An Overview of Preeclampsia in Pregnancy

Medical Experts: Frederick “Ricky” Friedman, Jr., MD; Anna Whelan, MD

There is a general, almost universal, understanding that with pregnancy often comes uncomfortable swelling. It’s to be expected. But while the occasional puffy feet or an ever-tightening wedding band can be a normal symptom of pregnancy, swelling can also be a sign of preeclampsia, which can be incredibly dangerous.

Throughout your pregnancy, your health care provider should be monitoring you for any signs of preeclampsia, specifically high blood pressure. But it’s equally important that you stay attuned to your body as well to ensure you can be assessed as quickly as possible when something feels off. Left undiagnosed, your chances of experiencing short- and long-term complications from preeclampsia are significantly higher, so the sooner your provider can help you manage the condition, the better.

To get all of the details on preeclampsia, from what it is to risk factors to how it’s managed, we turned to experts Anna Whelan, MD, OB-GYN and maternal-fetal medicine physician, and fellow with Physicians for Reproductive Health, and Frederick “Ricky” Friedman, Jr., MD, professor and vice chair of academic affairs in the department of obstetrics, gynecology, and reproductive sciences at the Icahn School of Medicine at Mount Sinai.

What Is Preeclampsia?

Much like gestational diabetes, preeclampsia is a condition unique to pregnancy that Dr. Friedman says affects between 5–7% of pregnant people. According to the American College of Obstetricians and Gynecologists (ACOG), preeclampsia typically develops after 20 weeks of pregnancy, most often in the third trimester, and can even show up after the baby has been delivered. When it develops before 34 weeks of pregnancy it is called “early-onset preeclampsia.”As for what causes preeclampsia, Dr. Whelan says, “it is thought to be due to abnormal development of the placenta, however, the true cause is unknown.”

In fact, the cause(s) of preeclampsia has been a mystery that doctors and scientists have been trying to solve for decades. Dr. Friedman humorously explains that researchers have seemingly considered everything—including worms in the blood (a theory that has since been debunked). But until a true cause can be confirmed, when it comes to diagnosing the condition, all doctors can do is keep risk factors in mind and closely monitor their patients.

Signs, Symptoms, and Risk Factors of Preeclampsia

So, what exactly do health care providers assess when considering the condition? And what should you be on the lookout for? Dr. Friedman and Dr. Whelan say some of the signs and symptoms of preeclampsia include:

• A persistent, severe headache that is not relieved with Tylenol or caffeine
• Excessive swelling, particularly in the fingers and face
• Chest pain
• Difficulty breathing
• Blurred vision
• Elevated blood pressure
• Pain under your ribs on your right side
• Severe abdominal pain
• Excess protein in the urine (this requires a urine test to detect)
• Unusual weight gain
• Increased reflexes

While anyone can end up developing preeclampsia, Dr. Friedman explains there are some risk factors that, if known, will alert providers to monitor the patient just a little more closely because they have a higher chance of being diagnosed.

“Occurrence increases with younger patients, such as teenagers, and patients who are over 35. Patients who are over 40 years old are at the highest risk. Underlying risk factors are any disorder of blood vessels, like chronic hypertension, kidney disease, lupus, and lupus-like disorders. Also, any situation where there’s more placenta than average, like with twins or triplets.”

Another risk of preeclampsia is having a history of the condition. “Someone who has preeclampsia once is more likely to have it a second time,” Dr. Friedman says, “And if it’s preeclampsia with severe features, especially pre-term preeclampsia, it’s much more likely to develop in a subsequent pregnancy.”

Preeclampsia Complications

If preeclampsia has been diagnosed and is not properly managed with appropriate interventions, then there can be serious complications that can be devastating for the birthing parent and/or the baby.

“Preeclampsia can lead to problems with fetal growth and put the baby at an increased risk for complications including preterm birth and stillbirth,” says Dr. Whelan, “These are reasons your doctor may recommend close monitoring with ultrasounds.”

These complications are scary enough as it is, but preeclampsia also comes with serious risks to the birthing parent’s health and well-being. Dr. Friedman explains that eclampsia is a severe seizure in a pregnant or early postpartum patient who developed preeclampsia. In layman’s terms, preeclampsia means “before a seizure,” and the subsequent eclampsia is a dangerous complication of the condition.

In addition to serious seizures, other complications that Dr. Friedman and Dr. Whelan say can occur with severe preeclampsia include kidney and liver failure, stroke, temporary change in mental status, temporary blindness, and even death.

Preventing and Managing Preeclampsia

Unfortunately, since doctors still don’t know what causes preeclampsia, there isn’t much pregnant people can do to avoid it. However, if a patient is at an elevated risk of developing the condition, their health care provider might put them on baby aspirin.

“In someone who’s at high risk for preeclampsia, baby aspirin has been shown in certain patients to help prevent it, or at least delay its onset,” explains Dr. Friedman, “Many patients with a history of preeclampsia, chronic hypertension, or obesity will be placed on this medication by their obstetrician.”

It’s important to note, however, that even low-dose aspirin is not considered safe to take during pregnancy, so you should not be taking it unless your doctor specifically tells you to and is closely monitoring you and your baby.

Even though there isn’t any proven way to prevent preeclampsia, take comfort in knowing that the condition doesn’t always end in complications. With proper care, it can be managed without any harm to the birthing parent or baby.

“The management of a patient with preeclampsia will depend on the gestational age at which it’s diagnosed and how severe the blood pressure changes and other findings are,” says Dr. Friedman. Some conservative management methods Dr. Whelan and Dr. Friedman say are common include:

• Blood pressure medications
• Intravenous magnesium sulfate (to help prevent seizures)
• Modified bed rest
• Frequent fetal well-being testing, such as non-stress tests
• Frequent sonograms to monitor baby’s weight

Dr. Friedman further explains that there is no “treatment” for the condition other than delivering the baby, and this is not a decision that is taken lightly—especially since it can result in pre-term delivery. However, when a doctor decides a patient’s preeclampsia has progressed to a point where induction and delivery are necessary, Dr. Friedman stresses that it is because it’s in the best interest of the parent and/or baby’s health.

Preeclampsia is a very serious diagnosis, but you’ll have the best outcome possible as long as you stay aware of changes in your body, are getting prenatal care from a provider you trust, and speak up when something feels off. To learn more about preeclampsia, visit the ACOG’s FAQ page here.