What Is Preeclampsia?
Preeclampsia, formerly called toxemia, is when pregnant women have high blood pressure, protein in their urine, and swelling in their legs, feet, and hands. It can range from mild to severe. It usually happens late in pregnancy, though it can come earlier or just after delivery.
Preeclampsia can lead to eclampsia, a serious condition that can have health risks for mom and baby and, in rare cases, cause death. If your preeclampsia leads to seizures, you have eclampsia.
The only cure for preeclampsia is to give birth. Even after delivery, symptoms of preeclampsia can last 6 weeks or more.
You can help protect yourself by learning the symptoms of preeclampsia and by seeing your doctor for regular prenatal care. Catching preeclampsia early may lower the chances of long-term problems for both mom and baby.
In addition to swelling (also called edema), protein in the urine, and blood pressure over 140/90, preeclampsia symptoms include:
- Weight gain over 1 or 2 days because of a large increase in bodily fluid
- Shoulder pain
- Belly pain, especially in the upper right side
- Severe headaches
- Change in reflexes or mental state
- Peeing less or not at all
- Trouble breathing
- Severe vomiting and nausea
- Vision changes like flashing lights, floaters, or blurry vision
Some women with preeclampsia don’t have any symptoms, so it’s important to see your doctor for regular blood pressure checks and urine tests.
When Do Symptoms Show Up?
Preeclampsia can happen as early as 20 weeks into pregnancy, but that’s rare. Symptoms often begin after 34 weeks. In a few cases, symptoms develop after birth, usually within 48 hours of delivery. They tend to go away on their own.
Many experts think preeclampsia and eclampsia happen when a woman’s placenta doesn’t work the way it should, but they don’t know exactly why. Some think poor nutrition or high body fat might contribute. A lack of blood flow to the uterus could play a role. Genes are also a factor.
Other High Blood Pressure Disorders in Pregnancy
Preeclampsia is one of four blood pressure disorders in pregnant women. The other three are:
- Gestational hypertension. This is high blood pressure that starts after the 20th week of pregnancy but doesn’t cause high amounts of protein in a woman’s urine. It usually goes away after delivery.
- Chronic hypertension. This is high blood pressure that starts before a woman gets pregnant or before the 20th week of pregnancy.
- Chronic hypertension with superimposed preeclampsia. This is chronic high blood pressure that gets worse as pregnancy goes on, causing more protein in urine and other complications.
Preeclampsia Risk Factors
Things that can increase your chance of getting preeclampsia include:
- Being a teen or woman over 40
- Being African American
- Being pregnant for the first time
- Having babies less than 2 years apart or more than 10 years apart
- Pregnancy with a new partner instead of the father of your previous children
- High blood pressure before getting pregnant
- A history of preeclampsia
- A mother or sister who had preeclampsia
- A history of obesity
- Carrying more than one baby
- In-vitro fertilization
- A history of diabetes, kidney disease, lupus, or rheumatoid arthritis
Preeclampsia can keep your placenta from getting enough blood, which can cause your baby to be born very small. This is called fetal growth restriction.
It’s also one of the most common causes of premature births and the complications that can follow, including learning disabilities, epilepsy, cerebral palsy, and hearing and vision problems.
Preeclampsia can cause rare but serious complications that include:
- Fluid buildup in your chest
- Heart failure
- Reversible blindness
- Bleeding from your liver
- Bleeding after you've given birth
When preeclampsia or eclampsia damages your liver and blood cells, you can get a complication called HELLP syndrome. That stands for:
- Hemolysis. This is when the red blood cells that carry oxygen through your body break down.
- Elevated liver enzymes. High levels of these chemicals in your blood mean liver problems.
- Low platelet counts. This is when you don’t have enough platelets, so your blood doesn’t clot the way it should.
HELLP syndrome is a medical emergency. Call 911 or go to the emergency room if you have symptoms including:
- Blurry vision
- Chest or belly pain
- Upset stomach or vomiting
- Swelling in your face or hands
- Bleeding from your gums or nose
Preeclampsia can also cause your placenta to suddenly separate from your uterus, which is called placental abruption. This can lead to stillbirth.
You have preeclampsia if you have high blood pressure and at least one of these other signs:
- Too much protein in your urine
- Not enough platelets in your blood
- High levels of kidney-related chemicals in your blood
- High levels of liver-related chemicals in your blood
- Fluid in your lungs
- A new headache that doesn’t go away when you take medication
To confirm a diagnosis, your doctor might give you tests including:
- Blood tests to check your platelets and to look for kidney or liver chemicals
- Urine tests to measure proteins
- Ultrasounds, nonstress tests, or biophysical profiles to see how your baby is growing
The only cure for preeclampsia and eclampsia is to give birth. Your doctor will talk with you about when to deliver based on how far along your baby is, how well your baby is doing in your womb, and the severity of your preeclampsia.
If your baby has developed well, usually by 37 weeks or later, your doctor may want to induce labor or do a cesarean section. This will keep preeclampsia from getting worse.
If your baby isn’t close to term, you and your doctor may be able to treat mild preeclampsia until your baby has developed enough to be safely delivered. The closer the birth is to your due date, the better it is for your baby.
If you have mild preeclampsia, also known as preeclampsia without severe features, your doctor may prescribe:
- Bed rest, either at home or in the hospital; resting mostly on your left side
- Careful monitoring with a fetal heart rate monitor and frequent ultrasounds
- Medicines to lower your blood pressure
- Blood and urine tests
Your doctor also may tell you to stay in the hospital so they can watch you closely. In the hospital, you might get:
- Medicine to help prevent seizures, lower your blood pressure, and prevent other problems
- Steroid injections to help your baby's lungs develop faster
Other treatments include:
- Injections of magnesium to prevent eclampsia-related seizures
- Hydralazine or another blood pressure drug
For severe preeclampsia, your doctor may need to deliver your baby right away, even if you're not close to term. Afterward, symptoms of preeclampsia should go away within 1 to 6 weeks but could last longer.
If you have a greater chance of getting preeclampsia, talk to your doctor about making lifestyle changes that can help keep you healthy. You might need to:
- Lose some weight if you’re overweight
- Stop smoking
- Exercise regularly
- Get your blood pressure or blood sugar under control
Your doctor might also tell you to take a low-dose (81 milligram) aspirin each day. But don’t take any medications, vitamins, or supplements without talking to them first.