Preeclampsia

doctors talking with pregnant patient in hospital bed During pregnancy, your body goes through many changes, some exciting and some not as pleasant. However, it can be challenging to know what’s normal and what might be a red flag.

At The Ohio State University Wexner Medical Center in Columbus, Ohio, our obstetricians want you to know what signs and symptoms might signal a complication, so we can help you identify problems early and find solutions for the best outcomes. One of the most common pregnancy complications is preeclampsia.

Our Maternal Fetal Medicine experts will help you understand the significance of preeclampsia, and what it means for you and your baby. We’re experts at helping people manage pregnancy, labor and delivery with preeclampsia, and we’re at the forefront of research to find better ways to treat and prevent it.

What is preeclampsia?

Preeclampsia, previously called toxemia, is a condition marked by sudden onset of high blood pressure during pregnancy or after giving birth, along with increased protein in urine and other symptoms that could harm your organs. Typically, preeclampsia appears after 20 weeks of pregnancy or in the days following birth.

If not identified early and managed correctly, preeclampsia can lead to serious complications, such as liver or kidney damage, for the mother. It can be life-threatening for both the pregnant person and the baby.

However, most people’s preeclampsia can be managed safely by experienced and trained obstetricians.

Postpartum preeclampsia

Sometimes preeclampsia doesn’t appear until after delivery. This is known as postpartum preeclampsia, which occurs when your blood pressure rises to an abnormal level in the days and weeks following birth.

How common is preeclampsia?

Preeclampsia occurs in about 2-8% of pregnancies worldwide, according to the World Health Organization. That number is higher (10-15%) at the Ohio State Wexner Medical Center as we manage a lot of high-risk pregnancies where risk factors for preeclampsia, such as having diabetes, chronic hypertension, carrying multiples or being of advanced maternal age, are already present. It’s a relatively common pregnancy complication for us, and our obstetricians and maternal fetal medicine physicians help hundreds of pregnant people manage preeclampsia annually.

What causes preeclampsia?

While we continue to research what causes preeclampsia, we don’t know exactly why it occurs in some pregnancies and not others. However, it is thought to be related to abnormal placental development early in pregnancy. We do know some women are at a greater risk of developing preeclampsia during pregnancy based on their history and other factors.

Risk factors for preeclampsia

Risk factors are certain conditions or characteristics that may put you at greater risk of developing preeclampsia. It’s important to remember that just because you have a risk factor does not automatically mean you’ll have preeclampsia, and sometimes pregnant people develop preeclampsia with no risk factors.

Some risk factors for preeclampsia include:

Chronic high blood pressure
Diabetes
Kidney disease
Having a previous pregnancy with preeclampsia
Carrying twins or multiples
Certain autoimmune diseases, such as lupus
Obesity
A first-time pregnancy
Pregnancy after in-vitro fertilization
Advanced maternal age
Having a family history (sister, mother, daughter) of preeclampsia
Certain racial or ethnic backgrounds, such as African American
Having a previous pregnancy with an infant with low birth weight or giving birth more than 10 years ago

If you have one or more of these risk factors, you should talk to your obstetrician about what you can do to prevent preeclampsia or what symptoms to look for.

Can you reduce your preeclampsia risk?

While there’s no sure way to prevent preeclampsia, you can take certain steps to lower your risk. Steps to lower your risk include:

Taking a daily low-dose aspirin starting before 16 weeks of pregnancy
Scheduling regular prenatal checkups that include blood pressure checks
Treating preexisting medical conditions
Making lifestyle changes, such as eating a healthy diet or exercising
Watching out for symptoms, such as headaches and visual disturbances, since catching preeclampsia early will allow us to better manage the condition

Preventing preeclampsia: What we know about aspirin and preeclampsia

Learn how Ohio State physicians are using aspirin to support management of pregnant people at risk of preeclampsia.

Preeclampsia symptoms

The hallmark sign of preeclampsia is high blood pressure during pregnancy, but often the condition presents without any noticeable symptoms. First signs of the condition are sometimes identified during a prenatal visit with your doctor, demonstrating how important prenatal care under an obstetrician or certified nurse-midwife can be. Besides high blood pressure (greater than 140/90 mm Hg), other symptoms of preeclampsia include:

Excess protein in urine (proteinuria) and other signs of kidney issues
Headaches
Vision disturbances (blurred vision, seeing spots)
Swelling in the hands and face
Upper abdominal pain
Chest pain or shortness of breath

Some of the above symptoms are common in pregnancy for other reasons, so it’s important to talk to your doctor about what’s normal and what might be cause for alarm, especially in relation to what routine urine and blood tests may indicate.

How can preeclampsia affect my baby?

Preeclampsia can restrict the baby’s growth. Also, depending on how severe it is for the mother, preeclampsia may lead to premature birth. Both preterm birth and low birth weight can cause various complications that could impact the health of your baby, including requiring a stay in the neonatal intensive care unit (NICU).

How is preeclampsia diagnosed?

Your doctor may perform several tests to confirm a diagnosis of preeclampsia, along with discussing your symptoms and examining you. Tools that help diagnose preeclampsia include:

Blood pressure checks
Urine tests to measure protein in the urine
Blood tests for signs of kidney, liver or other organ failure

What should I expect once diagnosed with preeclampsia?

If you’re diagnosed with preeclampsia, it doesn’t necessarily mean you’ll experience serious impacts on your pregnancy. At the Ohio State Wexner Medical Center, you’ll be monitored closely to ensure your preeclampsia doesn’t harm you or your baby. If you’re diagnosed with preeclampsia:

You may be referred to our Maternal Fetal Medicine physicians, who specialize in high-risk pregnancies.
You may have more frequent prenatal appointments to monitor blood pressure, urine, kidney and liver function, and blood (including platelets) count.
You may also be taught how to check your own blood pressure to monitor vitals at home in between visits.
You should talk to your doctor about any symptoms you may feel or changes in your body.
If your condition worsens, you may need to be hospitalized in our Maternal Special Care unit for in-hospital, high-risk care, where you’ll stay until delivery.

What are potential complications of preeclampsia?

Preeclampsia can be a very dangerous, even deadly, condition if not managed properly by pregnancy experts. Potential complications of preeclampsia include:

Kidney, liver or other organ problems
Eclamptic seizures
Fluid in lungs
HELLP, which stands for hemolysis (damaged red blood cells), elevated liver enzymes and low platelets
Placental abruption
Stroke
Preterm birth
Restricted fetal growth
Stillbirth
Death of pregnant person

Preeclampsia can also increase your risk of having cardiovascular disease, including elevated blood pressure, heart failure, heart attacks and stroke, later in your life.

When is preeclampsia an emergency?

Preeclampsia becomes an emergency when:

Your blood pressure rises above 160/100 mm Hg
Your headache, visual impairment or abdominal pain is severe and not responding to treatment at home
You have signs of organ failure
You have a seizure
You exhibit other serious complications, such as fluid in lungs or neurological concerns

How is preeclampsia treated?

Delivery is the only treatment for preeclampsia at this point, although we continuously lead or participate in research to develop medications to treat preeclampsia. Delivery may need to occur prematurely, making it important to manage the disease (keeping it safe for the mother) until your baby reaches a gestational age when it’s appropriate to deliver.

Determining your personalized treatment plan for preeclampsia will depend on a variety of factors including the severity of your condition, how far along you are in pregnancy and your overall health.

Preeclampsia without severe features and without complications

For preeclampsia that isn’t severe, your treatment plan will most likely include more frequent appointments and close monitoring. Your doctor may recommend delivery at 37 weeks of pregnancy.

Preeclampsia with severe features

Treatments for severe preeclampsia include:

Medications – We may give you anti-hypertensive medications to lower your blood pressure, anti-convulsant medicines to prevent seizures or corticosteroids to encourage your baby’s lungs to develop.
In-hospital observation – If you are less than 34 weeks pregnant, you may need to be admitted to our Maternal Special Care Unit for in-hospital, high-risk care, where we can monitor you and your baby closely.
Delivery – This is ultimately the only treatment for preeclampsia. We usually recommend delivery at 34 weeks unless it becomes too dangerous to continue to manage your symptoms. Then, we recommend delivering earlier than 34 weeks. We always weigh the risks of delivering early with the risks of continuing the pregnancy with severe preeclampsia.

Delivery

Delivering your baby should make symptoms of preeclampsia subside in a few days for most pregnant people. Delivery can be vaginal or cesarean, depending on what’s most appropriate.

You or your baby may need to be hospitalized for a few extra days for observation to ensure your condition is improving. After, it will be vital for you to be seen in clinic for blood pressure checks as well as monitor your blood pressure at home and report changes to your doctor.

Preeclampsia research at Ohio State

Ohio State is at the forefront of research and developing new ways to manage this common, yet very serious, pregnancy complication. Our research looks at not only ways to treat preeclampsia but also at how to best prevent and diagnose it. Our current research and clinical trials focus on:

Aspirin use in clinical care, including identifying the most beneficial dosage and who might respond best to aspirin.
Postpartum care, including studying the use of statins (cholesterol medications) and alternate blood pressure monitoring strategies to reduce your future risk of heart disease.
Biomarkers, such as looking at small particles (vesicles) released by the placenta to assess your response to aspirin therapy.
Blood pressure management strategies in women with preeclampsia without severe features