Preeclampsia During Pregnancy: Your Questions Answered

Preeclampsia, a serious condition that can occur during pregnancy, affects about 5% to 8% of all pregnancies in the United States and has been on the rise over the last two decades.

“It’s a common, serious condition and requires consistent prenatal care to catch it,” says Dr. Whitney Booker, a maternal-fetal medicine expert at NewYork-Presbyterian/ Columbia University Irving Medical Center. “Thanks to advanced treatment methods, most people who are diagnosed with preeclampsia will go on to deliver healthy babies and fully recover.”

Health Matters spoke with Dr. Booker, an assistant professor of Obstetrics and Gynecology at Columbia University Vagelos College of Physicians and Surgeons, to understand why preeclampsia during pregnancy occurs, who is at risk, and whether it can be prevented.

How does preeclampsia affect mom and baby?
Preeclampsia is characterized by high blood pressure and can lead to a host of health issues if left untreated. For moms, it can put them at risk of liver and kidney issues, stroke, seizures, blood clotting problems, and fluid buildup in the lungs. For babies, it can affect their growth during pregnancy and lead to premature birth, low birth weight, and in severe cases, stillbirth.

What causes preeclampsia?
Experts are still working to understand why preeclampsia occurs. It is thought to be related to abnormal implantation of the placenta into the uterine wall very early in pregnancy, when blood vessels are forming and attaching. Other possible causes are excessive inflammation in response to pregnancy, insufficient blood flow to the uterus, hormone imbalances, and genetics, among others.

What are the signs and symptoms of preeclampsia?
The most common sign is elevated blood pressure—anything higher than 140 over 90, or in severe cases 160 over 105. Preeclampsia can happen gradually, or symptoms can develop rapidly, and it can occur in those who have never had high blood pressure before. Many patients aren’t aware that their blood pressure is so high and may feel perfectly fine. That’s why we do blood pressure checks so frequently throughout pregnancy.

A common symptom that I’ve come across in patients is that they say they just feel “off.” They feel lethargic, their head feels spacey—similar to how you might feel when coming down with a cold. That’s when I do a blood pressure check and go from there.

For more severe cases, symptoms can include:

• Total body swelling (not just in the hands and feet but all over the body)
• Severe headaches
• Temporary vision loss or blurry vision
• Abdominal pain, usually in the upper right side
• Shortness of breath

When should you see your doctor?
If you are experiencing any of the above symptoms or are just feeling “off,” call your doctor right away. It is always better to be overly cautious. With earlier diagnosis and prompt treatment, preeclampsia can be managed to keep you and your baby safe.

How is it diagnosed?
Diagnosis entails a blood pressure check, blood work, a urine analysis to check kidney function, and a liver function test to check the liver.

Regular prenatal visits are critical. Preeclampsia can be a silent condition. If a person isn’t checking their blood pressure regularly, it can be missed. It’s important to have access to a blood pressure cuff at home. The earlier it’s diagnosed, the better.

Who is most at risk?
We see preeclampsia more commonly among younger pregnant patients, for example in teen pregnancies, and in patients who become pregnant after 40 years old. Preeclampsia can occur more often in a first pregnancy or if the patient had preeclampsia in a previous pregnancy or is carrying multiples (twins, triplets).

Other risk factors include chronic health conditions such as hypertension (high blood pressure), heart disease, obesity, diabetes, and kidney disease.

Black and Latina women also are disproportionately affected by preeclampsia. Unfortunately, we don’t know if that’s related to a genetic predisposition, underlying medical issues, or poor access to care. The reasons are still unclear.

When does preeclampsia occur?
Preeclampsia usually occurs after 20 weeks of pregnancy—in the second or third trimester. It can also occur in the days or weeks after childbirth, though that’s less common.

How is it treated?
As soon as preeclampsia is diagnosed, mom and baby are very closely monitored. Once preeclampsia occurs, it cannot be reversed. The only real “cure” is to deliver the baby and placenta as safely as possible. Certain medications to reduce blood pressure may help prolong a pregnancy, but in some cases the baby must be delivered immediately to save either the mom’s or baby’s life.

For severe cases, mothers are often kept in the hospital so they can be monitored. They may receive an IV medicine called magnesium sulfate to reduce the risk of stroke and seizure.

Can it cause future health problems?
People with preeclampsia are at higher risk of getting heart disease, chronic high blood pressure, and stroke later in life.

Can preeclampsia be prevented?
While we don’t have a way to prevent preeclampsia yet, taking a low-dose aspirin once a day during pregnancy may reduce the risk of preeclampsia for those who are high-risk; ask your doctor.

The best way to reduce the risk of preeclampsia is to manage health conditions you can control. Before becoming pregnant, people should work with their doctors to modify their diets to lose weight if needed and help get their blood pressure or diabetes under control.

“You want to have the healthiest lifestyle before and during pregnancy,” Dr. Booker says.

Whitney A. Booker, M.D., is a maternal-fetal medicine expert at NewYork-Presbyterian/Columbia University Irving Medical Center and an assistant professor of Obstetrics and Gynecology at Columbia University Vagelos College of Physicians and Surgeons. Dr. Booker treats people in all stages of their pregnancy. She has many areas of expertise including heart disease in pregnancy, high-risk pregnancy, medical complications in pregnancy, and pre-term birth prevention.