Pre-eclampsia and high blood pressure in pregnancy

Pre-eclampsia can be found at an antenatal appointment before you feel unwell. Blood pressure and urine checks help pick up changes you may not notice yourself. Keep those appointments even when you feel well.

Symptoms to act on immediately

Call 999 now (UK) or 911 (US), or your local emergency number, if you or someone with you has a new seizure, sudden face drooping, arm weakness or speech difficulty, or severe breathing difficulty with gasping or inability to get words out.

Call your maternity unit now in the UK, your obstetric clinician or maternity hospital in the US, or your doctor or midwife elsewhere if you have a severe headache that persists, blurred vision or flashing lights, pain below the ribs, sudden swelling of the face, hands or feet, new breathing difficulty, or feel very unwell. These symptoms need immediate assessment during pregnancy and after birth.

The NHS also lists vomiting and heartburn that does not settle with heartburn medicine as symptoms. In the UK, call 111 if you have recently given birth or cannot contact your maternity unit. Do not wait for the next routine appointment to report these symptoms.

How it differs from high blood pressure alone

High blood pressure is also called hypertension. Some people have it before pregnancy and others develop it during pregnancy. Pre-eclampsia is a separate, serious condition involving high blood pressure and effects on other parts of the body.

It usually occurs after 20 weeks, although the NHS says it can happen earlier. Protein in the urine is a common sign, but RCOG explains that the liver, kidneys or blood clotting can be affected even without protein in the urine. Your clinician looks at the results of the full assessment together.

Pre-eclampsia can affect how well the placenta works and slow a baby’s growth. Severe illness can cause seizures, stroke or problems with the liver and blood. Both symptoms and routine checks matter.

What assessment and treatment involve

If your midwife or doctor suspects pre-eclampsia, you will usually be referred to hospital. Assessment can include blood tests and ultrasound scans to check the baby’s growth, alongside blood pressure and urine checks.

Your care depends on how unwell you are, how far along you are in pregnancy and how the baby is doing. Some people have close outpatient monitoring; others need to stay in hospital. Treatment can include blood pressure medicine and, for severe illness, medicine to prevent seizures. Your doctor can explain the medicines being offered.

Sometimes an earlier birth is recommended because continuing the pregnancy carries greater risks. The options may include induction or a caesarean birth. Ask what the team is concerned about, how urgent the decision is and what each option means for you and your baby.

Ask your clinician about aspirin

Your clinician checks your risk factors, including pre-eclampsia in an earlier pregnancy, existing high blood pressure, kidney disease and diabetes. Aspirin may be recommended to lower risk for some people. Only take it for this purpose if your midwife or doctor advises it; ask your prescriber about the plan that applies to you.

If you already take prescribed blood pressure medicine, do not stop it without talking to your doctor. Tell the prescriber you are pregnant so the treatment can be reviewed.

Keep up with checks after birth

Symptoms usually improve after the baby is born, but complications can continue and pre-eclampsia can first appear after birth. You may still need blood pressure medicine and regular checks after leaving hospital. Follow the urgent and emergency contact advice above if symptoms occur, even if you have already gone home.

Before leaving hospital, ask for a written care plan. NICE recommends that the plan sets out who will provide follow-up care, how often blood pressure needs checking and which symptoms to watch for. Ask who to call with concerns and how the maternity team will share the plan with your GP or primary care doctor.

Arrange the follow-up appointment your team recommends. Having had pre-eclampsia is associated with a higher risk of high blood pressure, stroke and heart disease later in life. Tell your GP or primary care doctor that you had pre-eclampsia so they can include it in your ongoing care.