Preeclampsia is a pregnancy complication characterized by high blood pressure of 140/90 mmHg or higher that develops after 20 weeks of gestation, affecting 5 to 8 percent of all pregnancies in the United States. Some women experience no symptoms at all, which is why blood pressure monitoring at every prenatal visit is one of the most important parts of routine care. When caught early through consistent monitoring with an OBGYN, preeclampsia is manageable. The risk comes from cases that go unrecognized. This post covers the warning signs to watch for, who faces the highest risk, how the condition is diagnosed and managed, and exactly when to call for help.
What Are the Warning Signs of Preeclampsia?
Preeclampsia symptoms range from subtle to severe, and some women have none at all until blood pressure is measured at a prenatal appointment. Knowing the signs gives you a basis for acting quickly if something feels off.
| Warning Sign | What It Looks Like | Action |
| High blood pressure | 140/90 mmHg or higher on two readings | Contact OBGYN same day |
| Severe headache | Persistent, does not resolve with rest or acetaminophen | Contact OBGYN same day |
| Visual disturbances | Blurred vision, seeing spots or flashing lights, light sensitivity | Contact OBGYN same day |
| Facial and hand swelling | Puffiness around eyes, swollen fingers, rings no longer fit | Contact OBGYN same day |
| Sudden weight gain | More than 2 lbs in a single week | Contact OBGYN same day |
| Upper abdominal pain | Pain under the ribs on the right side or right shoulder | Contact OBGYN same day |
| Shortness of breath | Difficulty breathing at rest, not explained by exertion | Go to hospital |
| Decreased urine output | Noticeably less urination over several hours | Contact OBGYN same day |
One important distinction: swelling in the feet and ankles is common throughout pregnancy and does not on its own signal preeclampsia. Swelling that appears suddenly in the face and hands, particularly alongside other symptoms on this list, warrants a same-day call to your OBGYN.
Who Is Most at Risk for Preeclampsia?
Risk factors do not cause preeclampsia, but they identify which patients need closer monitoring throughout pregnancy. Having one or more of these factors is a reason to discuss a personalized prenatal monitoring plan with your OBGYN managing your high-risk pregnancy care.
First-Time Pregnancies and Multiple Gestations
Nulliparity (carrying a first pregnancy) is the single most common risk factor for preeclampsia. The body’s immune response to a first pregnancy is thought to play a role in placental development and blood vessel adaptation, both of which are implicated in preeclampsia causes. Women carrying twins or triplets face a significantly elevated risk, as do women who conceived through IVF, independent of age or other health factors.
Pre-Existing Medical Conditions
Several pre-existing conditions raise the likelihood of developing preeclampsia during pregnancy:
- Chronic hypertension
- Type 1 or Type 2 diabetes
- Kidney disease
- Autoimmune conditions including lupus and antiphospholipid syndrome
- Obesity (BMI over 30)
- Age over 35
- Family history of preeclampsia
- Prior preeclampsia in a previous pregnancy (recurrence rate of 15 to 25 percent)
Women with gestational diabetes also carry an elevated risk, as insulin resistance and vascular dysfunction overlap with the mechanisms behind preeclampsia.
How Is Preeclampsia Diagnosed?
Preeclampsia is diagnosed through a combination of blood pressure readings, urine testing, and blood work. Per ACOG guidelines updated in 2013, proteinuria (protein in the urine) is no longer required for diagnosis. Severe features such as persistently elevated blood pressure, abnormal lab values, or neurological symptoms are sufficient for a clinical diagnosis.
- Blood pressure criteria: Two separate readings of 140/90 mmHg or higher, taken at least four hours apart, in a patient who had normal blood pressure before 20 weeks.
- Urine testing: A urine dipstick, 24-hour urine collection, or protein-to-creatinine ratio is used to detect proteinuria, which remains a common finding even when not required for diagnosis.
- Blood tests: A complete blood count checks platelet levels. Liver enzyme tests (AST and ALT) and kidney function markers (creatinine) identify organ involvement consistent with HELLP syndrome, a severe complication of preeclampsia involving hemolysis, elevated liver enzymes, and low platelets.
- Fetal monitoring: A non-stress test, biophysical profile, and Doppler ultrasound of the umbilical artery assess fetal wellbeing and placental blood flow. These tests become more frequent as high risk pregnancy monitoring intensifies.
Preeclampsia with severe features is diagnosed when blood pressure reaches 160/110 mmHg or higher, or when severe headache, visual changes, upper abdominal pain, or HELLP syndrome markers are present.
How Is Preeclampsia Managed?
Delivery is the only definitive preeclampsia treatment. The timing and approach depend on gestational age and how severe the condition is at diagnosis.
Management Before 37 Weeks
When preeclampsia is diagnosed before 37 weeks, the goal is to extend the pregnancy safely for as long as mother and baby remain stable. Management typically includes:
- Antihypertensive medications (labetalol, nifedipine, or hydralazine) to keep blood pressure at safer levels
- Magnesium sulfate to prevent seizures (eclampsia)
- Corticosteroids to accelerate fetal lung maturity if early delivery becomes necessary
- Frequent fetal monitoring through non-stress tests, biophysical profiles, and Doppler ultrasound
- Hospitalization for women with severe features or rapidly worsening readings
Management At or After 37 Weeks
At 37 weeks or beyond, delivery is typically recommended rather than continued expectant management. Vaginal delivery is preferred when clinically appropriate. Women with preeclampsia require close blood pressure monitoring through delivery and for up to six weeks postpartum. Preeclampsia can develop for the first time after delivery, or worsen significantly in the days following birth. Blood pressure checks at postpartum visits are not optional for patients with a preeclampsia diagnosis.
Can Preeclampsia Be Prevented?
No intervention guarantees prevention of preeclampsia, but low-dose aspirin (81 mg daily) is the most evidence-backed tool currently available for reducing risk in high-risk patients. ACOG recommends low-dose aspirin for women with at least one high-risk factor or two moderate-risk factors, starting between 12 and 28 weeks of gestation, with the greatest benefit seen when started before week 16.
High-risk factors that qualify a patient for aspirin prophylaxis include prior preeclampsia, multifetal gestation, chronic hypertension, diabetes, kidney disease, and autoimmune conditions. Moderate-risk factors include first pregnancy, obesity, family history, and age over 35.
Beyond aspirin, supporting overall cardiovascular health before and during pregnancy plays a meaningful role. Managing chronic conditions, reaching a healthy weight before conception, and attending every scheduled prenatal appointment give your OBGYN the data needed to identify changes early. Read more about taking early action to avoid a high-risk pregnancy and what to expect during a high-risk pregnancy for a broader picture of proactive prenatal care.
When Should You Call Your OBGYN or Go to the Hospital?
The threshold for contacting your care team about potential preeclampsia symptoms should be low. These are not symptoms to monitor and wait on.
Call your OBGYN the same day if you experience:
- A headache that does not resolve with rest or acetaminophen
- New swelling in your face or hands
- Sudden weight gain of 2 or more pounds in 24 hours
- Any change in vision including blurring, spots, or light sensitivity
- Pain in your upper abdomen or right shoulder
- A noticeable decrease in how much you are urinating
Go to the hospital immediately or call 911 if you experience:
- A blood pressure reading of 160/110 mmHg or higher on a home monitor
- A seizure of any kind
- Severe shortness of breath at rest
- A sudden, severe headache unlike anything you have felt before
- Decreased fetal movement alongside any of the above symptoms
When in doubt, call. An OBGYN would always rather assess a symptom that turns out to be benign than have a patient delay reporting something serious. The role of your OBGYN in a high-risk pregnancy is precisely to be the first point of contact when something feels wrong.
Schedule Prenatal Care at Roswell Ob/Gyn, LLC
Preeclampsia is most manageable when identified early through consistent prenatal monitoring. Roswell Ob/Gyn, LLC provides high-risk pregnancy care for patients across Alpharetta, Atlanta, Canton, and Cumming, including specialized fetal monitoring, non-stress testing, and biophysical profiles for pregnancies that require closer oversight. Contact Roswell Ob/Gyn, LLC to schedule your prenatal care appointment and discuss a monitoring plan tailored to your pregnancy.
Frequently Asked Questions
Can preeclampsia develop after delivery?
Yes. Postpartum preeclampsia can develop within 48 hours of delivery or up to six weeks after birth, even in women who showed no signs during pregnancy. High blood pressure, severe headache, vision changes, and swelling after delivery are not normal postpartum symptoms. Any of these signs in the days or weeks after giving birth require immediate medical attention. Postpartum blood pressure checks at follow-up visits are a standard part of care for this reason.
Does preeclampsia affect the baby?
Preeclampsia affects the placenta’s ability to deliver oxygen and nutrients to the baby, which can lead to intrauterine growth restriction (IUGR), preterm birth, and in severe cases placental abruption. Babies born early from a preeclampsia-related delivery may require neonatal intensive care depending on gestational age. Close fetal monitoring through the remainder of the pregnancy allows the care team to track fetal growth and intervene at the right time.
Is preeclampsia the same as gestational hypertension?
No. Gestational hypertension is high blood pressure that develops after 20 weeks without the additional findings associated with preeclampsia such as proteinuria, organ involvement, or severe symptoms. Gestational hypertension can progress to preeclampsia, which is why women diagnosed with it are monitored closely for emerging signs. The two conditions share the same blood pressure threshold (140/90 mmHg) but differ in clinical severity and management approach.
Can I have a normal delivery if I have preeclampsia?
Vaginal delivery is preferred and achievable for many women with preeclampsia, depending on gestational age, cervical readiness, and the severity of the condition at the time of delivery. Cesarean delivery is not automatically required. The decision is made by the care team based on maternal and fetal status at the time of planned delivery. Women with preeclampsia deliver with additional monitoring in place, including continuous blood pressure assessment and magnesium sulfate for seizure prevention.
Does having preeclampsia mean I will have it again?
Having preeclampsia in one pregnancy does increase the risk of recurrence in future pregnancies, with recurrence rates estimated between 15 and 25 percent. Women with a prior diagnosis are typically started on low-dose aspirin prophylaxis early in subsequent pregnancies and monitored more closely from the first trimester onward. Prior preeclampsia also carries long-term cardiovascular implications, and discussing heart health with an OBGYN after pregnancy is a meaningful step in ongoing care.
