Preeclampsia is a serious blood pressure disorder that can affect all of the organs in a woman’s body. A woman has preeclampsia when she has high blood pressure and other signs that her organ systems are not working normally. One of these signs is proteinuria (an abnormal amount of protein in the urine). A woman with preeclampsia whose condition is worsening will develop other signs and symptoms known as “severe features.” These include a low number of platelets in the blood, abnormal kidney or liver function, pain over the upper abdomen, changes in vision, fluid in the lungs, or a severe headache. A very high blood pressure reading is also considered a severe feature.
When does preeclampsia occur?
Preeclampsia usually occurs after 20 weeks of pregnancy, typically in the third trimester. When it occurs before 32 weeks of pregnancy, it is called early-onset preeclampsia. It also can occur in the postpartum period.
Causes of preeclampsia
It is not clear why some women develop preeclampsia, but the risk of developing the condition is increased in women who:
- are pregnant for the first time
- have had preeclampsia in a previous pregnancy or have a family history of preeclampsia
- have a history of chronic hypertension, kidney disease, or both
- are 40 years of age or older
- are carrying more than one baby
- have certain medical conditions such as diabetes mellitus, thrombophilia or lupus
- are obese
- had in vitro fertilization
Signs and symptoms of preeclampsia
- swelling of face or hands
- a headache that will not go away
- seeing spots or changes in eyesight
- pain in the upper abdomen or shoulder
- nausea and vomiting (in the second half of pregnancy)
- sudden weight gain
- difficulty breathing
Risks for the baby when preeclampsia occurs
If preeclampsia occurs during pregnancy, your baby may need to be delivered right away, even if he or she is not fully grown. Preterm babies have an increased risk of serious complications. Some preterm complications last a lifetime and require ongoing medical care. Babies born very early may also die.
Risks for the woman when preeclampsia occurs
Women who have had preeclampsia, especially those whose babies were born preterm, have an increased risk later in life of cardiovascular disease and kidney disease, including heart attack, stroke and high blood pressure. Having preeclampsia once increases the risk of having it again in a future pregnancy. Preeclampsia can also lead to seizures, a condition called eclampsia. It can also lead to HELLP syndrome, a sever type of preeclampsia.
HELLP stands for hemolysis, elevated liver enzymes and low platelet count. In this condition, red blood cells are damaged or destroyed, blood clotting is impaired and the liver can bleed internally, causing chest or abdominal pain. HELLP syndrome is a medical emergency. Women can die from HELLP syndrome or have lifelong health problems as a result.
Managing mild gestational hypertension or preeclampsia without severe features
Management of mild gestational hypertension or preeclampsia without severe features may take place either in a hospital or on an outpatient basis. You may be asked to keep track of your baby’s movements by doing a daily kick count and to measure your blood pressure at home. Beaumont’s myBeaumontBaby mobile app has tracking features that can help you share this information with your doctor. You will need to see your health care provider at least weekly and sometimes twice weekly. Once you reach 37 weeks of pregnancy, it may be recommended that you have your baby. If test results show that the baby is not doing well, you may need to have the baby earlier.
Managing preeclampsia with severe features
Preeclampsia with severe features usually is treated in a hospital by a maternal-fetal medicine physician, who specializes in high risk or complicated pregnancy. If you are at least 34 weeks pregnant, it is often recommended that you have your baby as soon as your condition is stable. If you are less than 34 weeks pregnant and your condition is stable, it may be possible to wait to deliver your baby. Corticosteroids may be given to help the baby’s lungs mature, and you most likely will be given medications to help reduce your blood pressure and to help prevent seizures. If your condition or the baby’s condition worsens, prompt delivery will be needed.
Prevention of preeclampsia involves identifying whether you have risk factors for preeclampsia and taking steps to address these factors. If you have hypertension and are planning a pregnancy, see your health care provider for a pre-pregnancy check-up to find out whether your hypertension is under control and whether it has affected your health. If you are overweight, weight loss is usually advised before pregnancy. If you have a medical condition, such as diabetes, it is usually recommended that your condition be well controlled before you become pregnant.
Adapted from the American College of Obstetrics and Gynecologists FAQ034 Pregnancy; Preeclampsia and High Blood Pressure During Pregnancy.