Preeclampsia

Pregnancy causes many changes in the body, especially with blood flow and the development of the placenta — the organ that nourishes the baby. Sometimes these changes can cause health complications like preeclampsia. It’s important to remember that this health condition is not the result of lifestyle choices or anything that the expectant parent has done. It's a complex medical condition that happens due to a combination of factors, and AHN is here to help.

What is preeclampsia?

Preeclampsia is persistent high blood pressure that develops during pregnancy or the postpartum period and is often associated with high levels of protein in the urine or the new development of decreased blood platelets, trouble with the kidneys or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances. It's characterized primarily by high blood pressure, which is defined as 140/90 mmHg or higher, or a significant rise from a person's usual baseline. The exact cause of preeclampsia is not fully understood, but it's widely believed to originate in the placenta. It's thought that the blood vessels within the placenta don't develop or function as they should, which leads to reduced blood flow to this vital organ.

Preeclampsia can cause other health issues. Beyond just elevated blood pressure, preeclampsia also signifies damage to other organ systems, most commonly the liver and kidneys. If not properly managed, this condition can lead to severe, even fatal, consequences for both the pregnant individual and the baby.

Rest assured that the providers you see at AHN are highly experienced and skilled in treating and managing preeclampsia. The health of you and your baby are our top concerns, and your care team is dedicated to managing and treating this condition.

Preeclampsia can range in severity. Severe preeclampsia is diagnosed when blood pressure reaches extremely high levels, such as 160/110 mmHg or higher, or when there are more pronounced signs of organ damage or severe symptoms. Untreated, preeclampsia can lead to dangerous complications like eclampsia, where the mother experiences seizures; HELLP syndrome, a severe form involving the breakdown of red blood cells, elevated liver enzymes, and low platelets; stroke due to uncontrolled high blood pressure; or placental abruption, where the placenta detaches from the uterus. For the baby, preeclampsia can result in fetal growth restriction due to reduced blood flow, and often necessitates preterm birth, as delivery is frequently the only definitive cure for the mother's condition.

Preeclampsia affects approximately 2% to 8% of all pregnancies globally. In the United States, it is seen in about 3% to 5% of pregnancies. Although these percentages might seem small, they represent a significant number of individuals and their babies impacted each year, making preeclampsia a leading cause of maternal and infant illness and mortality worldwide, particularly in regions with limited medical resources. Given its potential severity, early identification and careful management are absolutely critical to improving outcomes for both the mother and her baby.

Preeclampsia care at AHN: Why choose us?

If you are facing preeclampsia, you need a highly competent, well-coordinated, and communicative care team within a facility equipped for complex maternal and neonatal care, all delivered with genuine empathy. AHN provides a combination of specialized medical expertise, comprehensive support, and clear communication, given the serious nature of the condition. At AHN, you can expect:

• Specialized expertise in high-risk obstetrics: We have demonstrated experience in managing complex pregnancies, specifically hypertensive disorders like preeclampsia.
• Comprehensive and multidisciplinary care team: Our team extends beyond the obstetrician to include nephrologists (kidney doctor), cardiologists, neurologists, and intensivists (critical care doctor), as needed. Our strong, experienced nursing team dedicated to high-risk pregnancy monitoring.
• Advanced monitoring and diagnostic capabilities: We have access to the latest technology for both maternal and fetal surveillance including:
  • Sophisticated blood pressure monitoring systems
  • Advanced laboratory testing for kidney, liver, and blood parameters
  • Continuous fetal monitoring and specialized ultrasound capabilities for assessing fetal growth and well-being
• Clear communication and a proactive management plan: Our providers clearly explain the condition, potential risks, and treatment rationales in an understandable way.
• Empathy and emotional support: Our compassionate providers listen to concerns and validate the patient's emotional experience. Our focus is on patient-centered care, treating the individual holistically.

Preeclampsia symptoms and signs

Knowing the common symptoms and signs of preeclampsia can be critical to early detection, intervention, and monitoring. It’s important to remember that not everyone will have all symptoms and signs, and some can be mistaken for normal pregnancy discomforts. This is why regular prenatal checkups are so crucial, as your health care provider will be monitoring for these signs even if you don't feel them yourself. Some of the most common symptoms of preeclampsia include:

• Persistent headache: This isn't just a regular headache; it's often severe, doesn't go away with typical pain relievers like Tylenol, and can feel like it's throbbing or pounding.
• Vision changes: This can include blurry vision, seeing spots or flashing lights, or even experiencing temporary loss of vision.
• Swelling (edema), especially in the hands and face: While some swelling in the feet and ankles is common in pregnancy, sudden and significant swelling in your hands or face can be a red flag.
• Upper abdominal pain: This pain is usually felt on the right side, just under the ribs. It can be mistaken for heartburn or indigestion, but it's often more severe and persistent.
• Nausea or vomiting: Again, while morning sickness is common, new or worsening nausea and vomiting later in pregnancy can be a symptom.
• Sudden weight gain: A rapid increase in weight over a day or two that isn't explained by eating habits could be due to fluid retention.
• Shortness of breath: This can sometimes occur due to fluid in the lungs.

Because many of the symptoms associated with preeclampsia can also be general pregnancy symptoms, prenatal appointments are necessary to monitor your health and potentially identify signs of preeclampsia. The signs that preeclampsia may be present include:

• High blood pressure (hypertension): This is often the first and most consistent sign. Your blood pressure will be taken at every prenatal visit, and a reading of 140/90 mmHg or higher on two separate occasions, at least four hours apart, is a key indicator.
• Protein in the urine (proteinuria): A urine sample will be tested for protein at your prenatal appointments. Significant levels of protein are a sign that your kidneys might be affected.
• Abnormal blood tests: Your health care provider might order blood tests to check your liver function, kidney function, and platelet count (which helps with blood clotting). Abnormal results in these tests can indicate preeclampsia.

Causes and risk factors

The causes and risk factors for developing preeclampsia aren’t the fault of the pregnant person. Instead, there are issues that can make a person more susceptible to having preeclampsia. These include:

• First pregnancy (nulliparity): Individuals pregnant for the very first time have a higher risk compared to those who have had previous successful pregnancies.
• History of preeclampsia: If you've had preeclampsia in a previous pregnancy, your risk of developing it again is significantly higher.
• Chronic high blood pressure (hypertension): If someone had high blood pressure before pregnancy, or it developed in the first 20 weeks, they are at a greater risk. This is sometimes called "chronic hypertension with superimposed preeclampsia."
• Chronic kidney disease: Preexisting kidney problems can increase the risk.
• Diabetes: Both type 1 and type 2 diabetes (before pregnancy or gestational diabetes) can elevate the risk.
• Autoimmune conditions: Conditions like lupus or antiphospholipid syndrome can increase the risk.
• Multiple pregnancy: Carrying twins, triplets, or more increases the demands on the placenta, raising the risk.
• Obesity: A higher body mass index (BMI) before pregnancy is associated with an increased risk.
• Age:
  • Very young (teenage pregnancy): Pregnant individuals under 20 years old.
  • Older (advanced maternal age): Pregnant individuals over 35 or 40 years old.
• Assisted reproductive technologies (ART): Pregnancies conceived through IVF, especially those involving donor eggs, may have a slightly increased risk.
• New paternity: A first-time father with the current partner, even if the pregnant person has had previous pregnancies with different partners, has been linked to a slightly increased risk. This is thought to be related to the immune system's adaptation to new paternal genes.
• Family history: If your mother or sister had preeclampsia, your risk is elevated, suggesting a genetic component.
• Certain medical conditions during pregnancy: Some rare conditions, like molar pregnancy, can also increase the risk.

Preeclampsia screening and diagnosis

Early detection and diagnosis are crucial for managing preeclampsia effectively. The screening and diagnosis process is quite thorough and typically involves a combination of routine prenatal care and specific tests if concerns arise.

Most of the screening for preeclampsia happens as part of your regular, routine prenatal appointments. This is why consistent prenatal care is so incredibly important.

• Blood pressure monitoring: This is the cornerstone of screening. At every single prenatal visit, your blood pressure will be taken. A blood pressure reading of 140/90 mmHg or higher is a red flag. If you have one elevated reading, they'll usually recheck it within a short period (e.g., 15 minutes, or on a different arm) and then often ask you to come back for another check a few hours or a day later. The diagnosis typically requires two elevated readings at least four hours apart.
• Urine testing (urinalysis): At many prenatal visits, you'll be asked to provide a urine sample. Your doctor is checking for the presence of protein in your urine (proteinuria). While a tiny amount of protein can sometimes be normal, a significant amount is a key indicator of preeclampsia.
• Symptom check: Your doctor will routinely ask you about common symptoms of preeclampsia during your appointments. They will likely ask you about headaches, vision changes, sudden swelling, upper abdominal pain, and rapid weight gain. Your honest and detailed answers are very important here.

If your screening results (like high blood pressure or protein in your urine) or symptoms raise suspicion, your health care provider will move into a more in-depth diagnostic phase. This usually involves a series of tests to confirm the diagnosis and assess the severity. Tests usually include:

• Confirmation of high blood pressure: As mentioned, sustained high blood pressure (140/90 mmHg or higher, twice, at least four hours apart) is a primary diagnostic criterion. For severe preeclampsia, the threshold is even higher (160/110 mmHg or higher).
• Confirmation of proteinuria: This is usually done with a 24-hour urine collection. This is considered the most accurate way to measure the total amount of protein you're passing in a day. Your doctor is looking to see if there is a total of 300 mg or more of protein in a 24-hour period. Alternatively, a protein/creatinine ratio of 0.3 or higher can also be used to confirm proteinuria.
• Blood tests: These are crucial to assess how preeclampsia might be affecting your organs. The specific tests your doctor may order include:
  • Liver function tests (LFTs): To check for liver inflammation or damage (e.g., AST, ALT levels).
  • Kidney function tests: To assess kidney health (e.g., creatinine, BUN levels).
  • Platelet count: To check if your blood's clotting ability is affected (low platelet count is a sign of severe preeclampsia).
  • Red blood cell count: To check for signs of hemolysis (destruction of red blood cells), which can occur in severe preeclampsia (part of the HELLP syndrome).
• Fetal monitoring: Since preeclampsia can affect the baby, monitoring the baby's well-being is also part of the diagnostic process. You will likely have:
  • Ultrasound: To check the baby's growth, amniotic fluid levels, and blood flow through the umbilical cord (Doppler studies).
  • Nonstress tests (NSTs) or biophysical profiles (BPPs): To assess the baby's heart rate patterns and overall well-being.

Preeclampsia is diagnosed when a pregnant person, after 20 weeks of gestation, develops:

• New-onset hypertension (blood pressure ≥140/90 mmHg on two occasions at least four hours apart) AND
• Proteinuria (≥300 mg in a 24-hour urine collection or protein/creatinine ratio ≥0.3) OR
• New-onset hypertension without proteinuria but with other signs of organ dysfunction, such as:  
  • Platelet count <100,000/μL
  • Liver enzymes (AST, ALT) at least twice the normal concentration
  • New-onset renal insufficiency (creatinine >1.1 mg/dL or a doubling of serum creatinine)
  • Pulmonary edema (fluid in the lungs)
  • New-onset cerebral or visual symptoms (severe headache not responsive to medication, blurred vision, scotoma)

Types of preeclampsia

There are a two main types of preeclampsia. They include:

1. Preeclampsia without severe features

This is when a pregnant person meets the basic criteria for preeclampsia but doesn't show signs of more severe organ dysfunction or very high blood pressure. This usually means the patient has:

• High blood pressure: 140/90 mmHg or higher on two occasions, at least four hours apart.
• Proteinuria: 300 mg or more in a 24-hour urine collection, OR a protein/creatinine ratio of 0.3 or higher.

While this was once called mild, it's important to understand that any preeclampsia needs careful monitoring because it can worsen quickly. The term “without severe features” emphasizes that it still requires vigilance.

2. Preeclampsia with severe features

This indicates a more serious form of the condition, where the high blood pressure is more extreme, and/or there's evidence of significant organ involvement or dysfunction. This type requires closer monitoring and often necessitates earlier delivery. This means the patient has:

• Severely high blood pressure: Systolic blood pressure of 160 mmHg or higher, OR diastolic blood pressure of 110 mmHg or higher, on two occasions at least four hours apart (while on bed rest, unless antihypertensive medication has been started).
• Thrombocytopenia: Platelet count less than 100,000/microliter (indicating an issue with blood clotting).
• Impaired liver function: Liver enzyme levels (AST and/or ALT) that are at least twice the normal concentration. This can also manifest as persistent right upper quadrant or epigastric pain (abdominal pain under the ribs or in the upper middle abdomen).
• Renal insufficiency: New-onset kidney problems, indicated by a serum creatinine concentration >1.1 mg/dL or a doubling of serum creatinine in the absence of other kidney disease.
• Pulmonary edema: Fluid accumulation in the lungs, which can cause shortness of breath.
• New-onset cerebral or visual disturbances: Such as a persistent, severe headache that doesn't respond to medication, blurred vision, flashing lights, or temporary vision loss.

Preeclampsia treatment

The treatment for preeclampsia is unique and based on the individual’s unique needs. It often revolves around managing the condition until the safest time for delivery. Unlike many diseases where there's a cure, the definitive cure for preeclampsia is the delivery of the baby and the placenta. However, until that point, the focus is squarely on managing symptoms, preventing complications, and extending the pregnancy as safely as possible for both parent and baby.

Here's an overview of the treatment approach, keeping in mind that it's highly individualized based on the severity of the preeclampsia, the gestational age of the baby, and the overall health of the pregnant individual. Treatment often includes:

1. Close Monitoring: This is paramount for both the pregnant person and baby. For the parent, regular blood pressure checks; urine tests for protein; blood tests (for liver and kidney function, platelet count); and close observation for symptoms like headaches, visual changes, or abdominal pain are critical. The baby often needs ultrasounds to check growth, amniotic fluid levels, and blood flow (Doppler studies). Your doctor will also often perform nonstress tests (NSTs) and use biophysical profiles (BPPs) to assess the baby's well-being.
2. Blood pressure control (Antihypertensive Medications): To prevent dangerously high blood pressures that could lead to stroke or other serious complications for the pregnant person. These medications do not cure preeclampsia or stop its progression; they only manage the symptom of high blood pressure. They are used cautiously to lower blood pressure without compromising blood flow to the placenta and baby.
3. Corticosteroids: These are given if the baby is preterm (usually between 24 to 36 weeks’ gestation) and there's a risk of early delivery. These medications help accelerate the development of the baby's lungs and other organs, significantly reducing the risk of complications from prematurity.
4. Magnesium sulfate: This is a critically important medication used to prevent seizures (eclampsia) in individuals with severe preeclampsia or impending delivery. It does not treat blood pressure directly but acts as a neuroprotective agent.

Delivery

The only definitive treatment for preeclampsia is delivery. The timing of delivery is a critical decision, balancing the risks of continuing the pregnancy (for both parent and baby) against the risks of prematurity. Your doctor will determine when it is safest to deliver your baby, but generally there are guidelines around when delivery should occur given the type of preeclampsia.

If the condition remains stable and the baby is doing well, delivery is often recommended around 37 weeks’ gestation. This allows the baby to mature as much as possible while minimizing the risk of the condition worsening.

If a patient has preeclampsia with severe features, delivery is usually recommended earlier. This can sometimes occur at or beyond 34 weeks. If delivery is recommended before 34 weeks, the goal is to extend the pregnancy for a few days to allow for corticosteroid administration (to mature baby's lungs) and maternal stabilization, as long as both parent and baby remain stable. However, if the condition worsens significantly (e.g., uncontrolled blood pressure, HELLP syndrome, signs of fetal distress, eclampsia), immediate delivery, regardless of gestational age, becomes necessary.

Even after delivery, careful monitoring continues, as preeclampsia symptoms (especially high blood pressure) can persist or even worsen in the first few days postpartum. Magnesium sulfate is often continued for 24 hours after delivery to prevent postpartum seizures.

In summary, preeclampsia treatment is an intricate balance of vigilant monitoring, strategic use of medications to control symptoms and prevent complications, and ultimately making the best decision for the timing and method of delivery. The entire process is managed by a dedicated health care team focused on positive outcomes for both the pregnant individual and their baby.

Preeclampsia FAQs

At AHN, we are dedicated to providing the most comprehensive and compassionate care for our expectant parents. Fetal health is one of the most important components of our care and you can rest assured that we will develop a tailored care plan to support your pregnancy. Questions during this time are normal and expected, and your care team is available to answer all of them. To help you get started in learning more about preeclampsia, we have included answers to many frequently asked questions.

What causes preeclampsia?

Preeclampsia is believed to start in the placenta, the organ that nourishes the baby. Early in pregnancy, special blood vessels are supposed to develop to supply the placenta with plenty of blood. In preeclampsia, these blood vessels don't develop properly; they remain narrow and don't expand enough. This leads to reduced blood flow to the placenta, which then releases substances into the pregnant person's bloodstream. These substances can cause widespread inflammation and damage to blood vessels throughout the body, leading to high blood pressure and issues with organs like the kidneys, liver, and brain. The exact why this happens isn't fully understood, but it's thought to be a complex interaction of genetic factors, immune system responses, and preexisting health conditions. It's important to remember that it's not caused by anything the pregnant person did or didn't do.

How to prevent preeclampsia?

Unfortunately, there's no guaranteed way to prevent preeclampsia entirely, and, for many, it develops without clear warning or preventable cause. However, for some individuals, certain strategies recommended by health care providers can help reduce the risk:

• Low-dose aspirin: For individuals identified as high-risk (e.g., those with a history of preeclampsia, chronic hypertension, diabetes, or multiple pregnancies), low-dose aspirin (typically 81 mg daily) is often recommended starting in the late first trimester (around 12 – 16 weeks) and continuing until delivery. This has been shown to reduce the risk of preeclampsia.
• Managing existing health conditions: If you have chronic conditions like high blood pressure, diabetes, or autoimmune disorders, working with your doctor to manage them well before and during pregnancy can lower your risk.
• Healthy lifestyle: Maintaining a healthy weight before pregnancy; eating a balanced diet; and engaging in regular, moderate exercise can contribute to overall health and may indirectly support a healthier pregnancy, though these are not direct preventives for preeclampsia.
• Calcium supplementation: In some regions or for individuals with low dietary calcium intake, calcium supplementation may be recommended.

It's crucial to discuss any risk factors you might have with your health care provider, as they can determine the best preventive strategies for your individual situation.

How quickly can preeclampsia develop?

Preeclampsia can develop quite rapidly, sometimes even within a matter of days or hours, especially the more severe forms. While it typically manifests after 20 weeks of pregnancy, often in the third trimester, it can sometimes appear suddenly and unexpectedly. This rapid onset is why consistent prenatal care, including regular blood pressure checks and urine tests, is so vital. It's also why individuals are advised to report any new or worsening symptoms, such as severe headaches, vision changes, or sudden swelling, to their health care provider immediately, even if they've just had a recent checkup. The speed of onset can vary greatly from person to person.

How does preeclampsia affect the baby?

Preeclampsia primarily affects the baby by compromising the placenta's function. Since the placenta is responsible for providing oxygen and nutrients to the baby, issues with its blood flow can lead to several potential complications:

• Fetal growth restriction (FGR): The baby may not receive enough nutrients and oxygen, leading to slower growth and a smaller size than expected.
• Premature birth: Because the definitive "cure" for preeclampsia is delivery, babies are often delivered early if the condition becomes severe or puts the parent's health at risk. Premature birth carries its own set of challenges, including breathing difficulties, feeding problems, and other developmental issues.
• Oligohydramnios: Reduced blood flow to the placenta can affect the baby's kidney function, leading to lower-than-normal levels of amniotic fluid (the fluid surrounding the baby in the womb).
• Placental abruption: In severe cases, the placenta can prematurely detach from the uterine wall, which is a medical emergency for both the parent and the baby.
• Fetal distress: The baby may show signs of distress due to lack of oxygen or nutrients, which can be detected through monitoring tests like nonstress tests or biophysical profiles.

Health care providers closely monitor the baby's well-being when preeclampsia is diagnosed to determine the safest timing for delivery, aiming to balance the risks of prematurity against the risks of continuing the pregnancy.

Contact us

If you don't have a diagnosis, call (412) DOCTORS 412-362-8677 to make an appointment with your primary care provider (PCP) or obstetrician gynecologist (OB-GYN). They will explore all possible causes of your symptoms.

Depending on your diagnosis, your doctor may refer you for treatment and additional resources for women's heart health at the AHN Women's Heart Center. When scheduling your appointment, mention your pregnancy and condition or diagnosis.

Alternatively, you can complete our request a call form if you were treated for preeclampsia and high blood pressure while pregnant, you still have high blood pressure, or you have chest pains. You will receive a call from our Women's Heart Center for follow-up.