Preeclampsia is a serious blood pressure condition that can develop during pregnancy or shortly after birth. It affects roughly one in 25 pregnancies in the United States and is a leading cause of maternal and infant illness. It can progress quickly, but with regular prenatal checks and quick action on warning signs, most women and babies do well.
What preeclampsia is
Preeclampsia usually develops after 20 weeks of pregnancy. It is diagnosed when a woman who previously had normal blood pressure develops high blood pressure (140/90 mmHg or higher) along with signs that other organs are affected, such as protein in the urine, low platelets, abnormal liver or kidney tests, fluid in the lungs, or new headaches or vision changes.
The exact cause is not fully understood, but it begins with problems in how the placenta develops and connects to the mother’s blood supply.
Warning signs
Some women have no symptoms, which is why blood pressure and urine checks at every prenatal visit are so important. Call your provider promptly or go to labor and delivery if you notice:
- A severe headache that does not go away with acetaminophen and rest
- Vision changes: blurred vision, flashing lights, spots or temporary loss of vision
- Pain in the upper right abdomen or under the ribs
- Nausea or vomiting in the second half of pregnancy
- Sudden swelling of the face, hands or around the eyes
- Sudden weight gain of more than about 2 to 5 pounds in a week
- Shortness of breath
- Confusion or a feeling that something is wrong
Some swelling of the feet and ankles is normal in pregnancy. Sudden or severe swelling, especially of the face and hands, is not.
Postpartum preeclampsia
Preeclampsia can also develop after birth, most often within the first week but sometimes up to six weeks later, even if blood pressure was normal during pregnancy. The warning signs are the same. Do not ignore a severe headache, vision changes or breathlessness in the weeks after delivery. Tell any doctor or emergency staff that you recently gave birth.
Who is at higher risk
High-risk factors:
- Preeclampsia in a previous pregnancy
- Pregnancy with twins or more
- Chronic high blood pressure
- Type 1 or type 2 diabetes before pregnancy
- Kidney disease
- Autoimmune conditions such as lupus or antiphospholipid syndrome
Keep reading
The rest of this guide is free. Watch a short ad to unlock it and support independent health writing.
Preparing your ad…
Moderate-risk factors:
- First pregnancy
- Obesity
- Age 35 or older
- Family history of preeclampsia (mother or sister)
- Black race, reflecting the effects of racism and health inequities rather than biology
- Lower income
- Pregnancy through IVF
- More than 10 years since a previous pregnancy
Prevention with low-dose aspirin
The U.S. Preventive Services Task Force recommends low-dose aspirin (81 mg a day) starting after 12 weeks of pregnancy for women at high risk of preeclampsia. It is also considered for women with more than one moderate risk factor. Aspirin lowers the risk of preeclampsia, preterm birth and growth problems in the baby. Do not start aspirin in pregnancy without talking to your provider.
Other helpful steps include attending all prenatal visits, managing blood pressure and diabetes, and, if recommended, monitoring your blood pressure at home.
Complications
Without treatment, preeclampsia can lead to:
- Eclampsia: seizures
- HELLP syndrome: breakdown of red blood cells, raised liver enzymes and low platelets
- Stroke
- Kidney, liver or lung problems
- Placental abruption, where the placenta separates early
- Restricted growth of the baby and preterm birth
Treatment
The only cure is delivery of the baby and placenta. Treatment depends on how severe the condition is and how far along the pregnancy is:
- Close monitoring of blood pressure, blood tests, urine and the baby’s growth and well-being
- Blood pressure medicines safe in pregnancy, such as labetalol or nifedipine
- Magnesium sulfate to prevent seizures in severe preeclampsia
- Corticosteroid injections to help the baby’s lungs mature if early delivery is likely
- Delivery, usually recommended at 37 weeks for preeclampsia without severe features, or earlier if the condition is severe
Long-term health after preeclampsia
Preeclampsia is now recognized as an early warning sign for heart disease. Women who have had it have a higher risk of high blood pressure, heart disease, stroke and kidney disease later in life. Tell your doctor about your history, have your blood pressure checked regularly, and focus on heart-healthy habits for years afterward.
The bottom line
Preeclampsia can develop quickly in the second half of pregnancy or in the weeks after birth. A severe headache, vision changes, upper abdominal pain, sudden swelling or breathlessness need same-day medical care. Low-dose aspirin can help prevent it in women at higher risk, and regular prenatal checks catch most cases early.
This article is for general information and does not replace advice from your obstetric provider. If you have warning signs, call your provider or go to labor and delivery right away.