Pre-eclampsia: Symptoms, Risk Factors and Prevention

Pre-eclampsia is defined as high blood pressure arising for the first time after 20 weeks of pregnancy, accompanied by protein in the urine or evidence of kidney, liver, clotting, neurological or placental dysfunction. It affects roughly 2–8% of pregnancies, and early recognition with close monitoring is decisive for the health of both mother and baby.

Warning signs: when to seek urgent care

Pre-eclampsia may initially cause no symptoms, which is why blood pressure is measured at every antenatal visit. Attend hospital without delay if you experience any of the following:

• A severe headache that does not respond to simple painkillers
• Blurred vision, flashing lights or double vision
• Pain below the ribs or in the upper abdomen, with nausea or vomiting
• Sudden, marked swelling of the face, hands or feet
• Breathlessness or reduced urine output
• Reduced fetal movements

Risk factors

• Pre-eclampsia in a previous pregnancy
• Chronic hypertension, pre-existing diabetes or kidney disease
• Lupus or antiphospholipid syndrome
• Twin or multiple pregnancy, IVF conception
• First pregnancy, age over 35, body mass index of 30 or above
• Pre-eclampsia in a mother or sister

Prevention with low-dose aspirin

Risk is assessed in the first trimester. In high-risk women, low-dose aspirin started between 12 and 16 weeks and continued until 36 weeks substantially reduces the risk of pre-eclampsia, particularly severe early-onset disease. Calcium supplementation may also be advised where dietary calcium intake is low. Aspirin should only be taken on medical advice.

Diagnosis and monitoring

Diagnosis is based on repeated blood pressure measurements, urine protein assessment (protein/creatinine ratio) and blood tests (platelets, liver enzymes and renal function). In selected cases the sFlt-1/PlGF ratio helps predict short-term risk. Fetal growth, amniotic fluid and blood flow are monitored with ultrasound and Doppler studies.

Treatment and timing of birth

• From 37 weeks: delivery is generally recommended.
• 34–37 weeks: close surveillance in the absence of severe features; delivery if mother or baby deteriorates.
• Before 34 weeks: inpatient monitoring, antihypertensives, corticosteroids for fetal lung maturity and magnesium sulphate for seizure prophylaxis where indicated.
• Severe pre-eclampsia, HELLP syndrome or eclampsia require delivery regardless of gestational age.

After birth

Pre-eclampsia can develop or worsen during the first six weeks after delivery; headache, visual disturbance or breathlessness during this period require urgent assessment. Because women who have had pre-eclampsia carry a higher lifetime risk of hypertension and cardiovascular disease, annual blood pressure checks and healthy lifestyle measures are important. See also our articles on gestational diabetes and prenatal screening tests.

Op. Dr. Sadık Kükrer, MD provides high-risk pregnancy care and pre-eclampsia management in Adana, Türkiye.