Pre-eclampsia in pregnancy: signs, symptoms and treatment
Emily Cater
WriterPre-eclampsia is a pregnancy complication that affects around 6% of pregnancies. In most cases it is mild and shouldn't cause any further complications. However, in severe cases it can be dangerous for both mum and baby's health. Here's what every mum-to-be should know.
What is pre-eclampsia?
Pre-eclampsia – also called pre-eclamptic toxaemia (PET) or preeclampsia – is a complication of pregnancy that causes high blood pressure and other medical issues for mum and baby. It's thought to be caused by problems with the placenta.
Symptoms of pre-eclampsia are generally mild – you may not even know you have it at first. However, left untreated, it can cause severe health complications for both mum and baby, affecting the growth and development of a newborn.
It can also lead to eclampsia – fits or convulsions – before or just after the baby is born. However, these are rare, occurring in only one in 4,000 pregnancies.
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What causes pre-eclampsia?
Experts still aren't sure exactly what causes it, but it's though to be down to how the placenta develops. For some women, the blood vessels that supply the placenta may be too narrow, and some experts think this is what leads to pre-eclampsia.
How common is pre-eclampsia?
It's thought to affect up to 6% of pregnancies in the UK, and is one of the most serious antenatal complications, according to the charity, Action on Pre-eclampsia.
When does pre-eclampsia happen?
Most cases of pre-eclampsia start during the second half of pregnancy, after you've reached 20 weeks pregnant (most commonly after 24-26 weeks).
When pre-eclampsia is diagnosed before 32 weeks of pregnancy, it is referred to as early-onset pre-eclampsia.
The earlier it develops, the more serious it tends to be.
Early signs and symptoms of pre-eclampsia
Early symptoms of pre-eclampsia are generally mild, and some mums-to-be may not even know they have it. However, the NHS states that 'the earlier it is diagnosed and monitored, the better the outcome for mother and baby.'
As there are often no visible early symptoms of pre-eclampsia, previously midwives performed two simple tests at the start of every routine antenatal check: A urine test looking for protein in the urine, and a blood pressure check for hypertension (high blood pressure).
However, a major change to NHS testing has now come into force, which will help protect countless mums-to-be and their babies from the serious pregnancy condition, pre-eclampsia.
In new guidance published, the National Institute for Health and Care Excellence (NICE) recommends new tests which will actually diagnose cases. They'll replace the previous test that could only rule out pre-eclampsia.
The four tests can be used from 20 weeks to 36 weeks and six days, with experts hoping they will now be able to diagnose the condition in the 6% of pregnancies affected by it.
Pregnant women who are thought to have the condition will be offered the test on the NHS, with results on the same day.
Find out more about what the new test will mean for mums.
More signs and symptoms of pre-eclampsia
As pre-eclampsia should be routinely picked up in your antenatal appointments (see above) it's unlikely you'll notice any other symptoms.
However, if it develops before your next appointment, you may notice the following symptoms:
- severe headache that doesn’t go away with simple painkillers
- problems with vision, such as blurring or flashing before the eyes
- sudden, excess weight gain
- severe pain just below the ribs
- heartburn that doesn’t go away with antacids
- rapidly increasing swelling of the face, hands or feet
- feeling very unwell
- feeling or being sick
If you notice any of these symptoms, it's important you contact your GP or midwife straight away – or call NHS 111 if you can't get hold of them.
If you do have pre-eclampsia, the sooner it's picked up, the lower the risk of complications for you and your baby. Remember, always trust your maternal instincts.
Am I at risk of developing pre-eclampsia?
Pre-eclampsia affects up to 6% of pregnancies in the UK. Although anyone can get it, the following factors will increase your chances:
- if your blood pressure was high before you became pregnant
- if your blood pressure was high in a previous pregnancy
- you have a medical problem such as kidney problems or diabetes or a condition that affects the immune system, such as lupus.
You are also considered to be at an increased risk of pre-eclampsia if:
- this is your first pregnancy
- you're aged 40 or over
- your last pregnancy was more than 10 years ago
- you're very overweight – a BMI (body mass index) of 35 or more
- your mother or sister had pre-eclampsia during pregnancy
- you're pregnant with twins or multiples.
If you've had pre-eclampsia before, your chance of getting it in subsequent pregnancies is about 16% (compared to about 6% for all women).
Can pre-eclampsia be prevented?
If you're in a high-risk group (see above) there's some evidence that taking a low dose of aspirin (75mg) every day from when you're 12 weeks pregnant can reduce your risk of getting pre-eclampsia.
However, only take medicine like this if your GP tells you to do so. Never use over-the-counter aspirin while you're pregnant, because the doses are much higher and could harm your baby.
Aside from this, it is recommended that you eat a balanced diet, stay active, attend all your antenatal appointments, and make sure you are taking your pregnancy supplements including folic acid and vitamin D.
What is the treatment for pre-eclampsia?
You'll have to be closely monitored throughout your pregnancy. There's no cure for pre-eclampsia, but there are treatments that can minimise any symptoms and reduce the risk of complications.
Initial treatment will include:
- blood pressure checks
- urine tests to monitor protein levels
- blood tests to check that the pre-eclampsia isn't affecting other organs, such as your liver
- baby's heart rate checks
- ultrasound scans to monitor your baby's growth and development
If your pre-eclampsia is mild, you won't need to be admitted to hospital. You'll have regular tests as an outpatient and will probably be advised to deliver your baby early – usually at around 37 weeks.
This will mean you'll have to be induced or will be booked in for a C-section.
If your pre-eclampsia is severe, you'll be given specialist care, and will need to stay in hospital until your baby's born. You'll be given medication or put on a drip to control your blood pressure. You may even be given medication to prevent fits.
The only way to get rid of pre-eclampsia is to have your baby so you'll discuss how soon this can be done with your obstetrician.
What are the possible complications of pre-eclampsia?
Although pre-eclampsia is easy to detect, it can have heartbreaking consequences if it isn't.
According to Action on Pre-eclampsia, 'every year in the UK about 1000 babies die because of pre-eclampsia – many of these as a consequence of premature delivery rather than the disease itself.'
It also states that 1-2 mothers die each year from complications of pre-eclampsia in the UK.
In rare cases, when pre-eclampsia isn't detected and monitored, it can lead to severe complications for mum and baby. These include:
- Eclampsia: a fit or convulsion. This only happens in about 1 in 4,000 pregnancies, and most women make a full recovery. However, there is a small risk of permanent disability or brain damage. Sadly, eclampsia can be fatal for up to 1 in 50 women and 1 in 14 babies.
- HELLP syndrome: problems with the liver and blood clotting. The only cure for this is to deliver the baby as soon as possible, after which many women make a full recovery.
- Stroke: where high blood pressure disturbs the flow of blood to the brain.
- Organ problems: again in rare cases, pre-eclampsia can lead to problems with the lungs, kidneys or liver.
The baby can also be affected, and may grow more slowly than normal, and be smaller at the birth. If your baby has to be born prematurely, this can also cause health problems, though they'll be carefully monitored after the birth. Sadly, severe pre-eclampsia can sometimes lead to stillbirth.
This may all sound very scary, but bear in mind that these complications are rare, and most likely when pre-eclampsia goes unnoticed.
If you've been diagnosed with pre-eclampsia, your healthcare team will monitor you carefully and do everything they can to reduce the risk of complications. Most mums and babies make a full recovery.
Will pre-eclampsia go away after the birth?
Most cases of pre-eclampsia go away once you've had your baby.
However, you'll be closely monitored for a few days after your labour in case of complications. You may also need to stay on medication and have further checks to lower and control your blood pressure.
If you had a severe case, you'll have postnatal checks with your obstetrician. You'll be referred to a specialist if there is still protein in your urine or your blood pressure is still high.
If your baby was born prematurely (before 37 weeks), they may need a stay in the neonatal intensive care unit (NICU) until they're strong enough for you to take them home.
What it means for your future health and future pregnancies
It's unusual for pre-eclampsia to cause problems for your future health, once you've had the baby as this tends to reverse the effects of the condition.
However, if pre-eclampsia causes complications such as organ damage, these can remain. It's also possible that you'll have high blood pressure problems.
The Royal College of Obstetricians & Gynaecologists(RCOG) states that one in six women who have had pre-eclampsia will get it again in a future pregnancy (about 16%). Your chances increase the earlier your baby had to be born.
Of women who had severe pre-eclampsia, or eclampsia:
- one in two women will get pre-eclampsia in a future pregnancy if their baby needed to be born before 28 weeks of pregnancy
- one in four women will get pre-eclampsia in a future pregnancy if their baby needed to be born before 34 weeks of pregnancy.
However, although it's more likely to reoccur, it's also likely to be a milder form.
Action on Pre-eclampsia also offers this reassuring advice on its website regarding future pregnancies:
'Most mothers who have suffered even the most severe form of the disease in a first pregnancy enjoy perfectly normal subsequent pregnancies.'
Always make sure you tell your GP and midwife about any previous cases of pre-eclampsia as soon as you're pregnant again.
What to Expect When You're Expecting by Heidi Murkoff is a must-read book for all expectant parents. See more details here at Amazon.
You can also buy it here at Waterstones.
Read more about pre-eclampsia and talk to others experiencing similar complications over on our forum:
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