Preeclampsia: symptoms, causes, diagnosis, treatment and prevention

Preeclampsia is a pregnancy-related condition in which high blood pressure develops, usually after 20 weeks of pregnancy, and may affect organs such as the kidneys, liver, brain and lungs. It can also affect the placenta and the baby’s growth.

One of the most important things to know about preeclampsia is that you may have it without feeling unwell. Sometimes the first clue is simply a high blood pressure reading or protein detected in a urine test during a routine antenatal appointment. This is why regular prenatal check-ups are so important.

Preeclampsia affects around 3–8% of women who give birth worldwide and can become dangerous if it progresses to eclampsia, which involves seizures. Early diagnosis and appropriate monitoring can substantially reduce the risk of serious complications.

What is preeclampsia?

Preeclampsia is a disorder of pregnancy characterised by new-onset high blood pressure after 20 weeks, together with protein in the urine and/or evidence that other organs are being affected.

A blood pressure of 140/90 mmHg or higher is considered hypertension in pregnancy when confirmed appropriately. Blood pressure of 160/110 mmHg or higher is considered severe hypertension and requires urgent medical assessment.

Preeclampsia can affect:

• The kidneys
• Liver
• Brain and nervous system
• Blood-clotting system
• Lungs
• Heart and blood vessels
• Placenta and fetal growth

Importantly, protein in the urine is not always necessary for a diagnosis. Preeclampsia can also be diagnosed when high blood pressure is accompanied by specific evidence of organ dysfunction.

What are the first signs of preeclampsia?

The earliest signs are often detected during a medical examination rather than noticed at home.

The three commonly recognised early signs are:

1. High blood pressure
2. Protein in the urine
3. Swelling or fluid retention, particularly when associated with sudden weight gain

However, swelling is common during pregnancy and does not by itself mean that someone has preeclampsia. Some women have no noticeable symptoms at all.

Other warning signs include:

• Persistent or severe headache
• Blurred vision or seeing spots
• Sensitivity to light
• Pain in the upper abdomen, particularly beneath the right ribs
• Sudden swelling of the face or hands
• Nausea or vomiting later in pregnancy
• Shortness of breath
• Reduced urine output

A severe headache, visual changes, significant upper abdominal pain, difficulty breathing or very high blood pressure during pregnancy should be assessed promptly.

What are the causes of preeclampsia?

There isn’t one single cause of preeclampsia.

Current understanding suggests that the condition begins, at least in many cases, with abnormal development or function of the placenta and the blood vessels supplying it. When placental blood flow and development are abnormal, substances released into the mother’s circulation can contribute to widespread blood-vessel dysfunction and high blood pressure.

Several factors can increase the likelihood of developing preeclampsia, including:

• Previous preeclampsia
• First pregnancy
• Multiple pregnancy, such as twins or triplets
• Chronic high blood pressure
• Type 1 or type 2 diabetes
• Kidney disease
• Autoimmune disorders
• Obesity
• Family history of preeclampsia
• Maternal age of 35 years or older
• Certain complications in previous pregnancies
• Pregnancy following assisted reproductive techniques such as IVF

Having a risk factor does not mean that a woman will definitely develop preeclampsia.

What is the main cause of preeclampsia in pregnancy?

The most widely accepted explanation is abnormal placental development and blood-vessel function, but preeclampsia is considered a complex condition involving placental, maternal, fetal, genetic and immune factors.

Researchers are still studying exactly why these changes occur in some pregnancies and not others.

Can male sperm cause preeclampsia?

No, it would be inaccurate to say that a man’s sperm directly “causes” preeclampsia.

There is research suggesting that paternal genetic material and the interaction between maternal and paternal factors can influence placental development and susceptibility to preeclampsia. However, this is part of a much larger biological picture and does not mean that the father or his sperm is the direct cause of the condition.

A systematic review of studies examining pre-pregnancy paternal sperm exposure also found complex associations rather than evidence that sperm itself directly causes preeclampsia.

So, preeclampsia should not be viewed as something caused by or attributable to the father.

Is the father’s DNA responsible for preeclampsia?

Paternal DNA can contribute to the baby’s genetic makeup and therefore to placental biology. Researchers have identified paternal genetic and fetal genetic factors that may influence susceptibility to preeclampsia.

However, paternal DNA is not considered the sole cause of preeclampsia. The condition results from multiple interacting factors involving the placenta, mother and fetus.

What week is preeclampsia most common?

Preeclampsia generally develops after 20 weeks of pregnancy, and many cases occur during the third trimester.

When it develops before 34 weeks, it is commonly described as early-onset preeclampsia. There isn’t one specific pregnancy week in which preeclampsia is universally “most common.” Risk and clinical presentation vary between pregnancies.

Preeclampsia can also develop after delivery. This is known as postpartum preeclampsia and can occur in the days or weeks following childbirth.

How is preeclampsia diagnosed?

Diagnosis usually begins with routine antenatal monitoring.

Your doctor may check:

Blood pressure

A reading of 140/90 mmHg or higher raises concern and generally needs confirmation with repeat measurements. Severe hypertension is 160/110 mmHg or higher.

Urine tests

Urine is checked for protein. A quantitative urine protein-to-creatinine ratio, albumin-to-creatinine ratio or 24-hour urine collection may be used to assess proteinuria.

Blood tests

Blood tests may evaluate:

• Platelet count
• Kidney function
• Liver function
• Other indicators of organ involvement

Fetal monitoring

Your doctor may recommend ultrasound examinations to assess fetal growth, amniotic fluid and placental function. Fetal heart-rate monitoring may also be used when clinically appropriate.

What does preeclampsia pee look like?

There is no specific urine colour or appearance that reliably indicates preeclampsia.

Protein in urine may sometimes make urine appear unusually foamy or frothy, but foamy urine can have many other causes and cannot be used to diagnose preeclampsia.

The only reliable way to determine whether there is significant proteinuria is through an appropriate urine test.

What is stage 1 preeclampsia?

“Stage 1 preeclampsia” is not a standard clinical classification used in major pregnancy guidelines.

You may see terms such as:

• Preeclampsia without severe features
• Preeclampsia with severe features
• Early-onset preeclampsia
• Postpartum preeclampsia

The important point is that preeclampsia can worsen, so the mother’s blood pressure, symptoms, blood tests and the baby’s wellbeing need ongoing assessment.

What happens if you do get preeclampsia?

The next step depends on how severe the condition is and how far along the pregnancy is.

If preeclampsia is diagnosed without severe features, your doctor may recommend closer monitoring, including:

• More frequent blood pressure checks
• Urine tests
• Blood tests
• Ultrasound examinations
• Fetal monitoring
• Medication when indicated

If the condition becomes severe, hospital admission may be necessary. Blood-pressure medication may be used, and magnesium sulfate may be given to reduce the risk of seizures.

If continuing the pregnancy becomes unsafe for the mother or baby, delivery may be recommended. Depending on the circumstances, this may involve induction of labour or caesarean delivery.

What do they do if you have preeclampsia?

Treatment is individualised.

Doctors generally aim to balance two goals: protecting the mother from complications while allowing the baby enough time to mature when it is safe to continue the pregnancy.

Treatment may include:

• Blood-pressure medicines
• Close maternal monitoring
• Fetal growth and wellbeing assessments
• Magnesium sulfate when seizure prevention is indicated
• Corticosteroids when early delivery is anticipated and fetal lung maturation is needed
• Delivery when the risks of continuing the pregnancy become greater than the risks of delivery

The only definitive way for pregnancy-related preeclampsia to resolve is delivery, although high blood pressure and other abnormalities can persist for some time afterwards.

Can a woman survive preeclampsia?

Yes. Most women with preeclampsia can recover, particularly when the condition is detected early and appropriately managed.

However, untreated or severe preeclampsia can become life-threatening. Complications can include eclampsia, stroke, HELLP syndrome, kidney or liver injury, pulmonary oedema and placental abruption.

This is why symptoms should never be ignored during pregnancy or after delivery.

Can preeclampsia harm the baby?

Yes, preeclampsia can affect the baby.

Because the condition can interfere with blood flow through the placenta, the baby may not receive enough oxygen and nutrients. This can contribute to fetal growth restriction.

Preeclampsia can also result in medically necessary premature delivery. Babies born prematurely have a higher risk of breathing, feeding and other complications.

Importantly, early delivery may sometimes be the safest option for both mother and baby when preeclampsia becomes severe.

How long does preeclampsia last?

Preeclampsia usually improves after delivery, but it does not necessarily disappear immediately.

Blood pressure and other abnormalities may continue for days or weeks after childbirth, which is why postpartum monitoring is important. Postpartum preeclampsia can also develop after the baby has been born.

If you have had preeclampsia, discuss follow-up blood pressure and health checks with your doctor even after you feel well.

What makes preeclampsia go away?

Delivery is the definitive treatment for preeclampsia.

That does not mean every woman with preeclampsia needs immediate delivery. If the pregnancy is still early and the mother and baby are stable, doctors may carefully monitor the pregnancy and use treatment to control risks while allowing the baby more time to develop.

If the mother’s condition deteriorates or the baby is in danger, delivery may need to happen earlier.

Can drinking water reduce preeclampsia?

Drinking enough water is important during pregnancy, but water does not treat or cure preeclampsia.

Preeclampsia is not simply caused by dehydration. Drinking excessive amounts of water in an attempt to lower blood pressure can also be harmful, particularly in severe preeclampsia, where doctors carefully manage fluid intake because of the risk of pulmonary edema.

Follow your obstetrician’s advice about fluid intake rather than trying to treat high blood pressure by drinking large amounts of water.

Is bed rest recommended for preeclampsia?

Routine strict bed rest is not generally recommended as a treatment for preeclampsia.

Complete inactivity has not been shown to prevent preterm birth or reduce preeclampsia risk and may increase the risk of complications such as blood clots. Your obstetrician may nevertheless recommend modifying activity based on your individual condition.

Always follow the activity restrictions specifically prescribed for your pregnancy.

What foods should I avoid if I have preeclampsia?

There is no special food that can cure preeclampsia. A balanced pregnancy diet is important.

It is sensible to limit:

• Highly processed foods
• Very salty packaged foods
• Foods high in added sugar
• Excessive caffeine
• Alcohol, which should be avoided during pregnancy

However, do not put yourself on a severely salt-restricted diet without medical advice. NICE specifically advises against salt restriction solely as a strategy to prevent preeclampsia.

Instead, focus on a varied diet containing vegetables, fruits, whole grains, pulses, appropriate protein sources and other nutritious foods recommended during pregnancy.

If you have preeclampsia, diabetes, kidney disease or another condition requiring dietary modification, a doctor or qualified dietitian can provide individual advice.

How to prevent preeclampsia naturally?

There is no guaranteed natural method to prevent preeclampsia.

However, several measures can reduce risk or help identify the condition early:

• Attend all antenatal appointments.
• Have your blood pressure checked regularly.
• Follow recommended urine and blood testing.
• Maintain a healthy weight before pregnancy where possible.
• Manage existing hypertension and diabetes.
• Stay physically active when your pregnancy care team says it is safe.
• Eat a balanced diet.
• Get adequate sleep.
• Know the warning symptoms of preeclampsia.

For women at increased risk, doctors may recommend low-dose aspirin during pregnancy. This should only be started on the advice of a healthcare professional. Depending on the guideline and individual risk profile, aspirin is generally considered from around 12 weeks.

In populations where dietary calcium intake is low, calcium supplementation may also be recommended as a preventive strategy.

Frequently asked questions about preeclampsia

Can preeclampsia happen without symptoms?

Yes. Some women have no obvious symptoms, which is why routine blood pressure and urine checks during pregnancy are so important.

Is 140/90 considered preeclampsia?

A blood pressure of 140/90 mmHg or higher meets the definition of hypertension in pregnancy when appropriately confirmed, but one high reading alone does not automatically establish preeclampsia. Doctors also assess urine protein and signs of organ involvement.

Is 160/110 dangerous during pregnancy?

Yes. Blood pressure of 160/110 mmHg or higher is severe hypertension and requires urgent medical assessment and treatment.

Can preeclampsia develop after delivery?

Yes. Postpartum preeclampsia can occur after childbirth, sometimes after the mother has already left the hospital.

Does preeclampsia mean I will need a C-section?

Not necessarily. Some women with preeclampsia can have a vaginal delivery. The mode and timing of delivery depend on factors such as gestational age, blood pressure, severity of the condition, cervical status and the health of the mother and baby.

What are the three early signs of preeclampsia?

The commonly recognised early signs are high blood pressure, protein in the urine and fluid retention or swelling. However, many women have no symptoms.

Can preeclampsia be completely cured during pregnancy?

There is no medication or home remedy that permanently cures preeclampsia while the pregnancy continues. Delivery is the definitive treatment, although doctors may safely manage some cases for a period of time before delivery.

When should you seek urgent medical attention?

If you are pregnant or have recently delivered and develop any of the following symptoms, contact your healthcare provider promptly or seek emergency medical care:

• Severe or persistent headache
• Blurred vision, flashing lights or spots
• Severe pain below the ribs or in the upper abdomen
• Sudden swelling of the face or hands
• Significant difficulty breathing
• Seizure or loss of consciousness
• Very high blood pressure
• Markedly reduced urine output
• A sudden feeling that something is seriously wrong

Preeclampsia can progress quickly, and some serious complications can occur even when symptoms are limited.

The importance of regular antenatal care

Preeclampsia can be frightening, but an important message is that early detection makes a difference.

Regular prenatal appointments allow your healthcare team to monitor blood pressure, urine, blood tests and the baby’s growth. If abnormalities appear, treatment and monitoring can begin before complications become severe.

If you have risk factors for preeclampsia or have experienced it during a previous pregnancy, discuss your individual risk and prevention options with your obstetrician before or early in pregnancy.

Preeclampsia is a serious pregnancy complication, but it is also a condition that healthcare professionals know how to monitor and manage. Paying attention to warning signs, attending antenatal appointments and seeking timely medical care are among the most important steps you can take for your health and your baby’s wellbeing.

Medical information in this article is for educational purposes and does not replace an examination or advice from your obstetrician or other qualified healthcare professional.

To consult a Gynecologist at Sparsh Diagnostic Centre, call our helpline number 9830117733.

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