Pregnancy Health Center

What Is Preeclampsia?

Preeclampsia is a pregnancy complication characterized by high blood pressure (hypertension) and signs of damage to another organ system — most often the liver and kidneys. It typically develops after 20 weeks of pregnancy in women whose blood pressure was previously normal.

It affects 5–8% of all pregnancies in the United States — roughly 200,000 women annually — making it one of the leading causes of maternal and fetal complications. Without treatment, preeclampsia can progress to eclampsia (seizures) or HELLP syndrome, both life-threatening conditions.

Signs & Symptoms

Preeclampsia can develop suddenly and doesn't always have obvious early warning signs — which is why regular prenatal blood pressure checks are critical. When symptoms do appear, they include:

Risk Factors

While preeclampsia can occur in any pregnancy, certain factors significantly increase risk. Knowing your risk level helps your care team monitor you more closely.

High-Risk Factors (single factor sufficient for close monitoring)

Moderate-Risk Factors (two or more = high risk)

HELLP Syndrome

HELLP syndrome is a severe variant of preeclampsia that can develop rapidly, sometimes without preceding blood pressure elevation. The name is an acronym:

• H — Hemolysis (breakdown of red blood cells)
• EL — Elevated Liver enzymes (indicating liver damage)
• LP — Low Platelet count (impaired clotting)

Symptoms unique to HELLP beyond preeclampsia include: nausea/vomiting with upper right pain, feeling very unwell ("sick all over"), malaise disproportionate to blood pressure readings. Women with suspected HELLP need urgent CBC, comprehensive metabolic panel, and uric acid levels.

Diagnosis

Preeclampsia is diagnosed based on:

• Blood pressure ≥140/90 mmHg on two occasions, ≥4 hours apart, after 20 weeks gestation
• Proteinuria: ≥300mg protein in 24-hour urine collection, OR protein/creatinine ratio ≥0.3, OR dipstick reading of 2+ (used only if other methods unavailable)
• In the absence of proteinuria: severe features such as thrombocytopenia (<100,000 platelets/μL), renal insufficiency, impaired liver function, pulmonary edema, or new-onset headache/visual disturbances

Your OB will monitor with serial blood pressure checks, urine protein testing, blood work (CBC, CMP, liver function), and fetal well-being assessments (non-stress tests, biophysical profiles, umbilical artery Doppler).

Treatment Options

The only definitive cure for preeclampsia is delivery. All other treatments are management strategies to protect the mother and buy time for fetal maturity.

Antihypertensive Medications

Used to bring severely elevated blood pressure (>160/110) to safer levels. Does not treat preeclampsia — only manages one dangerous component:

• Labetalol (oral or IV) — first-line in acute severe hypertension
• Nifedipine extended-release — commonly used oral agent
• Hydralazine — IV agent used in acute settings
• Methyldopa — older but still used, particularly outside the US
• ACE inhibitors (Lisinopril, etc.) and ARBs are contraindicated in pregnancy

Magnesium Sulfate (Seizure Prevention)

Magnesium sulfate IV is the standard treatment to prevent eclamptic seizures in women with severe features. It's given from diagnosis through 24–48 hours postpartum. Side effects include flushing, warmth, and slowed reflexes — all monitored closely.

Corticosteroids (Lung Maturation)

If delivery before 34 weeks is anticipated, betamethasone or dexamethasone are given to accelerate fetal lung development, reducing risk of neonatal respiratory distress.

Delivery Planning

• ≥37 weeks: Delivery recommended promptly
• 34–37 weeks: Balance fetal maturity against maternal risk (individualized)
• <34 weeks with severe features: Stabilize and deliver; conservative management only in specialized centers
• HELLP syndrome: Deliver regardless of gestational age

Medication Cost & Savings

Several preeclampsia-related medications can be expensive out-of-pocket. Free Rx discount cards can significantly reduce costs at most pharmacies:

Prevention & Monitoring

For high-risk women, low-dose aspirin (81mg daily) started at 12–16 weeks has strong evidence for reducing preeclampsia risk by up to 24%. The US Preventive Services Task Force gives this an A recommendation.

Additional preventive measures with supportive evidence:

• Adequate calcium supplementation (1–2g/day) in calcium-deficient populations
• Achieving healthy weight before pregnancy if possible
• Managing chronic hypertension, diabetes, and autoimmune conditions before conception
• Regular prenatal visits for blood pressure and urine protein screening
• Reporting symptoms promptly — don't wait for "next appointment"