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Preeclampsia

Also known as Toxemia, Pre-eclampsia. After 20 weeks, and can appear up to 6 weeks after birth.

Preeclampsia is a serious blood pressure disorder of the second half of pregnancy, and more than high numbers on a cuff. It reflects a placental problem that strains your kidneys, liver, brain, and blood vessels and cuts blood flow to your baby. Early on it often causes no symptoms, which is why blood pressure and urine are checked at every prenatal visit. Caught and watched, the large majority of cases reach a healthy delivery.

Know the warning signs When to call a provider
How common
5% to 8% of pregnancies
One of the more common serious complications of pregnancy.
When
After 20 weeks
Can also begin in the days to weeks after birth.
Urgency
Call your provider
Severe headache, vision changes, or upper-belly pain need care now.
Outlook
Good with monitoring
Delivery cures it; the goal is safe timing for you and baby.

Understanding it

What is preeclampsia?

Preeclampsia is new high blood pressure after 20 weeks plus signs that other organs are under strain: most often protein in the urine, sometimes low platelets, abnormal liver or kidney tests, fluid in the lungs, or new headaches and vision changes. It affects roughly 5% to 8% of US pregnancies.

It starts with the placenta and its supplying vessels. When they do not form or work normally, the placenta releases signals that raise your blood pressure and injure vessel linings throughout your body. That is how a condition rooted in the uterus reaches your brain, liver, and kidneys, and slows your baby's growth.

Its danger lies in how quietly it begins. Many feel completely well while their blood pressure climbs, which is why those routine checks matter. When symptoms surface, they usually signal more advanced disease: a pounding headache that will not lift, spots or blurring in your vision, pain under the right ribs, sudden swelling, or shortness of breath.

The one cure is delivering the baby and placenta. Managing preeclampsia is a balancing act: buying your baby time to mature while the disease stays mild, yet delivering before it threatens you. With good prenatal care, that balance holds for most pregnancies.

Symptoms

What are the symptoms?

Early preeclampsia is usually silent, caught only on blood pressure and urine checks. When symptoms do appear, they matter, often meaning the disease is turning severe.

Early signs

  • Often none in the early stages
  • Swelling of the face and hands (some swelling of the feet and ankles is normal in pregnancy)
  • Sudden weight gain over a few days
  • Feeling generally unwell

Emergency signs — call 911

  • A severe or persistent headache that will not ease
  • Changes in vision: blurriness, seeing spots or flashing lights, or temporary loss of vision
  • Pain in the upper belly, usually under the right ribs
  • Shortness of breath
  • New nausea or vomiting in the second half of pregnancy
  • A seizure, which is a 911 emergency

Why it matters

Risks to you and baby

Progression to eclampsia

Uncontrolled preeclampsia can tip into seizures, dangerous for you and your baby. Magnesium sulfate during labor and delivery sharply reduces the risk.

HELLP syndrome

A severe variant hitting the liver and blood clotting that can develop fast and turn life-threatening, one reason upper-belly pain and feeling unwell are taken seriously.

Stroke and organ injury

Very high blood pressure can injure the brain, kidneys, and liver, and rarely cause a stroke. Treating severe-range readings promptly aims squarely at preventing that.

Effects on your baby

Reduced placental blood flow can slow your baby's growth (fetal growth restriction) and raise the odds of preterm birth or placental abruption. Extra growth scans and monitoring watch for it.

Postpartum preeclampsia

Preeclampsia can appear or worsen in the days to weeks after birth, so the same warning signs count even after your baby arrives.

How it's found

How is it diagnosed?

Preeclampsia is diagnosed with a blood pressure cuff and simple labs, both part of every prenatal visit. No single symptom makes the call; it is the numbers and labs together.

Blood pressure measurement

A reading of 140/90 or higher on two occasions at least 4 hours apart, after 20 weeks in someone previously normal, is the entry point. 160/110 or higher is severe range and needs prompt treatment.

Urine protein test

Protein in the urine, by dipstick, 24-hour collection, or protein-to-creatinine ratio, is a classic sign the kidneys are affected.

Blood tests

Platelet count, liver enzymes, and kidney function (creatinine) reveal severe features even when blood pressure alone is not extreme.

Fetal monitoring

Growth ultrasounds and non-stress tests confirm your baby is growing and tolerating the reduced placental blood flow.

Blood pressure and urine are checked at every prenatal visit after 20 weeks. New high readings or symptoms trigger the blood tests and closer monitoring.

Treatment

How is it managed?

Management balances two goals: keeping you safe and giving your baby time to mature. How fast that tips toward delivery depends on how far along you are and whether severe features are present.

Treatment paths

Without severe features: close monitoring, frequent blood pressure checks, labs, and fetal surveillance, with delivery by about 37 weeks. With severe features: admission, magnesium sulfate to prevent seizures, medication for dangerously high blood pressure, and delivery at or after 34 weeks, sooner if you or your baby become unstable. A preterm delivery calls for steroids to mature your baby's lungs.

Medication

Magnesium sulfate is given during labor and delivery to prevent seizures in severe cases. Severe-range blood pressure is treated with labetalol, nifedipine, or hydralazine.

Monitoring

Because preeclampsia can surface or worsen after birth, blood pressure and symptoms are watched for several days postpartum, and you are told which warning signs to report from home.

Can it recur?

It can. Overall recurrence runs about 15%, rising to 25% or more if you had it before, and as high as 40% if your prior case was early or severe. Low-dose aspirin next pregnancy lowers that risk. Preeclampsia also raises your long-term risk of high blood pressure and heart disease, so your heart health deserves attention long afterward.

What you can do

Can it be prevented?

  • Low-dose aspirin for those at higher risk

    For anyone with one high-risk factor (prior preeclampsia, chronic high blood pressure, diabetes, kidney disease, an autoimmune condition, or a multiple pregnancy) or two or more moderate ones, a daily 81 mg aspirin started between 12 and 28 weeks, ideally before 16, and continued until delivery cuts the risk by roughly 15%.

  • Calcium if your intake is low

    If your dietary calcium is low, a calcium supplement lowers preeclampsia risk. Ask your provider whether it applies to you.

  • Go to every prenatal visit

    Because early preeclampsia is silent, the blood pressure and urine checks at routine visits are how it is caught in time. Do not skip them, especially in the third trimester.

Who is more at risk

Risk factors

A prior pregnancy with preeclampsia
One of the strongest predictors, and the reason low-dose aspirin is recommended next pregnancy.
Chronic health conditions
Chronic high blood pressure, type 1 or type 2 diabetes, kidney disease, and autoimmune conditions such as lupus each raise the risk.
This being a first pregnancy
First pregnancies carry a higher baseline risk, as do pregnancies with a new partner.
Carrying multiples
Twins or more increase the demand on the placenta and the risk.
Age, weight, and family history
Age 35 or older, obesity, a family history of preeclampsia, and conceiving through IVF all add to the risk.
Two or more of these moderate factors are enough to consider aspirin

Do not wait

When to call your provider or 911

  • Call 911 for a seizure, or a sudden severe headache with confusion, trouble speaking, or weakness.
  • Contact your provider now, or go in, for a severe or persistent headache, vision changes (blurring, spots, flashing lights), upper-right belly pain, or new shortness of breath.
  • Call for sudden swelling of your face and hands, or rapid weight gain over a few days.
  • If your home blood pressure is 160/110 or higher, be seen right away; call your provider for readings at or above 140/90.
  • Report these same warning signs in the days and weeks after birth, since preeclampsia can appear postpartum.

Talking to your team

Questions to ask your provider

  • Do I have preeclampsia with or without severe features?
  • Should I be taking low-dose aspirin, and when should I have started?
  • How often will you check my blood pressure, labs, and my baby's growth?
  • What home blood pressure reading should make me call or come in?
  • What is the plan and likely timing for delivery?
  • Will I need magnesium sulfate during labor?
  • What should I watch for after I deliver, and for how long?

Keep reading

More on preeclampsia

All pregnancy guides articles

Good to Know

Preeclampsia FAQs

Common questions about preeclampsia, answered.

I feel completely fine. Why are you worried about my blood pressure?

Because early preeclampsia is usually silent. Many feel well while it works on their kidneys, liver, or platelets. Waiting for symptoms would catch it late, which is why blood pressure and urine are checked at every visit.

Will I have to deliver early?

Possibly. Without severe features, delivery is usually planned around 37 weeks; with them, at or after 34 weeks, sooner if you or your baby are unstable. A preterm delivery comes with steroids to help your baby's lungs.

Is preeclampsia dangerous for my baby?

It can reduce placental blood flow, slowing your baby's growth or prompting an early delivery, which is why you will have extra growth scans and monitoring. With close care, most babies do well.

Can I do anything to prevent it?

If you are at higher risk, a daily low-dose aspirin started before 16 weeks lowers the odds by about 15%, and calcium helps if your intake is low. Beyond that, keeping every prenatal appointment is what catches it early.

What is the difference between preeclampsia and the high blood pressure I already had?

High blood pressure before pregnancy or before 20 weeks is chronic hypertension. Beginning after 20 weeks with no other organ signs, it is gestational hypertension. Add signs that other organs are affected, and it is preeclampsia. They are related and can overlap.

Can preeclampsia really happen after I give birth?

Yes. Postpartum preeclampsia can develop in the days to weeks after delivery, most often within 48 hours but sometimes up to six weeks out. The same warning signs apply, so do not brush off a severe headache or vision changes after birth.

Will I get it again in my next pregnancy?

You might. Recurrence is roughly 15% overall, higher if your case was early or severe. Low-dose aspirin in a future pregnancy can reduce that, so tell your provider your history early.

Does having preeclampsia affect my health years from now?

Yes. It is linked to a higher long-term risk of high blood pressure and heart disease. Treat it as an early signal to mind your cardiovascular health, with regular checkups and healthy habits after pregnancy.

Medically Reviewed · Updated

Reviewed by Dr. Grace Lin, MD, FACOG · OB-GYN

Obstetrician-gynecologist focused on reproductive and sexual health for women: pregnancy, BV, yeast, trichomoniasis and HPV/cervical screening. Our editorial guidelines →

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