The signs and symptoms of preeclampsia

Knowledge is power when it comes to this “silent” pregnancy disorder. Find out which symptoms you should never ignore and how preeclampsia is treated.

Preeclampsia is one of those pregnancy conditions most women have only vaguely heard about until their doctor delivers the unsettling news that they’re suffering from it. And because so many of the signs are “silent”, it can come as quite a shock to many sufferers.

What is preeclampsia?

Affecting 3 to 5 percent of pregnancies in the United States, preeclampsia is a disorder characterized by high blood pressure and protein in the urine (proteinuria). It generally develops after 20 weeks of pregnancy and can be very dangerous – even fatal – for both mother and baby if left untreated.

What are the signs and symptoms of preeclampsia?

Some preeclampsia sufferers don’t experience any symptoms at all. And when they do, they often confuse them with “normal” pregnancy symptoms. For this reason, proper prenatal care is necessary to detect signs of preeclampsia that may not be apparent to the patient but can be measured by healthcare professionals.

Signs and symptoms of preeclampsia include:

  • High blood pressure (exceeding 140/90 mmHG measured on two separate occasions at least four hours apart)
  • Excess protein in the urine (proteinuria)
  • Sudden weight gain (more than two pounds in a week)
  • Swelling (edema), especially in the ankles, hands, fingers and face
  • Severe headaches
  • Changes in vision, including blurred vision, spots, flashing lights, light sensitivity and temporary loss of vision
  • Nausea or vomiting
  • Upper abdominal pain (usually under the ribs on the right side) and shoulder pain
  • Lower back pain
  • Decreased urine output
  • Shortness of breath and anxiety
  • Strong reflexes (hyperreflexia)

“Sudden weight gain and swelling of the ankles, hands and fingers are symptoms that should never be ignored,” says Dr. Michael Kramer, Professor, Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine. If you experience any of these symptoms, speak to your healthcare professional immediately.

But what about the silent signs of preeclampsia you might have no idea about? “Most obstetricians, family doctors and midwives routinely measure blood pressure at antenatal care visits,” says Dr. Kramer. “Later in pregnancy, urine testing for protein is also routine.” If you want to set your mind at ease, ask your healthcare professional for the results of your blood pressure and urine tests at every antenatal visit.

What causes preeclampsia?

The exact causes of preeclampsia remain unknown, but most experts agree the placenta plays a key role in the disorder. “We now understand much more about the biological mechanisms underlying preeclampsia, but not about the true causes – that is, why some women get it and others don’t,” says Dr. Kramer. “Some risk factors are well known, such as obesity, first pregnancy and high blood pressure prior to pregnancy, but we still don’t understand how or why those factors lead to preeclampsia.”

Who’s at risk of developing preeclampsia?

The following factors increase your likelihood of developing preeclampsia:

  • Personal or family history of preeclampsia
  • History of chronic high blood pressure, diabetes, kidney disease or an organ transplant
  • First pregnancy
  • Multiple pregnancy (twins, triplets or other multiples)
  • Obesity (particularly if your BMI is over 30)
  • Being under 18 or over 40 years of age
  • Polycystic ovarian syndrome (PCOS)
  • Autoimmune diseases such as lupus, rheumatoid arthritis and multiple sclerosis
  • In vitro fertilization

What are the possible complications of preeclampsia?

The earlier preeclampsia appears in pregnancy and the more severe it is, the greater the risks for mother and baby. Here are some of the possible complications for the mother:

  • Placental abruption (the placenta separates from the wall of the uterus and causes heavy bleeding that can be life-threatening for mother and baby)
  • HELLP syndrome (a more severe form of preeclampsia that can be life-threatening)
  • Eclampsia (preeclampsia plus seizures)
  • Organ damage (kidney, liver, lungs, heart and eyes)
  • Stroke or other brain injury
  • Pulmonary edema (fluid on the lungs)
  • Future cardiovascular disease
  • Death (relatively rare in the US)

Risks for the baby include:

  • Preterm birth (before 37 weeks gestation)
  • Fetal growth restriction (slow growth)
  • Difficulties associated with preterm birth, including learning disorders, cerebral palsy, epilepsy, blindness and deafness
  • Death (relatively rare in the US)

How is it treated?

The only cure for preeclampsia is to deliver your baby. If you’ve reached 37 weeks gestation, which is considered “early term”, your healthcare provider might want to induce labor or perform a C-section as soon as possible to prevent your condition from getting worse.

But if you haven’t yet reached 37 weeks, your doctor may want to treat your preeclampsia for a while to give your baby more time to develop before birth.

Treatment options include:

  • Medications: Your doctor may prescribe antihypertensives to lower your blood pressure, corticosteroids to improve your liver and platelet function if you have severe preeclampsia or HELLP syndrome, and/or anticonvulsant medications to prevent seizures if your preeclampsia is severe.
  • Close monitoring: You will need to undergo frequent blood and urine tests, and your baby will be regularly monitored via ultrasound and a fetal heart rate monitor.
  • Bed rest: Although this used to be routinely recommended to help reduce blood pressure, its benefits have been questioned and it is only prescribed in certain cases.
  • Hospitalization: Severe cases of preeclampsia may require hospitalization. You might receive intravenous medications to lower your blood pressure and prevent seizures, as well as steroid injections to help the baby’s lungs mature before birth.
  • Delivery: If your preeclampsia is severe, your doctor may need to deliver your baby right away even if you’re not close to term to prevent serious complications for you or your baby.

In most cases, the signs and symptoms of preeclampsia disappear within six weeks of delivery.

By Sabrina Rogers-Anderson