Eclampsia: perspective on the possible repercussions on the child's health

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INTRODUÇÃO
Pregnancy is a period of intense physiological and psychological changes for women, which requires special care to ensure maternal and fetal health.However, some complications may arise during pregnancy, putting both lives at risk.One of these complications is eclampsia, a multifactorial and multisystemic syndrome, which is characterized by the presence of high blood pressure, proteinuria and edema during pregnancy, associated with seizures or coma.Eclampsia is one of the leading causes of perinatal morbidity and mortality worldwide, affecting between 1.5 and 16.7% of pregnancies, and resulting in 60,000 maternal deaths and more than 500,000 premature births each year.In Brazil, eclampsia contributes to a quarter of all registered maternal deaths, being the main cause of maternal death.
In addition to the serious damage to women's health, eclampsia can also have repercussions on the child's health, both in the short and long term.Eclampsia can cause placental insufficiency, which compromises the supply of oxygen and nutrients to the fetus, leading to prematurity, low birth weight, intrauterine growth restriction and small for gestational age⁵.These conditions increase the risk of perinatal and neonatal mortality, as well as neonatal complications such as asphyxia, hypoglycemia, jaundice, infection, hemorrhage, and seizures.Eclampsia can also cause brain damage in the fetus, which can result in intracranial hemorrhage, cerebral palsy, delayed neuropsychomotor development, cognitive deficits, behavioral problems, low quality of life and lower school performance.Furthermore, exposure to eclampsia can program metabolic and vascular changes in the child, which increase the risk of cardiovascular and kidney diseases in adulthood.
Preventing eclampsia involves identifying risk factors, such as maternal age, obesity, diabetes, kidney disease, thrombophilia, multiple pregnancy, among others.Furthermore, adequate prenatal care is important, with blood pressure measurement, laboratory and imaging tests, and use of medications, such as aspirin and magnesium sulfate, when indicated.Prevention also includes promoting healthy lifestyle habits,

Eclampsia: perspective on the possible repercussions on the child's health
Hortência Louzada Carotini¹, et.al. Articles that presented any of the following ineligibility criteria were excluded from the review: they did not address the outcomes of interest or measured them inappropriately or inaccurately; had insufficient, incomplete or overlapping samples; presented selection, confounding or information bias; they were reviews, case reports, letters to the editor or conference abstracts; were unavailable in full or in one of the selected languages.

RESULTADOS
16 studies were selected.Pre-eclampsia is a disease that affects between 2% and 8% of pregnancies, being more common in primigravidae, multiple pregnancies, late pregnancies, pregnancies with an egg donor, pregnancies with pre-existing diseases, such as diabetes, hypertension, obesity, kidney diseases, thrombophilias, among others.
Pre-eclampsia is characterized by the presence of arterial hypertension, equal to or greater than 140 x 90 mmHg, and proteinuria, equal to or greater than 300 mg in 24 hours, after the 20th week of pregnancy, in previously normotensive women.Preeclampsia can be classified as mild or severe, according to the presence of serious signs and symptoms, such as headache, visual changes, epigastric pain, nausea, vomiting, oliguria, pulmonary edema, laboratory changes, such as thrombocytopenia, elevated transaminases, creatinine, uric acid, among others.
Furthermore, eclampsia is the most severe form of pre-eclampsia, which is manifested by seizures or coma, which cannot be attributed to other neurological causes.Eclampsia can occur before, during or after childbirth, being more common in the third trimester of pregnancy or in the first 48 hours of the postpartum period.
Eclampsia is an obstetric emergency, which requires immediate and specialized care, as it can lead to maternal and fetal death, due to causes such as cerebral hemorrhage, pulmonary edema, renal failure, disseminated intravascular coagulation, placental abruption, among others.The incidence of eclampsia varies according to socioeconomic level and access to health services, being higher in low-and middle-income countries, where it can reach 10 cases per 1,000 live births.
Therefore, eclampsia can affect the child's health in several ways, both in the short and long term.In the short term, eclampsia can cause placental insufficiency, which compromises the supply of oxygen and nutrients to the fetus, leading to prematurity, low birth weight, intrauterine growth restriction and small for gestational age.These conditions increase the risk of perinatal and neonatal mortality, as well as neonatal complications such as asphyxia, hypoglycemia, jaundice, infection, hemorrhage, and seizures.Eclampsia can also cause brain damage in the fetus, which can result in intracranial hemorrhage, cerebral palsy, delayed neuropsychomotor development, cognitive impairment, behavior problems, low quality of life and lower school performance.
In the long term, eclampsia can cause metabolic and vascular changes in the child, which increase the risk of cardiovascular and kidney diseases in adulthood.Studies show that children born to mothers with eclampsia have a higher prevalence of high blood pressure, obesity, dyslipidemia, insulin resistance, diabetes, chronic kidney disease, among others.These changes can be explained by the fetal programming hypothesis, which postulates that the intrauterine environment can influence gene expression and the physiology of developing organs, determining susceptibility to diseases in adult life.Thus, exposure to eclampsia can induce a state of oxidative stress, inflammation, endothelial dysfunction and altered hormonal signaling, which can affect the child's metabolism and cardiovascular and renal function.
Preventing eclampsia is essential to reduce maternal and perinatal morbidity and mortality, as well as the repercussions on the child's health.To do this, it is necessary to identify the risk factors that may predispose to pre-eclampsia and eclampsia, such as: advanced or early maternal age, obesity, diabetes, chronic hypertension, kidney disease, thrombophilia, multiple pregnancy, pregnancy with an egg donor , between others.
These factors must be assessed at the first prenatal consultation and monitored throughout pregnancy, so that risk can be stratified and appropriate care can be planned.
Adequate prenatal care is essential to prevent eclampsia, as it allows early detection of signs and symptoms of pre-eclampsia, such as high blood pressure, Promoting healthy lifestyle habits is another preventive measure for eclampsia, as it contributes to improving maternal and fetal health.Among healthy lifestyle habits, the following stand out: a balanced diet, rich in fruits, vegetables, legumes, whole grains, lean proteins and good fats, and low in salt, sugar, saturated and trans fats, and processed and ultra-processed foods; regular, moderate and targeted physical activity, which can improve blood circulation, blood pressure, glycemic control, body weight, mood and self-esteem; smoking cessation, which is a risk factor for pre-eclampsia and eclampsia, in addition to other complications during pregnancy, such as miscarriage, intrauterine growth restriction, placental abruption, premature birth, among others; and stress control, which can negatively affect maternal and fetal health, increasing the release of hormones such as cortisol and adrenaline, which can raise blood pressure, alter placental blood flow, harm fetal development and increase the risk of premature birth .
Early diagnosis of eclampsia is crucial to avoid maternal and fetal complications, as it allows for timely intervention and adequate management of the condition.Early diagnosis depends on clinical suspicion, based on the woman's signs and symptoms, which must be evaluated during the prenatal consultation or at any other time the woman seeks medical care.The signs and symptoms of eclampsia are the same as those of severe pre-eclampsia, plus seizures or coma, which cannot be attributed to other neurological causes.The signs and symptoms of severe pre-eclampsia are: blood pressure equal to or greater than 160 x 110 mmHg, proteinuria equal to or greater than The selection of articles was made according to the PRISMA flowchart, following the steps of identification, screening, eligibility and inclusion.The identification of articles was carried out by searching the databases and consulting the references of the selected articles.Articles were screened by reading titles and abstracts, eliminating duplicates and clearly irrelevant ones.Article eligibility was determined by reading the Eclampsia: perspective on the possible repercussions on the child's health Hortência Louzada Carotini¹, et.al. Brazilian Journal of Implantology and Health Sciences Volume 6, Issue 3 (2024), Page 262-277.full texts, applying the inclusion and exclusion criteria.The inclusion of articles was made by the final selection of relevant articles for the review.The selection of articles was carried out by two independent reviewers, who resolved any disagreements by consensus or by consulting a third reviewer.

Eclampsia: perspective on
the possible repercussions on the child's health Hortência Louzada Carotini¹, et.al. Brazilian Journal of Implantology and Health Sciences Volume 6, Issue 3 (2024), Page 262-277.proteinuria, edema, headache, visual changes, abdominal pain, nausea, vomiting, among others.Prenatal care should be started as early as possible and follow recommendations regarding the frequency and quality of consultations, laboratory and imaging tests, and guidance on pregnancy and childbirth4.Prenatal care should also include the use of medications that can prevent or delay the progression of preeclampsia and eclampsia, such as aspirin and magnesium sulfate, when indicated by the doctor.
as a balanced diet, physical activity, smoking cessation and stress control.Scielo and Web of Science databases, using the following descriptors: eclampsia, child health, child development, child outcome and child morbidity.The search strategy was adapted for each database, using the Boolean operators AND and OR, language and publication date filters, and the terms MeSH, DeCS or Keywords, when applicable.The search was carried out in January 2024 and limited to articles published in the last 10 years, in Portuguese, Brazilian Journal of Implantology and Health Sciences Volume 6, Issue 3 (2024), Page 262-277.such Treatment must be carried out in a reference center, with a multidisciplinary team and appropriate equipment.The continuous assessment of eclampsia covers the perinatal, postpartum and postnatal period, considering the clinical, neurological, cognitive, behavioral and social aspects of the woman and child.Perinatal assessment involves monitoring fetal wellbeing, with cardiotocography, fetal biophysical profile, Doppler velocimetry and ultrasound.Postpartum assessment involves monitoring the woman's blood pressure, vital signs, laboratory tests, diuresis and lactation.Postnatal assessment involves monitoring the child's growth, development, cognition, behavior, quality of life and risk factors for chronic diseases.The objective of this systematic literature review is to identify and analyze scientific articles that investigated the effects of eclampsia on children's health, from birth to school age, considering clinical, neurological, cognitive, behavioral and social aspects.Eclampsia: perspective on the possible repercussions on the child's health Hortência Louzada Carotini¹, et.al. Brazilian Journal of Implantology and Health Sciences Volume 6, Issue 3 (2024), Page 262-277.METODOLOGIA This systematic literature review was conducted in accordance with the PRISMA checklist.A comprehensive search was carried out in the PubMed, Articles that met the following eligibility criteria were included in the review: (1) they evaluated children born to mothers with eclampsia, compared or not with children born to mothers without eclampsia or with pre-eclampsia; (2) measured some outcome related to the child's health, such as mortality, morbidity, growth, neuropsychomotor development, cognition, behavior, quality of life or risk factors for chronic diseases; (3) used any observational study design, such as cohort, case-control, or cross-sectional; (4) presented original, primary and quantitative data; (5) provided sufficient information to extract data or obtain information from authors.