Preeclampsia Symptoms During Pregnancy: Signs to Watch For

What is preeclampsia?

Preeclampsia is a pregnancy complication defined by new-onset high blood pressure (hypertension) after 20 weeks of pregnancy, often accompanied by signs that other organs — the kidneys, liver, brain, or placenta — are under stress. It complicates 2–8% of pregnancies worldwide and remains a leading cause of maternal and perinatal morbidity 3Ref 3American College of Obstetricians and Gynecologists (2020).Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222.Diagnostic criteria for preeclampsia (blood pressure thresholds, organ-involvement criteria), global prevalence, and management principles including delivery timing. Left untreated, it can progress to eclampsia (seizures), serious organ damage, or life-threatening complications for both the pregnant person and the baby. It can also develop postpartum, sometimes presenting for the first time in the days after delivery 1Ref 1US Preventive Services Task Force; Davidson KW, Barry MJ, Mangione CM, et al. (2021).Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: US Preventive Services Task Force Recommendation Statement.Risk factors for preeclampsia, recommendation for low-dose aspirin in high-risk individuals, and postpartum preeclampsia occurrence.

What are the warning signs?

Many people with preeclampsia feel normal initially — which is why prenatal blood pressure monitoring matters at every visit. However, the following symptoms require prompt evaluation:

Severe, persistent headache — particularly one that does not respond to usual pain relief

Vision changes — blurring, seeing spots or flashing lights, temporary vision loss, or sensitivity to light

Pain in the upper right abdomen or under the ribs — can signal liver involvement

Sudden, significant swelling — especially of the face, around the eyes, or hands (some leg swelling is normal in pregnancy; rapid onset in the face or hands is not)

Shortness of breath or difficulty breathing — can indicate fluid in the lungs

Nausea and vomiting that comes on in the second half of pregnancy (distinct from typical early pregnancy nausea)

Not all of these need to be present. Any one of them — particularly in the second half of pregnancy — warrants a call to your obstetric provider [1, 3].

Who is at higher risk?

Preeclampsia can occur in anyone who is pregnant, but certain factors are associated with higher risk:

• First pregnancy
• History of preeclampsia in a previous pregnancy
• Multiple gestation (twins, triplets)
• Pre-existing high blood pressure, diabetes, or kidney disease
• Obesity
• Family history of preeclampsia
• Age 35 or older
• Autoimmune conditions such as lupus

For people at high risk, low-dose aspirin started in the first trimester is recommended by the US Preventive Services Task Force to reduce the risk of preeclampsia 1Ref 1US Preventive Services Task Force; Davidson KW, Barry MJ, Mangione CM, et al. (2021).Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: US Preventive Services Task Force Recommendation Statement.Risk factors for preeclampsia, recommendation for low-dose aspirin in high-risk individuals, and postpartum preeclampsia occurrence.

How is preeclampsia diagnosed?

Your prenatal care provider monitors for preeclampsia at every visit — checking blood pressure and, when indicated, urine protein. According to ACOG Practice Bulletin 222, a diagnosis typically requires:

• Blood pressure of 140/90 mm Hg or higher on two readings taken at least 4 hours apart
• Evidence of organ involvement (protein in urine, abnormal lab values for the kidneys or liver, or other criteria)

Some forms of severe preeclampsia occur without significant protein in the urine, which is why the full clinical picture — not just one measurement — matters. If your provider is concerned, they may order blood tests, additional blood pressure monitoring, or a non-stress test for the baby 3Ref 3American College of Obstetricians and Gynecologists (2020).Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222.Diagnostic criteria for preeclampsia (blood pressure thresholds, organ-involvement criteria), global prevalence, and management principles including delivery timing.

What happens if preeclampsia is confirmed?

Management depends on gestational age and the severity of the condition. Delivery — of both the baby and the placenta — is ultimately the only cure for preeclampsia. In severe cases or near term, delivery may be recommended promptly. For milder cases at earlier gestational ages, careful monitoring and medications to manage blood pressure may allow pregnancy to continue for a time under close supervision.

This decision requires expert obstetric judgment and often involves a maternal-fetal medicine specialist. A gynecologist/OB-GYN or midwife is the right care team for this — not a decision you should manage alone 3Ref 3American College of Obstetricians and Gynecologists (2020).Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222.Diagnostic criteria for preeclampsia (blood pressure thresholds, organ-involvement criteria), global prevalence, and management principles including delivery timing.

Can preeclampsia happen after delivery?

Yes. Postpartum preeclampsia can occur, most often in the first 48 hours after delivery but occasionally up to 6 weeks afterward. For people who develop new-onset hypertension postpartum, ACOG Committee Opinion 767 recommends urgent antihypertensive therapy when blood pressure reaches severe-range values (160/110 mm Hg or higher) 2Ref 2American College of Obstetricians and Gynecologists (2019).ACOG Committee Opinion No. 767: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period.Urgent antihypertensive therapy thresholds for severe-range postpartum hypertension; management framework for postpartum preeclampsia. New severe headache, vision changes, or upper abdominal pain in the weeks after delivery require the same urgent attention as during pregnancy. If you experience these symptoms after going home from the hospital, contact your provider or go to the emergency department promptly.