Preeclampsia: Warning Signs, Risk Factors & When to Call Your Doctor

Preeclampsia is one of the most serious pregnancy complications, yet many women don't recognize the warning signs until it becomes severe. This condition affects approximately 1 in 15 pregnancies worldwide and can progress rapidly from mild to life-threatening. Understanding the symptoms, knowing your risk factors, and acting quickly can protect both you and your baby.

What Is Preeclampsia?

Preeclampsia is a pregnancy-specific disorder characterized by new-onset high blood pressure (hypertension) and protein in the urine (proteinuria) developing after 20 weeks of gestation. It affects multiple organ systems including the liver, kidneys, brain, and placenta.

See also: Baby Ear Infection: Signs, Treatment & When to See the Doctor and When Do Toddlers Stop Napping? Signs and How to Transition.

The condition is thought to originate from abnormal placental development early in pregnancy, leading to poor blood flow and the release of substances that damage blood vessel walls throughout the body. Without treatment, preeclampsia can progress to eclampsia (seizures), HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), organ failure, or placental abruption.

Warning Signs & Symptoms

While mild preeclampsia may be detected only through routine prenatal screening, severe preeclampsia produces distinct warning signs that require immediate attention:

Who Is at Risk

Any pregnant woman can develop preeclampsia, but certain factors significantly increase your risk:

• First pregnancy — risk is 2–3 times higher in first-time mothers
• Previous preeclampsia — recurrence rate of 15–20% in subsequent pregnancies
• Chronic hypertension — pre-existing high blood pressure before pregnancy
• Multiple gestation — twins or triplets increase risk significantly
• Age — women under 20 or over 35 face higher risk
• Obesity — BMI ≥30 doubles the risk
• Diabetes — type 1, type 2, or gestational diabetes
• Kidney disease — pre-existing renal conditions
• Autoimmune disorders — lupus or antiphospholipid syndrome
• Family history — mother or sister with preeclampsia
• IVF conception — slightly elevated risk with assisted reproduction

How It's Diagnosed

Preeclampsia is diagnosed when both of the following are present after 20 weeks of pregnancy:

• High blood pressure — systolic ≥140 mmHg or diastolic ≥90 mmHg on two readings at least 4 hours apart
• Proteinuria — ≥300 mg of protein in a 24-hour urine collection, or protein/creatinine ratio ≥0.3

In the absence of proteinuria, preeclampsia can still be diagnosed if hypertension is accompanied by low platelets, elevated liver enzymes, kidney insufficiency, pulmonary edema, or cerebral/visual symptoms.

Severe preeclampsia is diagnosed when blood pressure reaches ≥160/110 mmHg or when organ damage is present (HELLP syndrome, renal failure, or neurological symptoms).

Treatment & Management

The only definitive cure for preeclampsia is delivery of the baby and placenta. Treatment decisions depend on the severity and gestational age:

• Mild preeclampsia (before 37 weeks) — close monitoring with twice-weekly blood pressure checks, blood tests, and fetal surveillance. Bed rest may be recommended.
• Mild preeclampsia (at or after 37 weeks) — delivery is typically recommended as the risks of continuing pregnancy outweigh the benefits
• Severe preeclampsia — hospitalization, IV magnesium sulfate to prevent seizures, antihypertensive medications, and delivery planning
• Before 34 weeks — corticosteroids are given to accelerate fetal lung maturity before delivery

After delivery, blood pressure usually returns to normal within days to weeks, though monitoring continues for 6 weeks postpartum as late-onset postpartum preeclampsia can occur.

Can You Prevent It?

While preeclampsia cannot be completely prevented, evidence-based strategies can significantly reduce risk:

• Low-dose aspirin — 81–150 mg daily starting at 12–16 weeks reduces risk by ~25% in high-risk women. Recommended by ACOG for women with one or more high-risk factors.
• Calcium supplementation — 1.5–2 g daily may help women with low dietary calcium intake
• Regular exercise — moderate physical activity throughout pregnancy supports cardiovascular health
• Healthy weight — achieving a healthy BMI before pregnancy reduces baseline risk
• Managing chronic conditions — optimizing blood pressure, blood sugar, and kidney function before conception

When to Seek Emergency Care

Go to the hospital immediately or call emergency services if you experience any of the following:

• Severe headache that won't go away with rest or medication
• Visual disturbances — blurred vision, seeing spots, flashing lights, or temporary vision loss
• Severe pain below the ribs, especially on the right side
• Sudden severe swelling of face or hands
• Difficulty breathing or chest pain
• Confusion, altered consciousness, or seizures
• Vaginal bleeding with abdominal pain

Time matters with preeclampsia. The condition can progress from mild to life-threatening within hours. If you're unsure whether your symptoms are serious, always err on the side of caution and contact your healthcare provider immediately.