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Pregnancy isn’t always a walk in the park: There’s the mind-boggling (and even rude) pregnancy terminology, the stressful tests and screenings, and the constant fear that you’re going to somehow unintentionally hurt your unborn child. Something that can help? Understanding what you may actually need to worry about (and we’re not talking about your obsession with avoiding deli meats).
One of those things? Preeclampsia, a complication that occurs in 5 to 7% of pregnancies. Here’s what you should know about the condition and whether you’re at risk.
What is preeclampsia?
Ever since celebs like Beyoncé, Meghan Markle and Serena Williams started sharing their own experiences with preeclampsia, it’s become more commonly known, which is a good thing, since knowledge is power when it comes to pregnancy health.
So, what is it exactly?
Preeclampsia is a fairly common complication of pregnancy. It’s often discovered during routine prenatal visits with your doctor. It’s characterized by high blood pressure after 20 weeks of gestation and is usually accompanied by other problems like excess protein in your urine, decreased levels of platelets in your blood and increased liver enzymes.
Though the defining feature of preeclampsia is high blood pressure, one of the most easily recognized signs is edema, AKA swelling. Other noticeable symptoms include severe headaches, changes in vision (like loss of vision, blurry vision or light sensitivity), shortness of breath, upper belly pain, nausea, vomiting and sudden weight gain.
Who gets preeclampsia
The reasons people get the condition aren’t super clear or consistent. Here’s what we do know:
Preeclampsia is not super common (but also not rare)
As mentioned above, it occurs in a very small minority of pregnancies, but you shouldn’t feel bad or like you did anything wrong if you’re diagnosed with it. It’s just something that happens — and which may have several different causes.
Some factors do increase your risk of developing preeclampsia
These factors include the following:
- It’s your first pregnancy
- You’ve had preeclampsia before
- You have a family history (there is a genetic predisposition)
- You had preexisting hypertension or diabetes before pregnancy
- You’re either younger than 20 or older than 35
- You conceived by in vitro fertilization (IVF)
- You are obese or have a BMI over 30 before your pregnancy
Preeclampsia usually comes later in pregnancy
It is rare to develop preeclampsia early in your pregnancy — around 90% of cases are diagnosed at or after 34 weeks.
Preeclampsia can be complicated to diagnose
There’s no one perfect lab test to determine if you have preeclampsia (we’ll go into this more later), but there are specific things that doctors look for, like your blood pressure going up and abnormalities in urine or blood tests.
“In some patients who have other conditions, it can be hard to figure out if it's their chronic condition or new preeclampsia,” says Kathryn Gray, MD, PhD, a board-certified physician in Obstetrics & Gynecology, Maternal-Fetal Medicine and Clinical Genetics.
Why is preeclampsia so scary?
According to Gray, even if your chances of getting preeclampsia aren’t super high, it should still be taken very seriously — it's one of the main reasons that pregnant people and newborns get seriously sick or even die. Which is why it’s so important to get good prenatal care so it can be detected and treated.
For mothers: If you have preeclampsia, there’s a risk of your blood pressure going sky high and causing permanent damage or even leading to a stroke or seizure.
“It’s also important to know that people who've had preeclampsia are at a lifelong increased risk of cardiovascular disease and other metabolic conditions like diabetes and chronic kidney disease,” says Gray.
For babies: If you have preeclampsia your baby may need to be delivered early. They may also be smaller than usual for their gestational age and have an increased risk of cardiometabolic disease later in life.
And yes, this all sounds really scary — but with careful monitoring and guidance from your doctor, you can remain safe.
How do you treat preeclampsia?
So, how do you get “cured”? Generally, preeclampsia resolves after the baby is delivered, although there are rare cases of postpartum preeclampsia.
When it comes to treating preeclampsia while you’re still pregnant, it all depends on how severe your symptoms are and how far along the pregnancy is.
According to Gray, if you are 37 weeks or after, then you just deliver the baby. If you haven’t yet reached 37 weeks, then your treatment is based on how well you and baby are doing.
"Once a pregnant person gets to 34 weeks gestation, if they have a diagnosis of severe preeclampsia, then the recommendation is for delivery at 34 weeks,” says Gray.
If you're having issues before 34 weeks, then you’re probably going to need medicine to bring down your blood pressure and magnesium to prevent seizures. You're also going to need to have the baby monitored closely — requiring hospitalization and early delivery.
Is there new research about preeclampsia?
Because it can be so hard to diagnose, there is a lot of new and developing research looking at how to identify who is at high risk for developing preeclampsia.
“For a long time, people have been trying to predict who's going to get preeclampsia, and we're still not that great at it,” says Gray. “However, there are different points in the pregnancy at which different tests are useful.”
Some of these tests measure certain proteins in the blood that are great for predicting if a symptomatic person is going to get more severe preeclampsia in the very near future, but less helpful for those who are still in early pregnancy and trying to figure out their chances of developing the complication. Others can test if you have low values of a placental protein in the first trimester, which may mean you are at risk of developing preeclampsia later.
"One existing preeclampsia screening test combines a couple of protein markers with clinical risk factors to predict in the first trimester who is at risk for developing early preeclampsia, the type that develops before 34 weeks,” says Gray.
Which again, is great, but since 90% of people have preeclampsia after 34 weeks, you’re still not getting the bulk of people who will be affected.
And the newest test? One biotech company has developed a test that uses unique RNA signatures in the pregnant person’s blood to identify at-risk patients. This breakthrough test is exciting, but really only works best for pregnant individuals who are 35 years or older and who don’t have pre-existing high-risk conditions — which again, is a pretty specific population.
But, even if they aren’t perfect yet, every scientific breakthrough and newly developed test is monumental in the efforts to understand preeclampsia and how to take care of pregnant patients. After all, if doctors could predict high risk from the beginning, they could develop better preventive treatments and therapies.
“At the moment, do we really have a great predictive test of preeclampsia? No. Would it be super impactful for patients who live in obstetric care deserts and for those in lower-income countries without access to routine obstetric care? Yes, we all think it would be really useful,” says Gray.
And as for what you can do if you are at high risk of getting preeclampsia? Guidelines say that low-dose aspirin can be helpful when started before 16 weeks of gestation.
Things to keep in mind
As with any health issue, it’s important to check in with your doctor regularly. But if you had preeclampsia during one of your pregnancies, it’s especially important that you let your primary care doctor know, since it’s one of the key risk factors for later-in-life hypertension and cardiovascular disease. And your kiddo? They should also make sure to have regular check-ups, since they’re also a little more at risk of those issues further down the line.
Another thing to keep in mind? How important the continued research of conditions like preeclampsia is to people everywhere.
“I think we've been slow to advance research in this area because of a lack of prioritization of women's health overall,” says Gray. “Research on pregnancy has really been underfunded over time and remains a key area to invest in, because we really can't make improvements in care without investment in research.”
