What Is Preeclampsia and How to Manage It

Preeclampsia is a rare, serious condition that is important to watch out for during pregnancy, particularly if you have one of the known risk factors. If you are wondering how common preeclampsia is, it might help to know it only affects about 2 percent to 8 percent of pregnancies.

If you have recently been diagnosed with preeclampsia, it might have come as quite a shock, but you can help yourself feel more in control of the situation simply by learning more about what preeclampsia is.

What Is Preeclampsia?

Preeclampsia is a blood pressure disorder that usually occurs after week 20 of pregnancy in the second or third trimester. A similar condition called postpartum preeclampsia can occur after childbirth.

The high blood pressure of preeclampsia can come on quickly or there can be a slow but steady increase in your blood pressure. The severity can also vary from mild to severe:

• Mild preeclampsia. Even a slight increase in blood pressure can be a sign of preeclampsia; however, as the symptoms are not severe you might not even notice them. Mild preeclampsia will still require close monitoring by a doctor, and your labor may be induced once the pregnancy is full-term.

• Severe preeclampsia. Your blood pressure readings would be very high, and you would probably notice severe symptoms of preeclampsia (more on these below). Severe preeclampsia may require hospitalization. Your doctors will treat your symptoms, but in very rare and extreme cases your labor may need to be induced.

Your healthcare provider will be checking for preeclampsia regularly at your prenatal visits and treating it, if necessary. Most women with preeclampsia go on to have healthy babies.

Eclampsia: It’s easy to confuse preeclampsia with eclampsia. Eclampsia is a more severe and serious condition and involves seizures that are linked to high blood pressure. It usually requires the immediate delivery of the baby, regardless of how far along the pregnancy is.

Postpartum preeclampsia: Postpartum preeclampsia occurs after the delivery of your baby, and you may get it even if you showed no signs of preeclampsia while pregnant. Postpartum preeclampsia symptoms may appear as early as 48 hours after delivery, or up to 6 weeks later. These symptoms are usually the same as for preeclampsia; however, giving birth is the cure for preeclampsia, and the treatment for postpartum preeclampsia is usually medication to lower your blood pressure and to prevent seizures.

What Causes Preeclampsia?

Although it’s not always clear what causes preeclampsia during pregnancy, there are some known risk factors, including if

• this is your first pregnancy

• this is your first pregnancy by a new father

• it’s less than 2 years or more than 10 years between pregnancies

• you had preeclampsia in a previous pregnancy

• you have a family history of preeclampsia

• you have a history of high blood pressure or kidney disease

• you're over 40 years old

• you're carrying twins, triplets, or other multiples

• you have diabetes, a blood clotting disorder, lupus, or migraines

• you're obese

• your pregnancy is a result of IVF.

How to Prevent Preeclampsia

It’s not always possible to avoid preeclampsia, but if you have one of the known risk factors, you can take some precautions.

• Identify and address any risk factors, preferably before you become pregnant. For example, get high blood pressure under control; lose weight if necessary; and if you have diabetes, make sure the condition is well controlled before getting pregnant. Your healthcare provider can advise you on the best steps to take if you have already become pregnant, but have one of these risk factors.

• Some providers may recommend taking a low dosage of aspirin throughout the pregnancy if you are at a high risk.

Signs and Symptoms of Preeclampsia

Signs and symptoms of preeclampsia during pregnancy include:

• A persistent headache

• Seeing spots or other changes in vision

• Pain in the upper abdomen or shoulder

• Nausea and vomiting (in the second half of pregnancy)

• Sudden weight gain

• Sudden swelling in face and hands

• Difficulty breathing

• Decrease in urine output

Some of these symptoms (like swelling, nausea, and headaches) are also normal symptoms of pregnancy, so it can be difficult to tell when something is wrong. Go straight to your healthcare provider or visit the emergency room if you notice preeclampsia warning signs such as severe headaches, severely blurred vision, severe pain in the abdomen, or severe shortness of breath.

How Do Doctors Diagnose Preeclampsia?

Preeclampsia testing usually involves monitoring your blood pressure during prenatal visits. Blood pressure of 140/90 millimeters of mercury or more on two occasions at least four hours apart is abnormal. Make sure you tell your healthcare provider if you have noticed any signs of preeclampsia, as this will assist in making a diagnosis. Your provider may perform further preeclampsia tests such as:

• Blood tests to look at liver function, kidney function, and the level of blood platelets

• Urine analysis to check the amount of protein in your urine

• Fetal ultrasound to monitor your baby's growth, estimate her weight, and check the amount of amniotic fluid

• Non-stress test to check how your baby's heart rate reacts when she moves

• Biophysical profile to measure your baby's breathing, muscle tone, and movement.

Complications Associated With Preeclampsia

Preeclampsia complications might include:

Short-term: HELLP syndrome (a rare, but life-threatening liver disorder), eclampsia (a more severe form of preeclampsia involving seizures), and placental abruption (when the placenta detaches from the uterus wall, causing heavy bleeding).

Long-term: Greater risk of cardiovascular disease, kidney disease, heart attack, stroke, brain injury, and high blood pressure later in life. A higher chance of preeclampsia in the next pregnancy.

Preeclampsia might also have an effect on the baby, specifically a low birth weight. Inducing labor before the pregnancy is full-term is one solution for severe preeclampsia, but the potential health risks for the baby depend on how premature the birth is. It's estimated that 15 percent of premature births in the US are due to preeclampsia. Although preeclampsia is a serious condition that can be fatal if untreated, your healthcare provider will be able to guide you through your treatment options.

Some women wonder if preeclampsia might make a vaginal birth more complicated, but actually, a vaginal birth may be safer than a cesarean section in some cases. Your provider will be able to advise you on the options for your specific situation.

Preeclampsia Treatment Options

Delivering the baby is the only cure for preeclampsia. However, a preterm birth may be dangerous for the baby, in which case your healthcare provider will consider the best treatment options for you, depending on whether you have mild or severe preeclampsia, and how far along your pregnancy is.

• Mild preeclampsia. You may be asked to stay in the hospital, or be treated as an outpatient and asked to monitor your baby’s movements. More frequent prenatal checkups will be required. Your provider may recommend that your labor is induced at week 37.

• Severe preeclampsia. Usually treated in the hospital. If your preeclampsia gets worse, labor may be induced at or after 34 weeks. You may be given medications to help reduce blood pressure and prevent seizures. Corticosteroids may also be given to help improve liver and platelet function, and to help your baby’s lungs mature.

Preeclampsia is a rare and treatable condition that your healthcare provider will be able to monitor and manage. Keep in mind that most women with preeclampsia have healthy babies, and that it's just one of the many risks you need to know about and keep an eye out for during your pregnancy.