11 Silent Signs of Preeclampsia Every Woman Should Know
Learning to recognize the hidden warnings of this serious pregnancy complication could just save your baby’s life—and your own.
Rising blood pressure
Preeclampsia is a serious pregnancy complication marked by high blood pressure and problems with the way certain organs, such as the kidneys and liver, are functioning. According to the Preeclampsia Foundation, the condition develops in 5 to 8 percent of all pregnancies—and doctors still aren’t sure why. If not treated, preeclampsia can develop into full-blown eclampsia, which causes seizures and even death (this is what killed poor Sybil on Downtown Abbey). So even though you might not notice your blood pressure going up, it’s important to get it checked at every prenatal visit. “Blood pressure can sometimes increase without any warning,” says Sara Soto, MD, an ob-gyn for the PIH Health Women’s Center in Whittier, California. “A blood pressure of 140/90 in a person who does not have high blood pressure could be a sign of preeclampsia.” It’s also important to know what’s normal for you—for example, if your blood pressure is usually on the low side but it’s suddenly on the high side of normal, it might not catch the attention of a nurse, and may be up to you to point it out. (Make sure you know the incredibly scary reason why women die in childbirth every year.)
Protein in urine
One of the classic preeclampsia symptoms is protein in the urine—another symptom you’d only be able to detect in the doctor’s office, after peeing on a test strip. “Protein may be in the urine due to ‘leaky’ blood vessels in the kidneys, causing protein from the blood stream to go into the urine,” says Patricia Pollio, MD, director of ob-gyn at Good Samaritan Hospital, a member of the Westchester Medical Center Health Network, in Suffern, New York. This can happen when blood vessels are constricting due to high blood pressure. But, a 2013 report by a special task force of the American College of Obstetricians and Gynecologists (ACOG) found that preeclampsia can exist without protein in the urine. The report urged doctors to base their diagnosis on other symptoms as well.
Decreased urine output
Along with protein, your urine could hold more signs that your kidneys aren’t working properly. If you notice that you’re not peeing much, it could be because of the constriction of your blood vessels from rising blood pressure. “When preeclampsia becomes severe a person can start to produce less urine or even stop making urine altogether,” Dr. Soto says. If this happens, call your doctor immediately. (Check out these nine pregnancy myths that doctors want you to ignore!)
Preeclampsia usually occurs in the third trimester—which is when pregnant women are most prone to normal swelling due to fluid retention, according to ACOG. But one of the preeclampsia symptoms can be swelling, so how can you tell the difference? Look to the face. Swelling in the face and hands is more worrisome, because swelling of the feet and lower extremities is more common during pregnancy. “Swelling occurs during preeclampsia in part because of the relatively low protein level in the blood stream, and also due to leaking of water from the blood stream into the tissues,” Dr. Pollio says.
Headaches are also common in pregnancy, so how can you know if yours is something to worry about? If it’s severe and won’t go away, it could be one of the signs of preeclampsia, according to Dr. Soto. A recent study from the Albert Einstein School of Medicine showed that among women who had a “secondary headache” (one that’s a symptom of another condition), 38 percent had preeclampsia—much higher than the five to eight percent of the general population of pregnant women. Other studies have shown that women who have preeclampsia are also prone to migraines, making things even more confusing. With preeclampsia symptoms, “ a headache can occur as a direct result of high blood pressure, or indirectly due to swelling of the brain,” Dr. Pollio says.
Nausea or vomiting
Morning sickness should disappear after the first trimester, so if you all of a sudden have nausea or vomiting in the second or third trimester, chances are it’s caused by something else. A study out of Norway showed that women who had nausea or vomiting in pregnancy had a greater chance of having preeclampsia. “Nausea or vomiting can occur due to stress on the liver from leaky blood vessels,” Dr. Pollio explains. Even so, doctors may write it off as being caused by other things like the flu or gallbladder issues, according to the Preeclampsia Foundation, so make sure your doctor checks your blood pressure and urine for other signs of preeclampsia. (Check out these weird scientific explanations behind your bizarre pregnancy cravings.)
Sudden weight gain
As with puffiness of hands and face, a buildup of fluids in your body can lead to rapid weight gain with preeclampsia. “Sudden weight gain is a function of water retention and swelling,” Dr. Pollio says. Studies have shown that gaining too much weight during pregnancy, especially if you are overweight or obese, is linked to developing preeclampsia. But even if you previously were within the recommended weight gain guidelines, if you’re experiencing sudden gain within a couple of days, or more than two pounds a week, call the doctor. (Here is why you’re gaining too much or too little weight during your pregnancy.)
Changes in vision
Some 25 to 50 percent of preeclamptic patients reported visual symptoms, including blurriness, flashing lights, spots, or light sensitivity, according to the American Academy of Ophthalmology, Although these changes resolve after pregnancy, they are among the most serious of preeclampsia symptoms. “Changes in vision occur due to swelling of the optic nerve, a sign of brain swelling,” Dr. Pollio says. This swelling of the brain (cerebral edema) is life-threatening, so “any persistent vision changes should be evaluated by your doctor immediately,” Dr. Soto says. (Here are the nine surprising ways pregnancy can change your appearance.)
Unusually strong reflexes
This symptom, also called hyperreflexia, would be difficult to diagnose at home. You know when the doctor tests your reflexes with a rubber hammer? With hyperreflexia, you’d kick him over—or at least have a really strong reflex. “Hyperreflexia occurs due to central nervous system irritability because of brain swelling,” Dr. Pollio says. Unusually strong reflexes could be a precursor to the start of seizures, according to the Preeclampsia Foundation, so your doctors will let you know upon their exam whether immediate action should be taken.
Shortness of breath and anxiety
Late in pregnancy, it’s typical to feel short of breath as the internal organs get pushed together from the growing baby. But shortness of breath does also make the list for preeclampsia symptoms. “Shortness of breath can occur due to fluid accumulating in the lungs [pulmonary edema], which can also lead to anxiety from poor lung air exchange, and/or low oxygen levels,” Dr. Pollio says. A review of research found that preeclampsia is indeed an important cause of pulmonary edema during pregnancy. The feeling that “something is wrong” could, in fact, be anxiety over trouble breathing, and shouldn’t be ignored.
Pain in the upper right abdomen
You might think that pain under your ribs is heartburn or soreness from the baby kicking, but it could indicate a problem with your liver. “Constant pain in the right upper side of the abdomen can be a sign of liver swelling in severe forms of preeclampsia,” says Dr. Soto, and it can lead to liver rupture or stroke if not treated. According to the U.S. National Library of Medicine, a variant of preeclampsia called HELLP syndrome, marked by pain in the upper right abdomen (where your liver is) and sometimes also shoulder or lower back pain, affects 10 to 20 percent of women with preeclampsia. If you notice this or any of the symptoms listed here, don’t wait to call your doctor—it could mean saving your baby’s life, and your own. (Make sure you know these seven ways you can protect your baby from birth defects before and during your pregnancy.)