lisonkova & Joseph, 2013; Ayansina et al., 2016).
The constellation of symptoms that are used to define and diagnose pre-eclampsia in expectant mothers include signs like high levels of protein in the urine, severe headaches, pitting edema in the hands and feet, changes in vision, intense upper abdominal pain, and high blood pressure (Laresgoiti-Servitje et al., 2010; Li et al., 2014). Given that pre-eclampsia is largely considered a constellation of related symptoms rather than a clear progression that can be easily diagnosed, it is important to understand that any of these symptoms independently might not indicate pre-eclampsia, while many of them together might (Laresgoiti-Servitje et al., 2010). One symptom that is commonly seen in pre-eclampsia cases but is also commonplace in other types of pregnancies is edema in the hands and feet—although indicative of nothing independently, it can be indicative of pre-eclampsia when seen in tandem with other symptoms (Chaiworapongsa et al., 2014).
There are a number of risk factors associated with pre-eclampsia, some of which include advanced age, obesity, and diabetes mellitus of any type (Ayansina et al., 2016). As more and more of the world begins to fall into the medical category of “obese,” the problems associated with pre-eclampsia become elevated throughout worldwide populations. This has been a significant concern for medical professionals around the world, and has even been linked tentatively to the rising rates of maternal mortality in developed nations like the United States (Ayansina et al., 2016; Chaiworapongsa et al., 2014). There is little information available regarding the exact causes of pre-eclampsia, but the end result can lead to impaired liver function, fluid in the lungs, kidney failure, and death (Laresgoiti-Servitje et al., 2010; Villar et al., 2003; Sibai, Dekker, & Kupferminc, 2005).
Presentation of Problem
Pre-eclampsia is a problem that presents on a global level (Chaiworapongsa et al., 2014). As previously stated, it is a problem that seems to occur without prejudice; women from any socioeconomic background and any set of medical circumstances can present with problems associated with pre-eclampsia (Chaiworapongsa et al., 2014). There has been an increase in the number of cases of pre-eclampsia in the United States in recent years, and this rise has been linked to the increased levels of obesity in many parts of the country (Ayansina et al., 2016; Chaiworapongsa et al., 2014).
Naghavi et al. (2015) estimate that of the 188 countries surveyed in 2013, pre-eclampsia was responsible for 29,000 deaths; however, Ayansina et al. (2016) note that the number of global cases of the disease are increasing even as maternal mortality is falling. Worldwide, pre-eclampsia affects approximately two to eight percent of pregnancies; although this seems like a relatively low number, it has the potential to cause significant strain on medical systems and families around the world (Naghavi et al., 2015). Unfortunately, even a successful pregnancy is not a cure-all for the problem: women who have complications associated with pre-eclampsia during their pregnancies are much more likely to experience problems like heart attacks and strokes later in their lives (Ayansina et al., 2016; Chaiworapongsa et al., 2014).
Pre-eclampsia is a disease that has the potential to touch every expectant mother—and once a woman is affected by the disease, she becomes more likely to experience problems in later pregnancies (Ayansina et al., 2016; Chaiworapongsa et al., 2014; Bodnar et al., 2014). The problem of pre-eclampsia is so great that it affects nearly every woman of child-bearing age around the world when she becomes pregnant—the potential for development of the disease is always there. Despite the significant prevalence of this disease, however, there is very little information and education widely available to mothers, especially when they are in low-income settings (von Dadelszen et al., 2013). Women who experience pre-eclampsia are also more likely to experience problems in their next pregnancies, but women without easy access to education and medical professionals will be unlikely to have access to appropriate care (von Dadelszen et al., 2013). Because of the wide impact this disease has on women around the world, it is clear that there is a pressing need to address the issue from a medical and educational standpoint.
Justification of Study of the Problem
Problems associated with pre-eclampsia cost medical services around the world hundreds of millions of dollars each year, and tens of thousands of women die each year as a result of pre-eclampsia and related problems (Naghavi et al., 2015). Despite the need, there is still no real understanding of the overall mechanism associated with pre-eclampsia; medical professionals still do not have a good understanding as to why certain individuals develop the constellation of symptoms associated with the disease, and other individuals do not (Ayansina et al., 2016; Chaiworapongsa et al., 2014; Bodnar et al., 2014). The primary drive to solve the questions associated with pre-eclampsia is the drive to save the lives of expectant mothers and their children. However, with falling mother and infant mortality rates, the focus has also shifted into the underlying causes and collection of symptoms associated with pre-eclampsia as a disease.
History of the Problem
Chaiworapongsa et al. (2014) write that the first account of pre-eclampsia and eclampsia was given in the 5th century by Hippocrates; Villar et al. (2003) note the same, suggesting that the problem of pre-eclampsia is nearly timeless for humanity. Although there has never been an excellent understanding of the problem, midwives and doctors alike have long known that pre-eclampsia and eclampsia present a very real danger to an expectant mother (Chaiworapongsa et al., 2014; Villar et al., 2003).
The mechanism of the disease is still unknown, suggesting that is is very complex. The main symptom that was once considered a hallmark of the disease—extreme swelling in the hands and feet—is no longer considered endemic; as the understanding of the disease has evolved, the constellation of symptoms used to define the disease has also become more specific and targeted (Chaiworapongsa et al., 2014; Villar et al., 2003). Many of the previously-utilized treatments have been abandoned for pre-eclampsia, and many of the modern treatments for the disease focus on treating the symptoms rather than addressing any underlying causes. Pregnant women are, of course, unique patients in many senses, and it can be incredibly difficult to treat them for any set of symptoms without inadvertently stressing or harming the fetus (Chaiworapongsa et al., 2014).
Current Status of the Problem
Although global rates of maternal death related to pre-eclampsia are falling, the number of cases has not fallen in any significant way in recent decades (Lisonkova & Joseph, 2013; Chaiworapongsa et al., 2014; Villar et al., 2003). Maternal death might be rarer than ever before, but tens of thousands of women still die each year as a result of pre-eclampsia—and the disease is not understood thoroughly enough to have developed effective treatments, especially for women in low or middle-income countries with less access to medical care (Chaiworapongsa et al., 2014; Villar et al., 2003; von Dadelszen et al., 2013).
Some medical professionals may not even be aware of the newest research on the topic—indeed, the newest research, which suggests that bed rest and reduced sodium intake have little impact on the prevention or development of pre-eclampsia, strike against the traditional views on the disease in the medical field (Villar et al., 2003). Understanding these changes and developing new methods for addressing the problems associated with pre-eclampsia is essential moving forward for the medical community as a whole. Indeed, some of the newest research even seems to suggest that aspirin intake does little to alter the course for an expectant mother who is experiencing issues associated with pre-eclampsia (Villa et al., 2013; Li et al., 2014). These conflicting reports indicate the necessity for a more thorough investigation into these and related issues. Currently, researchers are addressing the problems associated with pre-eclampsia in a number of different ways; some researchers are looking at potential immunological causes, while others are more focused on treating the problem symptomatically or ruling out genetic causes (Bodnar et al., 2014; Ghulmiyyah & Sibai, 2012). In each of these cases, researchers have developed correlational connections, but no underlying cause of pre-eclampsia as a whole has been uncovered as of yet. The recommendations given by professionals changes based on new understandings, so it is important to remain apprised of new information in the field.
Research Questions
When determining the appropriate research questions in this case, a number of considerations regarding population, purpose of the study, and direction of the research were considered. Primarily, the researcher determined that the study should focus on education and medication as a way to determine the best possible outcome for both the mother and the fetus in the case of a mother developing pre-eclampsia. The primary research question to be investigated in this case is as follows:
In patients with preeclampsia, should education and medication therapy be considered versus early delivery of the fetus as the best approach to prevent maternal mortality?
However, the secondary research areas considered in this document will investigate the role of medication, culture and community education, first-time mother education, mortality rates for both the fetus and the mother, and the outcomes for mothers based on the severity of their symptoms. The secondary questions that will be addressed are as follows:
What is the role of medication for pre-eclampsia in the outcome for both the mother and the child?
What is the role of culture and community education regarding pre-eclampsia in the outcome for both the mother and the child?
What relationship does severity of symptoms have with the implementation of community education for first-time mothers?
This document investigates a number of these questions through the use of a meta-analytic literature review, and some of the questions through the development of an experimental approach. Each of these variables has been demonstrated by prior research to be essentially important in the overall prevention of pre-eclampsia, but their intersectionality has not been studied in any real depth. In addition, the effectiveness of educational programs has not been adequately studied.
Summary
Pre-eclampsia is one of the most important problems facing many mothers around the world. Although the exact mechanism of the disease is unknown, pre-eclampsia’s link with obesity has become clear in recent years—and the rise in obesity rates around the world is likely to lead to a spike in rates of pre-eclampsia and eclampsia (Salam et al., 2015; Laresgoiti-Servitje et al., 2015; Villar et al., 2003; Chaiworapongsa et al., 2014). The purpose of this study is to investigate how education and medication can be used as an alternative to early delivery of the fetus. In the following section, Chapter Two, the methodology associated with the study will be discussed in some depth, including a more detailed discussion of the population utilized for the study, and how these participants were selected from the potential participant pool. In addition, a detailed overview of the methodology used for result analysis will be established in this section.
References
Ayansina, D., Black, C., Hall, S. J., Marks, A., Millar, C., Prescott, G. J., & Bhattacharya, S. (2016). Long term effects of gestational hypertension and pre-eclampsia on kidney function: Record linkage study. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health.
Bodnar, L. M., Simhan, H. N., Catov, J. M., Roberts, J. M., Platt, R. W., Diesel, J. C., & Klebanoff, M. A. (2014). Maternal vitamin D status and the risk of mild and severe preeclampsia. Epidemiology (Cambridge, Mass.), 25(2), 207.
Chaiworapongsa, T., Chaemsaithong, P., Yeo, L., & Romero, R. (2014). Pre-eclampsia part 1: current understanding of its pathophysiology. Nature Reviews Nephrology, 10(8), 466-480.
Ghulmiyyah, L., & Sibai, B. (2012, February). Maternal mortality from preeclampsia/eclampsia. In Seminars in perinatology (Vol. 36, No. 1, pp. 56-59). WB Saunders.
Li, X. L., Chen, T. T., Dong, X., Gou, W. L., Lau, S., Stone, P., & Chen, Q. (2014). Early onset preeclampsia in subsequent pregnancies correlates with early onset preeclampsia in first pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 177, 94-99.
Laresgoiti-Servitje, E., Gómez-López, N., & Olson, D. M. (2010). An immunological insight into the origins of pre-eclampsia. Human reproduction update, 16(5), 510-524.
Lisonkova, S., & Joseph, K. S. (2013). Incidence of preeclampsia: risk factors and outcomes associated with early-versus late-onset disease. American journal of obstetrics and gynecology, 209(6), 544-e1.
Naghavi, M., Wang, H., Lozano, R., Davis, A., Liang, X., Zhou, M., & Aziz, M. I. A. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 385(9963), 117-171.
Salam, R. A., Das, J. K., Ali, A., Bhaumik, S., & Lassi, Z. S. (2015). Diagnosis and management of preeclampsia in community settings in low and middle-income countries. Journal of family medicine and primary care, 4(4), 501.
Sibai, B., Dekker, G., & Kupferminc, M. (2005). Pre-eclampsia. The Lancet, 365(9461), 785-799.
Villa, P. M., Kajantie, E., Räikkönen, K., Pesonen, A. K., Hämäläinen, E., Vainio, M., & Laivuori, H. (2013). Aspirin in the prevention of pre‐eclampsia in high‐risk women: a randomised placebo‐controlled PREDO Trial and a meta‐analysis of randomised trials. BJOG: An International Journal of Obstetrics & Gynecology, 120(1), 64-74.
Villar, K., Say, L., Gulmezoglu, A. M., Meraldi, M., Lindheimer, M. D., Betran, A. P., & Piaggio, G. (2003). Eclampsia and pre-eclampsia: a health problem for 2000 years. In Pre-eclampsia (pp. 189-207). RCOG Press, London.
von Dadelszen, P., Sawchuck, D., Hofmeyr, G. J., Magee, L. A., Bracken, H., Mathai, M., & Roberts, J. M. (2013). PRE-EMPT (Pre-eclampsia-Eclampsia Monitoring, Prevention and Treatment): A low and middle income country initiative to reduce the global burden of maternal, fetal and infant death and disease related to pre-eclampsia. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 3(4), 199-202.
