10 Warning Signs and Symptoms of Preeclampsia Every Pregnant Woman Should Know

Preeclampsia is a serious pregnancy complication characterized by high blood pressure and signs of damage to organ systems, most often the liver and kidneys. This condition typically develops after 20 weeks of pregnancy in women whose blood pressure was previously normal. If left untreated, preeclampsia can lead to severe complications for both mother and baby, including eclampsia, which involves seizures. Understanding the warning signs of preeclampsia is crucial for early detection and proper medical management.

Affecting approximately 5-8% of all pregnancies worldwide, preeclampsia requires immediate medical attention when symptoms appear. While some women with preeclampsia may not experience noticeable symptoms initially, recognizing the warning signs can be life-saving. This article outlines the ten most important symptoms of preeclampsia that every pregnant woman should be aware of to ensure timely medical intervention.

1. High Blood Pressure (Hypertension)

High blood pressure is the hallmark sign of preeclampsia and often the first indicator that healthcare providers detect. A blood pressure reading of 140/90 mmHg or higher on two separate occasions, at least four hours apart, is considered elevated during pregnancy.

This symptom is particularly concerning because many women don’t feel any different when their blood pressure rises. This is why regular prenatal checkups are essential – your healthcare provider will monitor your blood pressure at each visit. Some women may experience symptoms related to severely elevated blood pressure, such as:

• Pounding headaches that don’t respond to typical pain relievers
• Feeling flushed or experiencing facial redness
• Dizziness or feeling lightheaded
• A sensation of pressure in the chest

If you have a blood pressure monitor at home and notice consistently elevated readings, contact your healthcare provider immediately, even if you feel fine otherwise.

2. Protein in Urine (Proteinuria)

The presence of excess protein in your urine, medically known as proteinuria, is another key diagnostic criterion for preeclampsia. This occurs when the kidneys are damaged and begin to leak protein that should normally be retained in the bloodstream.

Proteinuria is typically detected through routine urine tests during prenatal visits. A result showing 300 milligrams or more of protein in a 24-hour urine collection, or a protein/creatinine ratio of 0.3 or higher in a random urine sample, indicates proteinuria. While you cannot detect this symptom on your own, some women may notice:

• Urine that appears foamy or bubbly
• Changes in urine color or odor
• Decreased urine output

Your healthcare provider will regularly test your urine during pregnancy to monitor for this important sign of preeclampsia.

3. Severe Headaches

Persistent, severe headaches that don’t improve with rest or over-the-counter pain medication can be a warning sign of preeclampsia. These headaches are often described as throbbing or migraine-like and are typically felt across the forehead or at the back of the head.

The headaches associated with preeclampsia differ from typical pregnancy headaches or tension headaches. They are caused by elevated blood pressure affecting blood vessels in the brain, and may be accompanied by:

• Sensitivity to light (photophobia)
• Sensitivity to sound
• Nausea or vomiting
• Blurred vision or visual disturbances
• A feeling of pressure or fullness in the head

If you experience a severe headache that persists for more than a few hours or is unlike any headache you’ve had before, especially in combination with other symptoms, seek medical attention promptly.

4. Visual Disturbances

Changes in vision are serious warning signs of preeclampsia that should never be ignored. These visual symptoms occur when high blood pressure affects the blood vessels in the eyes and the part of the brain responsible for processing visual information.

Women with preeclampsia may experience various types of visual disturbances, including:

• Blurred vision or inability to focus clearly
• Seeing spots, floaters, or flashing lights
• Temporary vision loss or blind spots
• Seeing auras (shimmering or wavy lines)
• Double vision
• Light sensitivity that makes it difficult to be in bright environments

These symptoms indicate that preeclampsia may be progressing to a severe stage. Any sudden changes in vision during pregnancy warrant immediate medical evaluation, as they could signal that the condition is affecting your nervous system.

5. Upper Abdominal Pain

Severe pain in the upper right portion of the abdomen, just below the ribs, is a significant symptom of preeclampsia that indicates potential liver involvement. This pain is often mistaken for heartburn, indigestion, or gallbladder problems, but it has distinct characteristics.

The abdominal pain associated with preeclampsia typically:

• Occurs in the upper right quadrant, beneath the ribcage
• May radiate to the right shoulder or back
• Feels sharp, stabbing, or like intense pressure
• Doesn’t improve with antacids or changes in position
• May be accompanied by nausea and vomiting
• Can be confused with HELLP syndrome, a severe variant of preeclampsia

This symptom suggests that the liver is becoming stressed or swollen due to preeclampsia. The pain occurs because the liver capsule (the membrane surrounding the liver) is being stretched. If you experience persistent upper abdominal pain during pregnancy, especially if accompanied by other preeclampsia symptoms, contact your healthcare provider immediately.

6. Sudden Weight Gain and Severe Swelling (Edema)

While mild swelling in the feet, ankles, and hands is common during normal pregnancy, sudden and severe swelling can be a red flag for preeclampsia. This occurs because the kidneys aren’t functioning properly and the body retains excess fluid.

Concerning signs of edema related to preeclampsia include:

• Rapid weight gain (more than 2 pounds in a week or 6 pounds in a month)
• Swelling in the face, especially around the eyes and in the cheeks
• Severe swelling in the hands that makes it difficult to remove rings
• Extreme puffiness in the feet and ankles that doesn’t improve with rest or elevation
• Swelling that causes the skin to retain an indentation when pressed (pitting edema)
• Tightness in shoes or inability to wear normal shoes

The key difference between normal pregnancy swelling and preeclampsia-related edema is the severity and speed of onset. While gradual swelling throughout pregnancy is typically normal, sudden swelling that appears over a day or two, particularly in the face and hands, should be reported to your healthcare provider.

7. Nausea and Vomiting

While nausea and vomiting are common in early pregnancy due to morning sickness, their appearance or return in the second half of pregnancy (after 20 weeks) can be a symptom of preeclampsia. This is particularly concerning if you had previously overcome morning sickness.

Preeclampsia-related nausea and vomiting typically:

• Occurs suddenly in the second or third trimester
• Is severe and persistent
• May be accompanied by upper abdominal pain
• Doesn’t improve with typical remedies for morning sickness
• Can lead to inability to keep food or fluids down
• May occur alongside other symptoms like headache or visual changes

When nausea and vomiting appear late in pregnancy, especially when combined with other preeclampsia symptoms, they may indicate that the condition is affecting your liver function or is progressing to a more severe stage.

8. Shortness of Breath

Difficulty breathing or shortness of breath that occurs suddenly or is more severe than the normal breathlessness of late pregnancy can be a warning sign of preeclampsia. This symptom may indicate fluid accumulation in the lungs (pulmonary edema) or other complications.

Concerning respiratory symptoms include:

• Sudden onset of breathing difficulty
• Inability to catch your breath even at rest
• Feeling like you can’t get enough air
• Chest tightness or pressure
• Rapid breathing or gasping for air
• Difficulty breathing when lying down
• Anxiety or feeling of panic related to breathing difficulties

While some breathlessness is normal in pregnancy as the growing uterus pushes against the diaphragm, severe or sudden shortness of breath is not normal and requires immediate medical evaluation. This can be a sign that preeclampsia is affecting your heart and lungs.

9. Decreased Urine Output

A noticeable reduction in the amount of urine you produce can indicate that preeclampsia is affecting your kidney function. The kidneys may not be filtering waste products and excess fluid as efficiently as they should.

Signs of decreased urine output include:

• Urinating less frequently than usual
• Producing smaller amounts of urine when you do go
• Dark-colored urine, which may indicate concentration
• Going several hours without needing to urinate
• Feeling like your bladder isn’t emptying completely

Normal urine output during pregnancy should be relatively consistent. If you notice you’re urinating significantly less than usual, or if you produce less than 500 ml of urine in a 24-hour period, this could indicate kidney dysfunction related to preeclampsia. This symptom often occurs alongside swelling and should be reported to your healthcare provider.

10. Mental Confusion and Altered Consciousness

Changes in mental state, confusion, or altered consciousness are serious symptoms that indicate preeclampsia may be progressing to eclampsia or affecting brain function. These neurological symptoms require immediate emergency medical attention.

Warning signs include:

• Feeling unusually confused or disoriented
• Difficulty concentrating or thinking clearly
• Unusual drowsiness or lethargy
• Feeling “out of it” or disconnected from your surroundings
• Memory problems or difficulty recalling recent events
• Slurred speech or difficulty communicating
• Unusual anxiety or sense of impending doom
• Restlessness or agitation

These symptoms suggest that high blood pressure is affecting blood flow to the brain or that you may be at risk for seizures. Mental status changes in pregnancy, especially when accompanied by other preeclampsia symptoms, constitute a medical emergency requiring immediate evaluation and treatment.

What Causes Preeclampsia

While the exact cause of preeclampsia remains not fully understood, researchers have identified several factors and mechanisms that contribute to its development. Understanding these causes can help identify women at higher risk and improve early detection.

Placental Problems: The most widely accepted theory is that preeclampsia originates with problems in the development of blood vessels in the placenta. During early pregnancy, new blood vessels develop to efficiently send blood to the placenta. In women with preeclampsia, these blood vessels don’t develop properly – they’re narrower than normal blood vessels and react differently to hormonal signaling. This restricts blood flow and can trigger the condition.

Immune System Factors: Some experts believe that preeclampsia may be related to how a woman’s immune system responds to her partner’s genetic contribution to the baby. When the body doesn’t properly adapt to the presence of the developing baby, it may trigger an immune response that affects blood vessels and leads to preeclampsia.

Genetic Factors: Preeclampsia tends to run in families, suggesting a genetic component. Women whose mothers or sisters had preeclampsia are at increased risk. Certain genetic variations may make some women more susceptible to developing the condition.

Blood Vessel Dysfunction: Problems with blood vessels, including damage to or abnormal development of the arteries supplying the uterus, can contribute to preeclampsia. This vascular dysfunction leads to high blood pressure and reduced blood flow to organs.

Risk Factors: While not direct causes, several factors significantly increase the risk of developing preeclampsia:

• First pregnancy or first pregnancy with a new partner
• History of preeclampsia in a previous pregnancy
• Chronic hypertension or kidney disease before pregnancy
• Age (women under 20 or over 40 have higher risk)
• Obesity (BMI of 30 or higher)
• Multiple gestation (twins, triplets, or more)
• Diabetes (type 1, type 2, or gestational)
• Autoimmune disorders such as lupus
• In vitro fertilization (IVF) pregnancy
• African American ethnicity
• Interval of more than 10 years since last pregnancy

Oxidative Stress: An imbalance between harmful free radicals and protective antioxidants in the body may play a role in preeclampsia development, leading to inflammation and blood vessel damage.

Prevention of Preeclampsia

While there is no guaranteed way to prevent preeclampsia, certain measures can help reduce the risk or minimize its severity, especially for women with known risk factors.

Low-Dose Aspirin: For women at high risk of preeclampsia, healthcare providers may recommend taking low-dose aspirin (usually 81mg daily) starting between 12 and 28 weeks of pregnancy and continuing until delivery. This has been shown to reduce the risk of preeclampsia in high-risk women. However, this should only be taken under medical supervision and prescription.

Calcium Supplementation: In women with low dietary calcium intake, calcium supplements may help reduce the risk of preeclampsia. The recommended dose is typically 1,000-2,000mg of calcium daily, but consult your healthcare provider before starting any supplementation.

Regular Prenatal Care: Attending all scheduled prenatal appointments is crucial for early detection. Your healthcare provider will monitor your blood pressure and check your urine for protein at each visit, allowing for early intervention if preeclampsia begins to develop.

Healthy Lifestyle: Before and during pregnancy, maintaining a healthy lifestyle can help reduce risk:

• Achieve and maintain a healthy weight before pregnancy
• Eat a balanced, nutritious diet rich in fruits, vegetables, whole grains, and lean proteins
• Stay physically active with pregnancy-safe exercises as approved by your doctor
• Limit salt intake to moderate levels (though severe salt restriction is not recommended)
• Stay well-hydrated by drinking plenty of water
• Avoid alcohol and smoking
• Manage stress through relaxation techniques, adequate rest, and support

Manage Pre-existing Conditions: If you have chronic health conditions such as high blood pressure, diabetes, kidney disease, or autoimmune disorders, work with your healthcare team to optimize control of these conditions before and during pregnancy.

Know Your Risk: Understanding your personal risk factors allows you and your healthcare provider to create a monitoring plan. Women with previous preeclampsia, multiple risk factors, or high-risk conditions may need more frequent prenatal visits and additional testing.

Monitor for Symptoms: Familiarize yourself with the warning signs of preeclampsia and report any concerning symptoms to your healthcare provider immediately. Early detection and management can prevent progression to severe disease.

Frequently Asked Questions About Preeclampsia

When does preeclampsia typically develop?

Preeclampsia most commonly develops after 20 weeks of pregnancy, typically in the third trimester. However, it can occur earlier in some cases, and some women develop postpartum preeclampsia within 48 hours to 6 weeks after delivery. Regular monitoring throughout pregnancy and immediately postpartum is important.

Can preeclampsia occur in a first pregnancy but not subsequent ones?

Yes, it’s possible to have preeclampsia in a first pregnancy and not experience it in later pregnancies. However, having preeclampsia once does increase your risk for future pregnancies. The risk is higher if you had severe preeclampsia, if it occurred early in pregnancy, or if you have the same partner. With a different partner, the risk is similar to a first pregnancy.

Is preeclampsia the same as high blood pressure during pregnancy?

No, they are not the same. Gestational hypertension is simply high blood pressure that develops after 20 weeks without protein in the urine or other organ damage. Preeclampsia involves high blood pressure plus signs of organ system damage, most commonly evidenced by protein in the urine, kidney dysfunction, liver problems, or other serious complications. Gestational hypertension can sometimes progress to preeclampsia.

How quickly can preeclampsia progress?

Preeclampsia can progress very rapidly, sometimes within days or even hours. Mild preeclampsia can suddenly become severe, which is why close monitoring is essential. Some women develop HELLP syndrome (a severe form involving hemolysis, elevated liver enzymes, and low platelets) or eclampsia (seizures) rapidly. This is why any symptoms should be reported to your healthcare provider immediately.

Will I need to deliver early if I have preeclampsia?

The timing of delivery depends on the severity of preeclampsia and how far along you are in pregnancy. Mild preeclampsia close to your due date (37 weeks or later) usually results in delivery soon after diagnosis. Earlier in pregnancy, your healthcare team may monitor you closely while trying to prolong pregnancy safely. Severe preeclampsia often requires delivery regardless of gestational age to protect both mother and baby.

Does preeclampsia go away after delivery?

For most women, preeclampsia begins to improve within 48 hours after delivery, though it can take several weeks for blood pressure to return to normal. However, some women develop postpartum preeclampsia after delivery, and symptoms should continue to be monitored. Women who have had preeclampsia have an increased risk of cardiovascular disease later in life and should inform their primary care physician about their history.

Can bed rest prevent or treat preeclampsia?

Current research shows that strict bed rest doesn’t prevent preeclampsia or improve outcomes and may actually increase risks such as blood clots. However, your healthcare provider may recommend reduced activity or modified rest in certain situations. The focus is on close monitoring and timely delivery rather than bed rest.

Are there long-term effects of preeclampsia?

Yes, women who have had preeclampsia have an increased risk of developing high blood pressure, heart disease, stroke, and kidney disease later in life. Babies born to mothers with preeclampsia may have a slightly increased risk of high blood pressure in adulthood. This makes long-term health monitoring and healthy lifestyle habits important for both mother and child.

Can preeclampsia be detected with home monitoring?

While home blood pressure monitoring can be helpful for tracking blood pressure between appointments, it cannot detect all signs of preeclampsia such as protein in urine, liver problems, or low platelet counts. Home monitoring should supplement, not replace, regular prenatal care. If you notice elevated blood pressure readings at home or experience any symptoms, contact your healthcare provider immediately.

Is preeclampsia more common with certain types of pregnancies?

Yes, preeclampsia is more common in certain situations: first pregnancies, pregnancies with a new partner, multiple gestations (twins or more), molar pregnancies, and pregnancies conceived through IVF. Women carrying babies with certain chromosomal abnormalities or birth defects may also have increased risk. However, preeclampsia can occur in any pregnancy.

References:

• American College of Obstetricians and Gynecologists (ACOG) – Preeclampsia and High Blood Pressure During Pregnancy
• Mayo Clinic – Preeclampsia: Symptoms and Causes
• Preeclampsia Foundation – Signs and Symptoms
• National Institute of Child Health and Human Development – Preeclampsia and Eclampsia
• NHS – Pre-eclampsia
• Centers for Disease Control and Prevention (CDC) – High Blood Pressure During Pregnancy