Pregnancy
Preeclampsia Symptoms: Warning Signs, Causes and Treatment
Preeclampsia is a serious pregnancy condition in which blood pressure rises to 140/90 or higher after 20 weeks, along with signs that organs such as the kidneys, liver or brain are under strain. Many people feel completely fine at first, which is why your blood pressure is checked at every visit. Warning signs include a headache that won't go away, vision changes, pain in the upper right belly, sudden swelling of the face or hands, and shortness of breath. These need same-day medical attention.
The hardest part of preeclampsia is that its symptoms look a lot like ordinary pregnancy. Headaches, swelling, heartburn: who doesn't have those at 34 weeks? This guide helps you tell the difference, and gives you permission to call when you're not sure.
What is preeclampsia?
It's a disorder that starts with the placenta and affects blood vessels throughout the body. It's diagnosed when you have:
- High blood pressure: 140/90 or higher on two readings at least 4 hours apart, after 20 weeks, in someone whose blood pressure was normal before
- Plus protein in the urine or signs of organ problems, such as low platelets, abnormal liver or kidney tests, fluid in the lungs, or headache and vision symptoms
It's called preeclampsia with severe features when blood pressure reaches 160/110 or higher, or when there are serious symptoms or lab changes.
Related conditions
| Condition | What it means |
|---|---|
| Gestational hypertension | High blood pressure after 20 weeks without protein or organ signs; can progress to preeclampsia |
| Chronic hypertension | High blood pressure before pregnancy or before 20 weeks |
| Preeclampsia | High blood pressure after 20 weeks plus protein or organ involvement |
| HELLP syndrome | A severe form with red blood cell breakdown, high liver enzymes and low platelets |
| Eclampsia | Preeclampsia with seizures; a medical emergency |
Normal pregnancy or warning sign?
| Usually normal | Call your provider |
|---|---|
| Swollen feet and ankles at the end of the day that improve overnight | Sudden swelling of the face, hands or around the eyes |
| An occasional headache that eases with rest, water or acetaminophen | A headache that doesn't get better with rest or acetaminophen |
| Heartburn after meals | Pain in the upper right belly or under the ribs, sometimes mistaken for heartburn |
| Gradual weight gain | Rapid weight gain over a day or a few days |
| Feeling a bit winded on stairs | Shortness of breath at rest or lying down |
| Early-pregnancy nausea | New nausea or vomiting in the second half of pregnancy |
Also call for vision changes (blurriness, flashing lights, spots, light sensitivity), confusion, or a strong feeling that something is very wrong. That last one counts. Many people say afterward that they knew something was off but didn't want to bother anyone. Bother them.
Some people have no symptoms at all, which is why the blood pressure cuff at every visit matters so much.
Who is at risk?
ACOG and the USPSTF group risk factors into high and moderate.
High-risk factors (one is enough for your provider to recommend low-dose aspirin):
- Preeclampsia in a previous pregnancy
- Twins or more
- Chronic high blood pressure
- Diabetes before pregnancy (type 1 or type 2)
- Kidney disease
- Autoimmune disease, such as lupus or antiphospholipid syndrome
Moderate-risk factors (more than one may lead to an aspirin recommendation):
- First pregnancy
- Obesity (BMI over 30)
- A mother or sister who had preeclampsia
- Age 35 or older
- Pregnancy through IVF
- Black race, reflecting the effects of racism and unequal access to care rather than biology
- Lower income
- More than 10 years since your last pregnancy, or a previous baby with low birth weight or a poor outcome
Can it be prevented?
There's no guaranteed way, but low-dose aspirin lowers the risk for people at higher risk. It's typically started between 12 and 28 weeks, ideally before 16 weeks, and continued until delivery. Your provider decides whether you need it and what dose. Don't start aspirin on your own. See safe medications during pregnancy.
If you have risk factors and nobody has mentioned aspirin by your first or second visit, ask: "Should I be on low-dose aspirin?"
Checking your blood pressure at home
Many providers ask higher-risk patients to check at home with a validated cuff. A few tips that make the numbers more reliable:
- Use an upper-arm cuff in the right size, not a wrist cuff.
- Sit quietly for 5 minutes first, back supported, feet flat, arm resting at heart level.
- Don't check right after coffee, climbing stairs or rushing for the train.
- Take two readings a minute apart and write both down with the time.
- Know your numbers to call about (see the last section) and keep them on your fridge.
Ask whether your insurance covers a cuff; many plans do with a prescription.
How it's treated
The only cure is delivering the baby and placenta. Treatment depends on how far along you are and how severe it is:
- Without severe features: close monitoring with frequent blood pressure checks, blood and urine tests, and fetal ultrasounds and non-stress tests. In practice that often means one or two extra appointments a week. Delivery is usually recommended at about 37 weeks.
- With severe features: usually hospital care, blood pressure medicine, and magnesium sulfate to prevent seizures. Magnesium can make you feel hot, flushed and wiped out; that's expected. Delivery is often recommended at 34 weeks or sooner if you or the baby are unstable. Steroid shots may be given to help the baby's lungs if delivery may come early.
You'll likely be co-managed with a maternal-fetal medicine specialist if you have severe features or chronic high blood pressure.
How it affects the baby
Preeclampsia can reduce blood flow through the placenta, which can lead to:
- Slower growth (fetal growth restriction)
- Low amniotic fluid
- Placental abruption, when the placenta separates from the uterus early
- Preterm birth, often because delivery is needed to protect the parent's health
After delivery: it isn't over yet
Preeclampsia can start or worsen after the baby is born, usually within the first week but sometimes up to about six weeks later. This catches people off guard because everyone's attention is on the baby. If you have a severe headache, vision changes, shortness of breath or chest pain after giving birth, get help right away and tell staff you recently gave birth. Keep checking your blood pressure at home if your provider asked you to.
Long-term health
Preeclampsia raises your lifetime risk of high blood pressure, heart disease and stroke. Tell your primary care provider and keep up with blood pressure and cholesterol checks. It can also come back in future pregnancies, so share this history at your next first prenatal visit.
Getting care in New York
If you're uninsured, NY Medicaid covers pregnant people with incomes up to 223% of the federal poverty level, with coverage continuing 12 months after pregnancy ends. That postpartum year matters here, since follow-up blood pressure care often runs well past the six-week visit. Search the directory for OB/GYNs and MFM specialists near you.
When to call your provider
Call your provider the same day if:
- Your home blood pressure reading is 140/90 or higher
- You have a headache that won't go away
- You have new swelling in your face or hands, or sudden weight gain
- You have new nausea or vomiting in the second half of pregnancy
- Your baby is moving less than usual
Call 911 or go to labor and delivery right away if:
- Your blood pressure is 160/110 or higher
- You have vision changes, severe upper belly pain, shortness of breath or chest pain
- You have a seizure, confusion or trouble speaking
- You have a severe headache, especially the worst of your life
Frequently asked questions
What are the first signs of preeclampsia?
Often the first sign is high blood pressure found at a prenatal visit, sometimes with protein in the urine. Symptoms such as a headache that won't go away, vision changes, upper belly pain or sudden swelling of the face and hands can appear as it worsens.
When does preeclampsia usually start?
Preeclampsia usually develops after 20 weeks of pregnancy, most often in the third trimester. It can also first appear after delivery, usually within the first week, but sometimes up to about six weeks after birth.
Can baby aspirin prevent preeclampsia?
For people at high risk, low-dose aspirin started after 12 weeks, ideally before 16 weeks, lowers the chance of preeclampsia. Only take it if your provider recommends it, and use the dose they prescribe.
Is swelling a sign of preeclampsia?
Some swelling of the feet and ankles is normal in pregnancy. Sudden swelling of the face or hands, or rapid weight gain over a few days, can be a sign of preeclampsia and should be reported.
Sources
- ACOG — Gestational Hypertension and Preeclampsia (Practice Bulletin 222)
- ACOG — Low-Dose Aspirin Use for the Prevention of Preeclampsia (Clinical Practice Advisory)
- ACOG — Preeclampsia and High Blood Pressure During Pregnancy FAQ
- USPSTF — Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality
- CDC — Hear Her: Urgent Maternal Warning Signs
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.