Preeclampsia and Eclampsia

Overview

Preeclampsia and eclampsia are high blood pressure disorders related to pregnancy. These disorders typically occur after 20 weeks of pregnancy or close to delivery.

Preeclampsia is a combination of high blood pressure during pregnancy and signs that the body’s organs are not working well. The mother’s high blood pressure reduces the blood supply to the fetus, which may get less oxygen and fewer nutrients. It is a leading cause of preterm birth.

If preeclampsia affects brain function and causes seizures or coma, it is called eclampsia.

Gestational hypertension occurs when a woman who previously had normal blood pressure develops high blood pressure when she is more than 20 weeks pregnant and her blood pressure returns to normal within 12 weeks after delivery. This problem usually occurs without other symptoms, and in many cases does not harm the mother or fetus. Severe gestational hypertension, however, may be associated with preterm birth and infants who are small for their age at birth. Some women who have gestational hypertension later develop preeclampsia.

A serious complication of hypertensive disorders in pregnancy is HELLP syndrome, a situation in which a pregnant woman with preeclampsia or eclampsia suffers damage to the liver and blood cells. The letters in the name HELLP:

• H — Hemolysis, in which oxygen-carrying red blood cells break down
• EL — Elevated liver enzymes, showing damage to the liver
• LP — Low platelet count, meaning the cells responsible for stopping bleeding are low

Preeclampsia and eclampsia can also develop after the baby is delivered (postpartum), usually between 48 hours and 6 weeks after delivery. This can happen even if a woman did not have high blood pressure or preeclampsia during pregnancy.

Signs and Symptoms

Women who have preeclampsia often do not feel sick at first. However, some symptoms to watch for include:

• High blood pressure
• Swelling in the hands or face
• Sudden weight gain over 1 to 2 days, or gaining more than 2 pounds a week
• High protein levels in urine

The following symptoms require immediate medical attention:

• Headache that does not go away or becomes worse
• Vision changes, including blurry vision, seeing spots, and temporary blindness
• Trouble breathing
• Pain on the right side, below the ribs, or in the right shoulder
• Nausea and vomiting
• Feeling lightheaded or faint
• Urinating less often than normal
• Seizures
• Easy bruising or bleeding or extreme fatigue (signs of HELLP syndrome)

Related Health Effects

Effects on the Mother

Preeclampsia during pregnancy is mild in most cases.

However, a woman can progress from mild to severe preeclampsia or to full eclampsia very quickly — even in a matter of days.

Women with preeclampsia are at increased risk for damage to the kidneys, liver, brain, and other organ and blood systems. This can also lead to:

• Separation of the placenta from the uterus (called placental abruption)
• Preterm birth
• Pregnancy loss or stillbirth
• Organ failure or stroke
• Death

After Pregnancy, a mother’s high blood pressure and other symptoms usually return to normal within 6 weeks of the infant’s birth. However, preeclampsia can cause long-term changes in the blood vessels. In the years after pregnancy, women who had preeclampsia are more likely to develop:

• High blood pressure
• Ischemic heart disease (reduced blood supply to the heart muscle, which can cause heart attacks)
• Blood clot
• Stroke

Preeclampsia and eclampsia can also develop between 48 hours and 6 weeks after the baby is delivered. It is important to recognize and treat postpartum preeclampsia and eclampsia because the risk of complications may be higher than if the conditions had occurred during pregnancy. They can progress very quickly if not treated and may lead to stroke or death.

Effects on the Baby

Preeclampsia may be related to problems with the placenta early in pregnancy. These problems can pose risks to the fetus, including:

• Lack of oxygen and nutrients, which can slow growth
• Preterm birth
• Stillbirth
• Infant death

Infants born preterm due to preeclampsia face a higher risk of some long-term health issues, mostly related to being born early. These include learning disorders, cerebral palsy, epilepsy, deafness, and blindness. Infants born preterm may also need to be hospitalized for a long time after birth and may be smaller than infants born at full term. Infants who experienced poor growth in the uterus may later be at higher risk of diabetes, congestive heart failure, and high blood pressure.

Causes and Risk Factors

The causes of preeclampsia and eclampsia are not known. Scientists are investigating many factors that could contribute to these conditions, including:

• Placental abnormalities, such as insufficient blood flow
• Genetic factors
• Environmental exposures
• Nutritional factors
• Maternal immune system and autoimmune disorders
• Cardiovascular and inflammatory changes
• Hormonal imbalances

Factors that can increase a woman’s risk include:

• First pregnancy
• High blood pressure or preeclampsia during a previous pregnancy
• Age: Women older than 40 are at higher risk
• Being pregnant with more than one fetus
• African American ethnicity
• Family history of preeclampsia
• Pregnancy resulting from egg donation, donor insemination, or in vitro fertilization

Preeclampsia is more common among women who have histories of certain health conditions:

• Chronic high blood pressure or kidney disease before pregnancy
• Obesity
• Diabetes or gestational diabetes
• Migraines
• Autoimmune disease (e.g., rheumatoid arthritis, lupus, scleroderma, multiple sclerosis)
• Polycystic ovary syndrome
• Sickle cell disease
• Urinary tract infections
• Gum disease

Prevention Guidance

There are several steps women can take to prevent preeclampsia or protect their health after pregnancy.

Before Pregnancy

• Schedule a pre-pregnancy visit with a healthcare provider to discuss ways to lower risk.
• Work to control blood pressure by limiting salt intake, exercising regularly, and losing weight if needed before getting pregnant.
• If taking medicine to control blood pressure, ask a healthcare provider whether it is safe to use during pregnancy.
• Talk with a healthcare provider about family health history, since a family history of preeclampsia may call for extra precautions.

During Pregnancy

The U.S. Preventive Services Task Force recommends that women at very high risk for preeclampsia take low-dose aspirin starting after 12 weeks of pregnancy to prevent the condition.

Other ways to help prevent preeclampsia or related complications during pregnancy include:

• Get regular prenatal care, including regular blood pressure checks, urine tests for protein, and weight checks.
• Know the signs of preeclampsia.
• Avoid alcohol and tobacco.
• Talk with a healthcare provider about any drugs or supplements being taken, including vitamins and herbs.
• Eat heart-healthy foods and stay physically active.
• Manage stress
• Get support from friends and family to help monitor symptoms and get medical care when needed.

After Pregnancy

• Healthcare providers should closely monitor women who had high blood pressure or preeclampsia during pregnancy for 72 hours after delivery.
• Women should take extra care of their heart health.

Diagnosis

A healthcare provider checks a pregnant woman’s blood pressure and urine during each prenatal visit. If the blood pressure reading is high (140/90 or higher), especially after the 20th week of pregnancy, the healthcare provider will likely perform other tests, including:

• Blood tests to check how well the mother’s liver and kidneys are working
• Blood tests to check platelet levels
• Blood tests to count red blood cells
• A maternal weight check
• An ultrasound to assess the fetus’s size
• A check of the fetus’s heart rate
• A physical exam to look for swelling in the mother’s face, hands, or legs

Healthcare providers use the following criteria to diagnose pregnant women:

• Gestational hypertension: High blood pressure but no protein in the urine. It can progress into preeclampsia.
• Mild preeclampsia: Blood pressure of 140/90 mmHg or higher and either protein in the urine or kidney or liver dysfunction, fluid in the lungs, or visual impairments.
• Severe preeclampsia: Blood pressure of 160/110 mmHg or higher, high levels of protein in the urine, signs of kidney or liver damage, severe stomach pain, fluid buildup, or visual disturbances.
• Superimposed preeclampsia: Preeclampsia on top of high blood pressure that was present before pregnancy. Healthcare providers look for an increase in blood pressure and either protein in the urine, fluid buildup, or both.
• Eclampsia: A woman with preeclampsia has seizures before, during, or after labor.
• HELLP syndrome: Laboratory tests show burst red blood cells, elevated liver enzymes, and low platelets.

Treatment and Management

Treatment decisions consider:

• How severe the condition is
• The potential for complications
• How far along the pregnancy is
• Potential risks to the fetus

Preeclampsia

Before 37 weeks, the woman and her healthcare provider may consider treatment options that give the fetus more time to develop, depending on how severe the condition is.

• If preeclampsia is mild, it may be possible to wait to deliver. The healthcare provider may ask the woman to go on bed rest to try to lower blood pressure and increase blood flow to the placenta.
• Healthcare providers will closely monitor the woman and her fetus. This may include blood and urine tests, ultrasound, heart rate monitoring, and amniotic fluid assessment.
• A healthcare provider might use medicine to prevent a seizure or control a woman’s blood pressure in cases of severe preeclampsia. They may also give steroid injections to help speed up the development of the fetus’s lungs.
• Preterm delivery may be necessary.

Women may be asked to:

• Check their blood pressure at home.
• Keep track of how many times the baby kicks each day.
• Adjust their physical activity.
• Take medicine to control their blood pressure, if prescribed by a doctor.
• Take aspirin in the second trimester, if recommended by a doctor.
• Visit a healthcare provider more often.

After 37 weeks, the healthcare provider will usually want to deliver the fetus to treat preeclampsia and avoid further complications.

After pregnancy, women who had preeclampsia need to take extra care of their heart health. One of the best steps is to share the details about pregnancy complications with all healthcare providers.

Eclampsia

Eclampsia is a medical emergency. Immediate treatment is needed to stop the mother’s seizures, treat high blood pressure, and deliver the fetus. Magnesium sulfate (a type of mineral) may be given to treat active seizures and prevent future seizures. Antihypertensive medicines may be given to lower blood pressure.

HELLP syndrome can lead to serious complications. Treatment may include:

• Delivery of the fetus
• Medicine to control blood pressure and prevent seizures
• Steroid injections to help speed up the development of the fetus’s lungs

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on preeclampsia.

Find Treatment

Women who are pregnant or thinking about getting pregnant should talk with their healthcare provider about preeclampsia risk and ways to reduce the risk.

• American College of Obstetricians and Gynecologists (ACOG): An association of obstetricians, gynecologists, and other health professionals who provide healthcare to women.
• Society for Maternal-Fetal Medicine: The membership organization for obstetricians and gynecologists who have additional formal education and training in maternal-fetal medicine. Search the society’s physician locator to find a specialist.
• March of Dimes: Provides information on preeclampsia.

Community Support

• Preeclampsia Foundation provides information for women and families affected by preeclampsia and other hypertensive disorders of pregnancy.
• Preeclampsia Registry allows women who have or have had high blood pressure disorders during pregnancy to share their medical records with researchers studying the causes of preeclampsia.
• The Heart Truth® for Women

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH. 

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH supports research to understand what causes preeclampsia and eclampsia and how they can be prevented and better treated. Examples of preeclampsia research include studies on:

• Factors that influence the growth of blood vessels in pregnancy
• Mechanisms and functions of the placenta and any problems with the placenta
• Genetic factors affecting blood pressure during pregnancy
• Proteins and other elements in the blood that may signal the onset of preeclampsia
• The role of factors such as obesity and genetics in the development of preeclampsia
• Characteristics and factors that cause or contribute to the progression of preeclampsia to eclampsia
• Preventive measures
• Long-term effects of preeclampsia, eclampsia, and HELLP syndrome on the mother’s health and on the health of the infant

The Maternal-Fetal Medicine Units Network conducts clinical trials on pregnancy-related issues, and has conducted several studies on preeclampsia.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.