Preeclampsia and high blood pressure

Pre-eclampsia is a condition associated with pregnancy. Her symptoms are increased pressure of a new nature and the appearance of protein in the urine. Symptoms usually pass after childbirth. In rare cases, high blood pressure is observed for up to 6 weeks after the birth of the baby. Preeclampsia is a dangerous condition, both for the mother (damage is inflicted on the kidneys, liver and brain), and for the child (who receives insufficient nutrients and oxygen). Women in serious condition may have convulsions (eclampsia).

[1], [2], [3], [4]

Causes Preeclampsia and high blood pressure

The reason for the development of pre-eclampsia has not been sufficiently studied.

Pre-eclampsia develops as a result of placental pathology, which circulates blood poorly, but the cause of abnormal function of the placenta is still a mystery. It is also not known why the mother's body raises blood pressure during pregnancy. Until now, the factors that provoke the development of preeclampsia are:

• family predisposition;
• a malfunction of the immune system of a pregnant woman. Pre-eclampsia often appears in the primipara, as well as in those who already have children, but when trying to give birth to a child from another man. Experts believe that the violation of the immune system of the mother provokes the disease, because the mother's body begins to repel the father's antigen. As a result, there may be a narrowing of the vessels throughout the body, causing an increase in blood pressure and other diseases;
• biochemical factor, which provokes narrowing of blood vessels and increase of arterial pressure. Pre-eclampsia may occur as a result of the body's reaction to placental dysfunction, or the symptoms of placental anomalies and preeclampsia may be provoked by the same factor;
• diabetes and other diseases that cause vasoconstriction.

Experts suggest that pre-eclampsia:

• begins to develop when there is insufficient blood flow in the uterus;
• is inherited;
• is the result of the reaction of the mother's immune system to the sperm of the father, placenta or fetus;
• develops when high blood pressure was observed before pregnancy;
• appears as a result of obesity, polycystic ovary syndrome and diabetes.

Risk factors

• Hypertension
• Chronic kidney disease.
• Diabetes
• Disease of blood vessels.
• High blood pressure after 34 weeks gestation.
• Family predisposition
• Obesity (more than 20% of excess weight) at the time of conception. The higher the body mass index, the greater the risk of developing preeclampsia.
• Multiple fetuses (two or three fetuses).
• First pregnancy, the first pregnancy with a new partner or the first pregnancy for the past 10 years.
• Age of mother under 21 years of age or older 35.
• Chorionadenoma.
• Polyhydramnios caused by rhesus-sensitization or inflammation in the uterus.
• Artificial insemination.

Women with hypertension are at risk of premature detachment of the placenta from the uterine wall. The risk increases when:

• mother smokes;
• hypertension is observed and preeclampsia is developing;
• the mother uses narcotic substances (cocaine);
• there is a trauma of the uterus as a result of a car accident.

Experts believe that after the birth it is possible to increase the pressure in those women who have had symptoms of pre-eclampsia.

Does preeclampsia and high blood pressure during pregnancy lead to hypertension in the future?

If before pregnancy you did not have hypertension, then after childbirth, it is most likely to return to normal. But high blood pressure before pregnancy indicates that even after childbirth, it does not fall by itself. Experts believe that pre-eclampsia does not provoke hypertension in the future after childbirth. But at the same time women with symptoms of pre-amlamphia during pregnancy.

[5], [6], [7], [8]

Pathogenesis

In women who have a chronic form of hypertension, pressure usually falls during the first two trimesters. At the end of the second and third trimester, it begins to rise again, and after childbirth it, as a rule, remains at a high level. High blood pressure during pregnancy increases the risk of developing pre-eclampsia.

Pre-eclampsia affects blood pressure, placenta, liver, blood, kidneys and the brain. The disease can proceed in mild or severe form and worsen gradually or rapidly. Both mother and child are at risk.

• Arterial pressure. There is no increase in the volume of blood, as it should be during pregnancy, which affects the growth and development of the fetus, while the blood vessels (vasospasm) narrow, increasing blood pressure.
• Placenta. Blood vessels of the placenta do not grow enough in the walls of the uterus and do not expand, as it should be, so the fetus does not receive enough blood and nutrients.
• Liver. Violation of blood circulation leads to destruction of the liver, which causes HELLP-syndrome - a dangerous condition that requires immediate treatment.
• The kidneys. During a normal course of pregnancy, the kidneys function 50% more, but with pre-eclampsia their work is disrupted.
• Brain. Visual disturbances, persistent headaches and convulsions (eclampsia) can develop as a result of reduced blood circulation to the brain. 1% of women with preeclampsia have convulsions. Eclampsia can cause someone to mother and lead to the fading of the fetus, so in almost all cases of pre-eclampsia women are prescribed preventive medications.
• Blood. With pre-eclampsia, a small number of platelets is observed. Sometimes blood clotting occurs - generalized thrombohemorrhagic syndrome. After childbirth, he, as a rule, passes. After the birth and birth of the placenta, the symptoms of preeclampsia go away. With a worsening of the condition and the absence of labor, a caesarean section is done. After childbirth, blood pressure returns to normal after a few days, and sometimes - 6 or more weeks.

Newborn

The earlier in pregnancy the pressure rises, the greater the risk of premature birth, which is fraught with complications in the newborn. If a child is born before the 37th week, a respiratory distress syndrome may occur. The small weight and height of the child also indicates the impact of the disease on the fetus because of insufficient blood circulation through the placenta, resulting in the child receiving a small amount of nutrients and oxygen.

According to statistics, one in 100 pregnancies, at which symptoms of preeclampsia were observed, results in the fading of the fetus.

[9], [10], [11], [12]

Hypertension

Arterial pressure indicates how the blood pressure on the walls of the arteries. If the head is too strong, the pressure rises (hypertension). If the pressure rises after 20 weeks of pregnancy, this may be a sign of pre-eclampsia.

Arterial pressure is measured in two numbers - the upper number (systolic) shows the strain with which the heart pumps blood. Lower (diastolic) - the pressure with which the heart relaxes and becomes filled with blood. The pressure is considered high if the upper one is more than 140 millimeters of mercury and the lower one is over 90. The upper can be raised, lower, or both - 150/95.

The pressure may be high before pregnancy or increase with the onset of pregnancy, while a woman needs to come to a doctor more often than usual. Nothing predicts the onset of pre-eclampsia, so careful monitoring of the doctor is necessary throughout the pregnancy. Hypertension and preeclampsia are interrelated, but they have distinctive features.

Usually the pressure of a pregnant woman falls in the second trimester, but by the end of the third it returns to normal. Sometimes blood pressure rises in the second and third trimester, which is called gestational hypertension, which leads to pre-eclampsia. It is often necessary to measure pressure and undergo a course of treatment if necessary. As a rule, the pressure is normalized after the birth of the child. But when the pressure was high even before pregnancy, it does not go down even after giving birth. A slight increase in blood pressure is not a problem, just need to be under the supervision of a doctor who checks for pre-eclampsia. At high pressure, the fetus does not receive enough nutrients and oxygen, which affects growth and development, and can lead to premature detachment of the placenta and stillbirth of the fetus.

Symptoms Preeclampsia and high blood pressure

As a rule, the blood pressure of a pregnant woman is slightly lower than usual during the second trimester of pregnancy, but then it gradually returns to normal. Nevertheless, in 10% of pregnant women, blood pressure begins to rise significantly (hypertension) after the 20th week of pregnancy. This condition is called late gestational hypertension. Sometimes the pressure rises in the first days after birth. At the first increase in arterial pressure, the doctor will not be able to predict, the pressure will remain slightly elevated, it will progress or testify about pre-eclampsia. If preeclampsia begins to develop, a urine test will show an elevated protein level. This is a sign that the kidney function is impaired. If before pregnancy you have hypertension, you have a chronic form of hypertension, which may be preserved after the birth of the child.

Increase in blood pressure during pregnancy If the pressure rises before the 20th week of pregnancy, it is usually chronic. In rare cases, this indicates the development of preeclampsia. The increase in pressure after the 20th week of pregnancy is a sign of preeclampsia.

Usually high blood pressure does not cause symptoms, but sometimes there is a headache, difficulty breathing, or a change in visual perception.

A moderate degree of pre-eclampsia does not provoke symptoms. But a pregnant woman can quickly gain weight and experience a sharp increase in the volume of the hands or swelling of the face. Severe form of pre-eclampsia causes difficulty in breathing, headache, visual impairment, abdominal pain and frequent urination.

Increased blood pressure is not always accompanied by symptoms, and to accurately determine the need for a cuff to measure pressure and a stethoscope.

Pressure is measured in numbers, for example, 140/90 millimeters of mercury or higher, indicating hypertension, and 160/110 and above - a life-threatening condition.

Symptoms of preeclampsia may occur suddenly or gradually.

• The systolic blood pressure is above 140, or the diastolic blood pressure is above 90, and this is measured after 6 hours.
• Increase of protein in the urine. Its high amount is 300 mg for 24 hours.

You may also have other symptoms, but the diagnosis of "pre-eclampsia" is to be made only in the case of hypertension and protein in the urine. Other symptoms of preeclampsia:

• The swelling of the hands and face does not go away during the day (but in the absence of other symptoms, puffiness of the face is normal during pregnancy).
• Rapid weight gain (more than 900 grams per week or 2.700 per month).
• Poor blood coagulation.

Severe form of preeclampsia

In severe pre-eclampsia, the systolic pressure is higher than 160, and the diastolic pressure is higher than 110. As the circulation of blood in the body decreases, more severe symptoms can also be observed:

• a severe headache that does not go away after using acetaminophen;
• visual impairment;
• decreased urination (less than 400 grams per 24 hours);
• permanent pain in the abdominal cavity, especially in the right side;
• difficulty breathing, especially lying on the back;
• HELLP-syndrome (decrease in the number of platelets).

HELLP-syndrome (decrease in the number of platelets) is a dangerous disruption of the liver, which correlates with preeclampsia. Seek immediate help from a specialist when observing the following symptoms:

• pain in the upper abdomen (liver);
• pain in the shoulders, neck and other upper body parts (the source of pain is the liver);
• fatigue;
• nausea and vomiting;
• headache;
• a disorder of vision.

With severe pre-eclampsia, the risk of seizures increases.

Eclampsia

When pre-eclampsia appears convulsions of incomprehensible etiology, they indicate eclampsia - a dangerous state for both the mother and the fetus.

Diagnostics Preeclampsia and high blood pressure

Usually, hypertension and pre-eclampsia are diagnosed during a doctor's visit. Therefore, it is not possible for pregnant women to miss their planned visits to the treating doctor. A sharp increase in pressure is the first sign of the problem. The doctor prescribes a urine test for protein, the presence of which indicates the development of pre-eclampsia. If you have high blood pressure, tell your doctor immediately about the appearance of pain in the abdominal cavity or headache, which are observed before the appearance of protein in the urine.

Hypertension and preeclampsia, as a rule, are found during regular prenatal examinations. Since this condition can quickly deteriorate and harm both the mother and the future child, it is very important to visit the doctor systematically.

Pre-Pregnancy Period

Before pregnancy, the goal of controlling blood pressure is:

• the detection of hypertension, since it is important to know if high blood pressure is chronic before pregnancy, since there is a possibility of developing pre-eclampsia;
• control measurement of blood pressure before conception to compare the indices of pressure during pregnancy.

[13], [14], [15], [16], [17], [18], [19]

Planned testing during pregnancy

During each visit to the doctor, a woman is measured with blood pressure to detect pre-eclampsia at an early stage. The doctor will also prescribe a urine test for the presence of protein and weigh the pregnant woman, because rapid weight gain indicates a fluid retention in the body and is a sign of pre-eclampsia.

Testing of pregnant women who are at risk for developing pre-eclampsia

In order to identify pre-eclampsia, other tests are also performed:

• a blood test for the diagnosis of HELLP syndrome and signs of kidney dysfunction (an increase in the amount of uric acid in the blood indicates the development of preeclampsia;
• a test for creatinine, for which it is necessary to collect urine in 24 hours and donate blood (the kidneys are determined);
• The analysis of urine collected in 24 hours for the presence of protein.

If the results of the tests indicate the development of pre-eclampsia, you will be under constant nausea until the end of pregnancy. The type and frequency of testing depends on the severity of the disease and the duration of pregnancy. A woman needs to take tests more often if signs of pre-eclampsia are detected before the 36th week of pregnancy.

If a woman has signs of pre-eclampsia, the following diagnosis is performed to determine the state of health and the fetus:

• physical examination for signs and symptoms of a progressive disease;
• the analysis of blood on its components and the work of the kidneys;
• a test for the content of creatinine (to determine the functioning of the kidneys).

In the presence of convulsions (a sign of eclampsia) additional tests are performed after childbirth to determine the state and functioning of the brain:

• computed tomography (cut-KT) is performed for a detailed study of structural changes within the body.
• Magnetic resonance imaging (MRI) uses the tomographic method of examining internal organs and tissues using the physical phenomenon of nuclear magnetic resonance.
• Electroencephalogram (ECG) measures the electrical activity of the brain with the help of sensors and a computer.

Fetal examination

At high pressure (pre-eclampsia), the mother and child are under close medical supervision. The frequency of monitoring the fetus depends on the severity of the mother's condition - from once a week to once a day. To determine the condition of the fetus, the following testing is used:

• Electronic monitoring of the fetal condition for determining the cardiac activity of the fetus during movement;
• Fetal ultrasound (to determine the condition of the child, placenta and uterus), namely, the growth and weight of the fetus, the possibility of premature detachment of the placenta, the amount of amniotic fluid;
• Ultrasound dopplered study.

Sometimes an amniocentesis is performed in the case of premature births to determine the condition of the fetus. During the procedure, a sample of amniotic fluid is used to check the chemicals that indicate the maturity of the lungs.

[20], [21], [22], [23], [24]

Early detection of the disease

During planned visits, the doctor conducts a blood pressure measurement and assigns a urinalysis to determine signs of pre-eclampsia.

Pre-eclampsia and high blood pressure during pregnancy: Overview of treatment

If the blood pressure begins to rise during pregnancy, the woman is under close medical supervision right up to the delivery. The pressure may increase slightly and does not inflict time on the mother and child. But with the first signs of preeclampsia, the risk increases significantly when the pressure reaches a critical level (hypertension).

[25], [26], [27], [28], [29]

Treatment Preeclampsia and high blood pressure

If the doctor believes that you have too high blood pressure and with the purpose of preventing seizures, he will prescribe certain medications, but the only way to get rid of pre-eclampsia is the birth of a child. Perhaps the doctor will also prescribe special medications that accelerate the maturation of the fetal lungs and, at the first signs of maturity, carry out early fetal extraction for the safety of the mother and child, while the child may be in intensive care for a while.

Treatment during pregnancy includes:

Full monitoring of the condition of the mother and child

Use of drugs to lower blood pressure. Sometimes a woman with a chronic form of hypertension is constantly taking medications, but if the condition improves during pregnancy, the dose may be lowered. A slight increase in blood pressure usually requires only monitoring by the doctor. In the case of a rapid increase in pressure (140/105), the doctor prescribes certain drugs. With hypertension (160/110) there is a threat of slowing the growth of the fetus, therefore, the use of antihypertensive drugs is recommended.

During pregnancy, you can not take certain medications, so with hypertension, be sure to tell your doctor about pregnancy and show him the entire list of medications that you take.

Preeclampsia and eclampsia

If signs of pre-eclampsia are observed, the pregnant woman is hospitalized or at home under the supervision of a doctor. The aim of the treatment is to prevent a life-threatening condition and prolong the pregnancy as long as possible, so that the baby is born full and healthy.

Treatment is usually carried out until the end of pregnancy, during labor and during recovery, but it all depends on the severity of the disease. Therapy includes: anticonvulsant drugs, drugs that lower blood pressure and the delivery itself, after which preeclampsia disappears.

• With a mild form of pre-eclampsia, which does not progress, a woman is recommended to reduce activity, listen attentively to her well-being and regularly visit a doctor.
• With moderate or severe form of pre-eclampsia or with a sharp deterioration in health, immediate hospitalization is required, where the pregnant woman is under the supervision of doctors, taking certain medications and adhering to bed rest, and with the progression of the disease the woman will receive the necessary help. With cramps, magnesium sulfate is injected, which relieves seizures and prevents their occurrence in the future. If a woman is on her last pregnancy or her condition worsens dramatically, the doctor may schedule premature birth.
• With a life-threatening condition, the only alternative to treatment is the administration of magnesium sulfate and the birth itself. If the gestation period is less than 34 weeks and it is possible to delay the extraction of the fetus for 24-48 hours, antinatal corticosteroids are introduced to accelerate the maturation and opening of the lungs.

After childbirth

With moderate or severe pre-eclampsia, the risk of seizures (eclampsia) persists the first two days after the birth of the child.

In rare cases, they can be observed later. Therefore, it is recommended to continue the administration of magnesium sulfate for 24 hours after delivery.

Arterial pressure usually returns to normal several days after birth (if the disease is not chronic). In some women, high blood pressure is observed for up to 6 weeks after childbirth. If the diastolic pressure is higher than 100 at the time of discharge from the hospital, the doctor will prescribe certain drugs to reduce pressure. In the future, you need to regularly visit a doctor for preventive examination.

[30], [31], [32]

Taking medications to reduce pressure during breastfeeding

There are several drugs to reduce pressure, which are considered safe during breastfeeding. They contain labetalol and propranolol along with such drugs as hydralazine and methyldopa. Such substances as nadolol, metoprolol and nifedipine fall into the mother's milk, but do not cause the child side effects.

Anticonvulsants

The average and severe form of preeclampsia or in the presence of convulsions (eclampsia) requires the introduction of magnesium sulfate.

[33], [34], [35], [36], [37], [38],

Preparations for pressure reduction

Use of drugs to reduce blood pressure:

• does not exclude the deterioration of the condition, since the increase in pressure is only a symptom, not a cause;
• reduces the flow of blood to the placenta in the case of a sharp drop in blood pressure, which can harm the fetus. Therefore, such drugs are used only in emergency cases, with the existing danger of life, for both the mother and the child.

Childbirth

Vaginal births are generally considered safe for the mother and child if the mother's condition is normal. In the case of progression of preeclampsia and impairment of the fetus, when vaginal birth is not possible, a cesarean section is performed.

Pre-eclampsia usually does not cause problems in the future. You should lead a healthy lifestyle, namely, to play sports and eat right. Consult with your doctor about what you need to do to stay healthy.

[39], [40]

Other treatments for preeclampsia

In severe pre-eclampsia, it is important to stabilize the mother's condition (prevent the occurrence of seizures by administering magnesium sulfate and monitor blood pressure) before the birth of the child. If the woman is on the last term of pregnancy, the doctor can decide that it is necessary to remove the child prematurely. Preference is given to vaginal delivery.

With high blood pressure and pre-eclampsia during pregnancy, surgical methods of treatment are not used. Caesarean section is performed in the following cases:

• the need for immediate extraction of the fetus in order to preserve the life of the mother and child;
• if the stimulation of labor has not yielded results;
• medical indications, namely, placenta previa.

Observation

The condition of a woman can be improved through bed rest, no matter at home or in the hospital. It is important to give time to the fetus to fully mature and prepare the mother's body for natural childbirth.

Social support

When pre-eclampsia, it is necessary to reduce activity and avoid stressful situations. Sometimes it helps to communicate with women who are in the same situation.

Pre-eclampsia: treatment at home

If you are constantly high blood pressure and you take medications to reduce it, be sure to consult a doctor before the pregnancy, because some drugs can cause irreparable harm to the future child.

If you are unable to normalize the pressure before the pregnancy, take all the necessary measures to control it:

• Visit your doctor regularly for continuous monitoring, as a dangerous increase in blood pressure may not cause any symptoms. You can periodically record pressure indices at home.
• Avoid smoking, and this will help lower blood pressure and improve the health of the unborn child.
• Try to keep your weight under control during pregnancy. Consult your doctor about the permissible standards.
• Do light exercise during pregnancy. Several times a week walk and swim, which will undoubtedly be useful to you and your child.
• Avoid stressful situations. Allocate time for rest, especially if you work, take care of young children or have a busy schedule.
• Having listened to these tips, you can take out a healthy child, avoid complications during labor and successfully pass the period of postnatal rehabilitation.

Observation of women with preeclampsia

If you have signs of pre-eclampsia in the early stages of pregnancy, your doctor can provide the necessary recommendations for their elimination, which will need to be followed for several weeks. For example, to stop working activity, to reduce the level of activity, to give more time for rest, including partial bed rest. Complete bed rest increases the risk of blood clots. In spite of that, they recommended you to reduce activity or adhere to part of the bed rest regime, one thing is clear - you can not fully fulfill your duties, take care of children and remain active.

Perhaps the doctor will advise you to monitor your condition at home on a daily basis, so you will have to ask yourself or someone close to you:

• to measure blood pressure at home
• to do urine test for protein
• control the weight (before weighing go to the toilet and remove slippers)
• watch the fetus move

Record all the results in the diary, indicating the date and time, and show them to the doctor during the planned visit.

Medications for the treatment of preeclampsia

Drugs for the treatment of preeclampsia and high blood pressure can be used to:

• Control of high blood pressure. Reducing pressure does not prevent the progression of the disease, because high blood pressure is only a symptom of the condition, not the cause. The doctor prescribes drugs only when the diastolic pressure exceeds 105 millimeters of mercury. With a slight increase in pressure, a woman should be kept under medical supervision only.
• Preventing seizures. The introduction of magnesium sulfate begins before birth and lasts for 24 hours after them if the pregnant woman has convulsions caused by preeclampsia or in severe form of the disease.
• Acceleration of the fetal lung maturation process. Whenever possible, a pregnant woman is given corticosteroids before the onset of premature birth (up to 34 weeks). This drug contributes to the maturation and opening of the baby's lungs, which reduces the risk of difficulty breathing, which often happens in premature infants.

After childbirth: taking medications during breastfeeding

Choice of drugs

• Drugs that are taken during pregnancy to lower blood pressure:
• Methyldopa (oral drug to control high blood pressure during pregnancy)
• Hydralazine (an intravenous drug for rapid lowering of high blood pressure during pregnancy)
• Labetalol (an intravenous drug for rapid lowering of high blood pressure in hospital treatment or an oral medication to control home pressure)
• Nifedipine (oral drug for rapid lowering of high blood pressure during pregnancy)
• Magnesium sulfate is the most commonly prescribed drug for preventing eclampsia (seizures) during pregnancy.
• Steroid drugs (betamethasone and dexamethasone) are prescribed for the rapid maturation of fetal lungs if premature fetal extraction is necessary.

When to seek help from a doctor?

If you have pre-eclampsia, there may be seizures (eclampsia), which can lead to a mother coma and fading of the fetus. It is necessary immediately to call an ambulance in case of an attack in a pregnant woman. Therefore, friends and family members need to know how to help a pregnant woman with pre-eclampsia at the beginning of an attack. Urgently seek medical help if you have symptoms of pre-eclampsia during pregnancy:

• Visual disturbance
• Frequent headaches that progress and a constant headache, which can not be removed with the help of medications.
• Soreness of the abdominal cavity, especially in the upper sector.
• Weight gain of more than 900 grams throughout the day.
• Pain in the shoulders, neck and other upper body parts.

With a mild form of pre-eclampsia, symptoms may be absent, so it is important to visit the doctor regularly for a scheduled examination. You will be measured by blood pressure, a urinalysis is prescribed, on which it is possible to establish the presence of protein and make a diagnosis.

Observation

Symptoms such as heartburn and leg swelling are considered normal during pregnancy and do not always indicate pre-eclampsia. Tell the doctor about it the next time you visit. But if swelling is observed along with other symptoms of pre-eclampsia, seek immediate medical attention.

Who to contact?

For high blood pressure and pre-eclampsia symptoms, refer to:

• midwife
• family doctor
• perinatologist

What should I think about?

To date, it is impossible to say with certainty which of the above listed drugs is most effective in combating high blood pressure during pregnancy. Some drugs should not be taken during pregnancy. Therefore, if you are taking medications to reduce blood pressure and plan to have a baby, be sure to consult a doctor, and if you are pregnant, show your doctor the entire list of medications. Too fast a drop in blood pressure reduces the flow of blood to the placenta, damaging the fetus, so you need to take the medication with a strong increase in pressure, when there is a threat to the life of the mother and child.

Prevention

If you have high blood pressure (hypertension), you can bring it back to normal before the pregnancy begins with the help of sports, a healthy diet with lots of fruits and vegetables, and also keeping the weight that corresponds to your body mass index. Lowering pressure prevents your body from developing pre-eclampsia.

During pregnancy, you should regularly visit a doctor for the early detection of the disease. That's when you need to start treatment on time to prevent the development of severe pre-eclampsia. Recent studies show that calcium supplements and aspirin in small doses contribute to the prevention of the disease, especially among those women who are at risk. They also reduce the risk of developing severe pre-eclampsia and a child with underweight. The recommended daily intake of calcium for a pregnant woman is 1200 mg.

Scientists agree that the use of vitamins C and E does not reduce the risk of developing pre-eclampsia.

[41], [42], [43],