Preeclampsia

Overview

What is preeclampsia?

Preeclampsia is a serious blood pressure condition that develops during pregnancy. People with preeclampsia often have high blood pressure (hypertension) and high levels of protein in their urine (proteinuria). Preeclampsia typically develops after the 20th week of pregnancy. It can also affect other organs in the body and be dangerous for both the mom and her developing fetus (unborn baby). Because of these risks, preeclampsia needs to be treated by a healthcare provider.

What happens when you have preeclampsia?

When you have preeclampsia, your blood pressure is elevated (higher than 140/90 mmHg), and you may have high levels of protein in your urine. Preeclampsia puts stress on your heart and other organs and can cause serious complications. It can also affect the blood supply to your placenta, impair liver and kidney function or cause fluid to build up in your lungs. The protein in your urine is a sign of kidney dysfunction.

How common is preeclampsia?

Preeclampsia is a condition unique to pregnancy that complicates up to 8% of all deliveries worldwide. In the United States, it's the cause of about 15% of premature deliveries (delivery before 37 weeks of pregnancy).

Who gets preeclampsia?

Preeclampsia may be more common in first-time mothers. Healthcare providers are not entirely sure why some people develop preeclampsia. Some factors that may put you at a higher risk are:

Symptoms and Causes

What are the symptoms?

Many people with preeclampsia do not have any symptoms. For those that do, some of the first signs of preeclampsia are high blood pressure, protein in the urine and retaining water (this can cause weight gain and swelling).

Other signs of preeclampsia include:

  • Headaches.
  • Blurry vision or light sensitivity.
  • Dark spots appearing in your vision.
  • Right side abdominal pain.
  • Swelling in your hands and face (edema).
  • Shortness of breath.

It's essential to share all of your pregnancy symptoms with your healthcare provider. Many people are unaware they have preeclampsia until their blood pressure and urine are checked at a prenatal appointment.

Severe preeclampsia may include symptoms like:

  • Hypertensive emergency (blood pressure is 160/110 mmHg or higher).
  • Decreased kidney or liver function.
  • Fluid in the lungs.
  • Low blood platelet levels (thrombocytopenia).
  • Decreased urine production

If your preeclampsia is severe, you may be admitted to the hospital for closer observation or need to deliver your baby as soon as possible. Your healthcare provider may give you medications for high blood pressure or to help your baby's lungs develop before delivery.

What causes preeclampsia?

No one is entirely sure. Preeclampsia is believed to come from a problem with the health of the placenta (the organ that develops in the uterus during pregnancy and is responsible for providing oxygen and nutrients to the fetus). The blood supply to the placenta might be decreased in preeclampsia, and this can lead to problems with both you and the fetus.

Does stress cause preeclampsia?

While stress may impact blood pressure, stress is not one of the direct causes of preeclampsia. While some stress is unavoidable during pregnancy, avoiding high-stress situations or learning to manage your stress is a good idea.

What week of pregnancy does preeclampsia start?

Preeclampsia typically occurs after 20 weeks of pregnancy, but it can come earlier. Most preeclampsia occurs at or near term (37 weeks gestation). Preeclampsia can also come after delivery (postpartum preeclampsia), which usually occurs between the first few days to one week after delivery. In rare cases, it begins weeks after delivery.

Will preeclampsia affect my baby?

Preeclampsia can cause preterm delivery (your baby needing delivered early). Premature babies are at increased risk for health complications like low birth weight and respiratory issues.

Diagnosis and Tests

How is it diagnosed?

Preeclampsia is often diagnosed during routine prenatal appointments when your healthcare provider checks your weight gain, blood pressure and urine.

If preeclampsia is suspected, your healthcare provider may:

  • Order additional blood tests to check kidney and liver functions.
  • Suggest a 24-hour urine collection to watch for proteinuria.
  • Perform an ultrasound and other fetal monitoring to look at the size of your baby and assess the amniotic fluid volume.

Preeclampsia can be categorized as mild or severe. You may be diagnosed with mild preeclampsia if you have high blood pressure plus high levels of protein in your urine.

You are diagnosed with severe preeclampsia if you have symptoms of mild preeclampsia plus:

  • Signs of kidney or liver damage (seen in blood work).
  • Low platelet count
  • Fluid in your lungs.
  • Headaches and dizziness.
  • Visual impairment or seeing spots.

Management and Treatment

How is preeclampsia treated?

Your healthcare provider will advise you on the best way to treat preeclampsia. Treatment generally depends on how severe your preeclampsia is and how far along you are in pregnancy.

If you're close to full term (37 weeks pregnant or greater), your baby will probably be delivered early. You can still have a vaginal delivery, but sometimes a Cesarean delivery (C-section) is recommended. Your healthcare provider may give you medication to help your baby's lungs develop and manage your blood pressure until the baby can be delivered. Sometimes it is safer to deliver the baby early than to risk prolonging the pregnancy.

When preeclampsia develops earlier in pregnancy, you'll be monitored closely in an effort to prolong the pregnancy and allow for the fetus to grow and develop. You'll have more prenatal appointments, including ultrasounds, urine tests and blood draws. You may be asked to check your blood pressure at home. If you are diagnosed with severe preeclampsia, you could remain in the hospital until you deliver your baby.

If the preeclampsia worsens or becomes more severe, your baby will need to be delivered.

During labor and following delivery, people with preeclampsia are often given magnesium intravenously (directly into the vein) to prevent the development of eclampsia (seizures from preeclampsia).

Is there a cure for preeclampsia?

No, there isn't a cure for preeclampsia. Preeclampsia can only be cured with delivery. Your healthcare provider will still want to monitor you for several weeks after delivery to make sure your symptoms go away.

Prevention

How can I reduce my risk of getting preeclampsia?

For people with risk factors, there are some steps that can be taken prior to and during pregnancy to lower the chance of developing preeclampsia. These steps can include:

  • Losing weight if you have overweight/obesity (prior to pregnancy-related weight gain).
  • Controlling your blood pressure and blood sugar (if you had high blood pressure or diabetes prior to pregnancy).
  • Maintaining a regular exercise routine.
  • Getting enough sleep.
  • Eating healthy foods that are low in salt and avoiding caffeine.

Can you prevent preeclampsia?

Taking a baby aspirin daily has been demonstrated to decrease your risk of developing preeclampsia by approximately 15%. If you have risk factors for preeclampsia, your healthcare provider may recommend starting aspirin in early pregnancy (by 12 weeks gestation).

Outlook / Prognosis

What are the most common complications of preeclampsia?

If left untreated, preeclampsia can be potentially fatal to both you and your baby.

Before delivery, the most common complications are preterm birth, low birth weight or placental abruption.

Preeclampsia can cause HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count). This happens when preeclampsia damages your liver and red blood cells and interferes with blood clotting. Other signs of HELLP syndrome are blurry vision, chest pain, headaches and nosebleeds.

After you've delivered your baby, you may be at an increased risk for:

  • Kidney disease.
  • Heart attack.
  • Stroke.
  • Developing preeclampsia in future pregnancies.

Does preeclampsia go away after delivery?

Preeclampsia typically goes away within days to weeks following delivery. Sometimes, your blood pressure can remain high for a few weeks after delivery, requiring treatment with medication. Your healthcare provider will work with you after your pregnancy to manage your blood pressure. People with preeclampsia — particularly those who develop the condition early in pregnancy — are at greater risk for high blood pressure (hypertension) and heart disease later in life. Knowing this information, those women can work with their primary care provider to take steps to reduce these risks.

Living With

When should I see my healthcare provider?

Preeclampsia can be a fatal condition during pregnancy. If you're being treated for this condition, make sure to see your healthcare provider for all of your appointments and blood or urine tests. Contact your obstetrician if you have any concerns or questions about your symptoms.

Go to the nearest hospital if you're pregnant and experience the following:

  • Symptoms of a seizure-like twitching or convulsing.
  • Shortness of breath.
  • Sharp pain in your abdomen (specifically the right side).
  • Blurry vision.
  • Severe headache that won't go away.
  • Dark spots in your vision that don't go away.

What questions should I ask my doctor?

If your healthcare provider has diagnosed you with preeclampsia, it's normal to have concerns. Some common questions to ask your healthcare provider are:

  • Do I need to take medication?
  • Do I need to restrict my activities?
  • What changes should I make to my diet?
  • How are you planning to monitor me and my baby now that I have preeclampsia?
  • Will I need to deliver my baby early?
  • How can I best manage preeclampsia?

Frequently Asked Questions

What's the difference between preeclampsia and eclampsia?

Eclampsia is severe preeclampsia that causes seizures. It's considered a complication of preeclampsia, but it can happen without signs of preeclampsia. In rare cases, it can lead to coma, stroke or death.

What is postpartum preeclampsia?

Postpartum preeclampsia is when you develop preeclampsia after your baby is born. It typically happens within two days of giving birth but can also develop several weeks later. The signs of postpartum preeclampsia are similar to preeclampsia and include swelling in your limbs and extremities, headaches, seeing spots, stomach pains and nausea. It's a serious condition that can cause seizures, stroke and organ damage.

A note from Cleveland Clinic

Preeclampsia is a serious condition that you may not be aware you even have. It's important to go to all your prenatal appointments and be open about all the symptoms you feel during pregnancy. When preeclampsia is caught early, it can be treated and managed to keep both you and your baby safe and healthy. Most people with preeclampsia go on to have healthy babies.

Last reviewed by a Cleveland Clinic medical professional on 10/14/2021.

References

  • American Pregnancy Association. Preeclampsia. (https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/preeclampsia/) Accessed 10/29/2021.
  • The American College of Obstetricians and Gynecologists. Preeclampsia and High Blood Pressure During Pregnancy. (https://www.acog.org/womens-health/faqs/preeclampsia-and-high-blood-pressure-during-pregnancy?utm_source=redirect&utm_medium=web&utm_campaign=otn#gestational) Accessed 10/29/2021.
  • Merck Manual. Preeclampsia and Eclampsia. (https://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/preeclampsia-and-eclampsia) Accessed 10/29/2021.
  • March of Dimes. Preeclampsia. (https://www.marchofdimes.org/complications/preeclampsia.aspx) Accessed 10/29/2021.
  • Preeclampsia Foundation. Various Pages. (https://preeclampsia.org/) Accessed 10/29/2021.

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