Preeclampsia and Eclampsia

Preeclampsia (pree-i-KLAMP-see-uh) and eclampsia (ih-KLAMP-see-uh) are pregnancy-related high blood pressure disorders. In preeclampsia, the mother’s high blood pressure reduces the blood supply to the fetus, which may get less oxygen and fewer nutrients. Eclampsia is when pregnant women with preeclampsia develop seizures or coma. NICHD and other agencies are working to understand what causes these conditions and how they can be prevented and better treated.

About Preeclampsia and Eclampsia

Preeclampsia and eclampsia are part of the spectrum of high blood pressure, or hypertensive, disorders that can occur during pregnancy.

At the mild end of the spectrum is gestational hypertension, which 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. In many cases, gestational hypertension 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.1 Some women who have gestational hypertension later develop preeclampsia.2,3,4

Preeclampsia is similar to gestational hypertension because it also involves high blood pressure at or after 20 weeks of pregnancy in a woman whose blood pressure was normal before pregnancy. But preeclampsia can also include blood pressure at or greater than 140/90 mmHg, increased swelling, and protein in the urine.5,6 The condition can be serious and is a leading cause of preterm birth (before 37 weeks of pregnancy).7 If it is severe enough to affect brain function, causing seizures or coma, it is called eclampsia.

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 stand for the following problems:

  • 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 that the cells responsible for stopping bleeding are low

Postpartum preeclampsia describes preeclampsia that develops after the baby is delivered, usually between 48 hours and 6 weeks after delivery.8 Symptoms can include high blood pressure, severe headache, visual changes, upper abdominal pain, and nausea or vomiting.5,6  Postpartum preeclampsia can occur regardless of whether a woman had high blood pressure or preeclampsia during pregnancy.9

Postpartum eclampsia refers to seizures that occur between 48 and 72 hours after delivery. Symptoms also include high blood pressure and difficulty breathing.5,6  About one-third of eclampsia cases occur after delivery, and nearly half of those are more than 48 hours after the birth.10

Postpartum preeclampsia and eclampsia can be serious and, if not treated quickly, may result in death.11 Visit the Preeclampsia Foundation website for more information: https://www.preeclampsia.org/stillatrisk .

Citations

  1. Roberts, J. M., Bodnar, L. M., Lain, K. Y., Hubel, C. A., Markovic, N., Ness, R. B., & Powers, R. W. (2005). Uric acid is as important as proteinuria in identifying fetal risk in women with gestational hypertension. Hypertension, 46(6), 1263–1269. Retrieved January 4, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/16246973
  2. Barton, J. R., O’Brien, J. M., Bergauer, N. K., Jacques, D. L., & Sibai, B. M. (2001). Mild gestational hypertension remote from term: Progression and outcome. American Journal of Obstetrics & Gynecology, 184(5), 979–983. Retrieved November 6, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/11303208
  3. Davis, G. K., Mackenzie, C., Brown, M. A., Homer, C. S., Holt, J., McHugh, L., & Mangos, G. (2007). Predicting transformation from gestational hypertension to preeclampsia in clinical practice: A possible role for 24 hour ambulatory blood pressure monitoring. Hypertension in Pregnancy, 26(1), 77–87. Retrieved November 6, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/17454220
  4. Leeman, L., Dresang, L. T., & Fontaine, P. (2016). Hypertensive disorders of pregnancy. American Family Physician, 93(2), 121–127. Retrieved November 6, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/26926408
  5. ACOG Committee on Practice Bulletins, Obstetrics. (2020). Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin Number 222 https://pubmed.ncbi.nlm.nih.gov/32443079/ 
  6. ACOG Committee on Practice Bulletins, Obstetrics. (2019). Chronic Hypertension in Pregnancy: ACOG Practice Bulletin Number 203 https://pubmed.ncbi.nlm.nih.gov/30575676/ 
  7. Goldenberg, R. L., Culhane, J. F., Iams, J. D., & Romero, R. (2008). Epidemiology and causes of preterm birth. The Lancet, 371(9606), 75–84. Retrieved December 13, 2016, from http://www.thelancetnorway.com/journals/lancet/article/PIIS0140-6736(08)60074-4/fulltext 
  8. Bigelow, C. A., Pereira, G. A., Warmsley, A., Cohen, J., Getrajdman, C., Moshier, E., Paris, J., Bianco, A., Factor, S. H., & Stone, J. (2014). Risk factors for new-onset late postpartum preeclampsia in women without a history of preeclampsia. American Journal of Obstetrics & Gynecology, 210(4), 338.e1–338.e8. Retrieved October 22, 2018, from https://www.sciencedirect.com/science/article/pii/S0002937813019984?via%3Dihub 
  9. Skurnik, G., Hurwitz, S., McElrath, T. F., Tsen, L. C., Duey, S., Saxena, A. R., Karumanchi, A., Rich-Edwards, J. W., & Seely, E. W. (2017). Labor therapeutics and BMI as risk factors for postpartum preeclampsia: A case-control study. Pregnancy Hypertension, 10, 177–181. Retrieved October 22, 2018, from https://www.sciencedirect.com/science/article/pii/S2210778917300442?via%3Dihub#b0075 
  10. Cairns, A. E., Pealing, L., Duffy, J. M. N., Roberts, N., Tucker, K. L., Leeson, P., MacKillop, L. H., & McManus, R. J. (2017). Postpartum management of hypertensive disorders of pregnancy: A systematic review. BMJ Open, 7(11), e018696. Retrieved September 11, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719299/
  11. ACOG. (2017). Committee Opinion 692: Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Retrieved October 22, 2018, from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Emergent-Therapy-for-Acute-Onset-Severe-Hypertension-During-Pregnancy-and-the-Postpartum-Period?IsMobileSet=false 

What causes preeclampsia and eclampsia?

The causes of preeclampsia and eclampsia are not known. These disorders previously were believed to be caused by a toxin, called “toxemia,” in the blood, but health care providers now know that is not true. Nevertheless, preeclampsia is sometimes still referred to as “toxemia.”

To learn more about preeclampsia and eclampsia, scientists are investigating many factors that could contribute to the development and progression of these diseases, including:

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

What are the risks of preeclampsia & eclampsia to the mother?

Preeclampsia during pregnancy is mild in the majority of cases.1 However, a woman can progress from mild to severe preeclampsia or to full eclampsia very quickly―even in a matter of days. Both preeclampsia and eclampsia can cause serious health problems for the mother and infant.

Women with preeclampsia are at increased risk for damage to the kidneys, liver, brain, and other organ and blood systems. Preeclampsia may also affect the placenta. The condition could lead to a separation of the placenta from the uterus (referred to as placental abruption), preterm birth, and pregnancy loss or stillbirth. In some cases, preeclampsia can lead to organ failure or stroke.

In severe cases, preeclampsia can develop into eclampsia, which includes seizures. Seizures in eclampsia may cause a woman to lose consciousness and twitch uncontrollably.2 If the fetus is not delivered, these conditions can cause the death of the mother and/or the fetus.

Although most pregnant women in developed countries survive preeclampsia, it is still a major cause of illness and death globally.3 According to the World Health Organization, preeclampsia and eclampsia cause 14% of maternal deaths each year, or about 50,000 to 75,000 women worldwide.4

In "uncomplicated preeclampsia," the mother's high blood pressure and other symptoms usually go back to normal within 6 weeks of the infant's birth. However, studies have shown that women who had preeclampsia are four times more likely to later develop hypertension (high blood pressure) and are twice as likely to later develop ischemic heart disease (reduced blood supply to the heart muscle, which can cause heart attacks), a blood clot in a vein, and stroke as are women who did not have preeclampsia.5

Less commonly, mothers who had preeclampsia can experience permanent damage to their organs, such as their kidneys and liver. They can also experience fluid in the lungs. In the days following birth, women with preeclampsia remain at increased risk for developing eclampsia and seizures.3,6

In some women, preeclampsia develops between 48 hours and 6 weeks after they deliver their baby—a condition called postpartum preeclampsia.7,8 Postpartum preeclampsia can occur in women who had preeclampsia during pregnancy and among those who did not. One study found that slightly more than one-half of women who had postpartum preeclampsia did not have preeclampsia during pregnancy.9 If a woman has seizures within 72 hours of delivery, she may have postpartum eclampsia. 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.10 Postpartum preeclampsia and eclampsia can progress very quickly if not treated and may lead to stroke or death. Visit the Preeclampsia Foundation website for more information: https://www.preeclampsia.org/stillatrisk .

Citations

  1. Sibai, B. M. (2004). Magnesium sulfate prophylaxis in preeclampsia: Lessons learned from recent trials. American Journal of Obstetrics & Gynecology, 190(6), 1520–1526. Retrieved November 14, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/15284724
  2. National Institute of Neurological Disorders and Stroke. (2016). The epilepsies and seizures: Hope through research. Retrieved January 4, 2017, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Epilepsies-and-Seizures-Hope-Through
  3. Preeclampsia Foundation. (2018). FAQs. Retrieved November 14, 2018, from https://www.preeclampsia.org/health-information/faqs 
  4. Lim, K.-H., Steinberg, G., & Ramus, R. M. (2018). Preeclampsia. Retrieved November 14, 2018, from http://emedicine.medscape.com/article/1476919-overview 
  5. Bellamy, L., Casas, J. P., Hingorani, A. D., & Williams, D. J. (2007). Pre-eclampsia and risk of cardiovascular disease and cancer in later life: Systematic review and meta-analysis. British Medical Journal, 335(7627), 974. Retrieved November 14, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/17975258
  6. Smith, M., Waugh, J., & Nelson-Piercy, C. (2013). Management of postpartum hypertension. The Obstetrician & Gynaecologist, 15(1), 45–50. Retrieved December 28, 2016, from http://onlinelibrary.wiley.com/doi/10.1111/j.1744-4667.2012.00144.x/pdf  (PDF 561 KB)
  7. ACOG Committee on Practice Bulletins, Obstetrics. (2020). Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin Number 222 https://pubmed.ncbi.nlm.nih.gov/32443079/
  8. ACOG Committee on Practice Bulletins, Obstetrics. (2019). Chronic Hypertension in Pregnancy: ACOG Practice Bulletin Number 203 https://pubmed.ncbi.nlm.nih.gov/30575676/
  9. Yancey, L. M., Withers, E., Bakes, K., & Abbott, J. (2011). Postpartum preeclampsia: Emergency department presentation and management. Journal of Emergency Medicine, 40(4), 380–384. Retrieved November 14, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/18814997
  10. Andrus, S. S., & Wolfson, A. B. (2010). Postpartum preeclampsia occurring after resolution of antepartum preeclampsia. Journal of Emergency Medicine, 38(2), 168–170. Retrieved November 14, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/18547773

What are the risks of preeclampsia & eclampsia to the fetus?

Preeclampsia may be related to problems with the placenta early in the pregnancy.1 Such problems pose risks to the fetus, including:

  • Lack of oxygen and nutrients, which can impair fetal growth
  • Preterm birth
  • Stillbirth if placental abruption (separation of the placenta from the uterine wall) leads to heavy bleeding in the mother
  • Infant death (Visit the Preeclampsia Foundation for current figures) external link

Stillbirths are more likely to occur when the mother has a more severe form of preeclampsia, including HELLP syndrome.

Infants whose mothers had preeclampsia are also at increased risk for later problems, even if they were born at full term (39 weeks of pregnancy).3 Infants born preterm due to preeclampsia face a higher risk of some long-term health issues, mostly related to being born early, including learning disorders, cerebral palsy, epilepsy, deafness, and blindness. Infants born preterm may also have to be hospitalized for a long time after birth and may be smaller than infants born 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.4

Citations

  1. Kaufmann, P., Black, S., & Huppertz, B. (2003). Endovascular trophoblast invasion: Implications for the pathogenesis of intrauterine growth retardation and preeclampsia. Biology of Reproduction,69(1), 1–7. Retrieved January 4, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/12620937
  2. Preeclampsia Foundation. (2013). FAQs. Retrieved June 7, 2016, from https://www.preeclampsia.org/health-information/faqs external link
  3. Mendola, P., Mumford, S. L., Männistö, T. I., Holston, A., Reddy, U. M., & Laughon, S. K. (2015). Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth. Epidemiology, 26(1), 17–26. Retrieved January 4, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/25437315
  4. Cosmi, E., Fanelli, T., Visentin, S., Trevisanuto, D., & Zanardo, V. (2011). Consequences in infants that were intrauterine growth restricted. Journal of Pregnancy. Retrieved June 7, 2016, from http://www.hindawi.com/journals/jp/2011/364381/cta external link

Who is at risk of preeclampsia?

Although preeclampsia occurs primarily in first pregnancies, a woman who had preeclampsia in a previous pregnancy is seven times more likely to develop preeclampsia in a later pregnancy.5

Other factors that can increase a woman's risk include:5

  • Chronic high blood pressure or kidney disease before pregnancy
  • High blood pressure or preeclampsia in an earlier pregnancy
  • Obesity. Women with overweight or obesity are also more likely to have preeclampsia in more than one pregnancy.6
  • Age. Women older than 40 are at higher risk.
  • Multiple gestation (being pregnant with more than one fetus)
  • African American ethnicity. Also, among women who have had preeclampsia before, non-white women are more likely than white women to develop preeclampsia again in a later pregnancy.6
  • Family history of preeclampsia.7, 17

Preeclampsia is also more common among women who have histories of certain health conditions, such as migraines,8 diabetes,9 rheumatoid arthritis,10 lupus,11 scleroderma,12 urinary tract infections,13 gum disease,14 polycystic ovary syndrome,15 multiple sclerosis, gestational diabetes, and sickle cell disease.16

Preeclampsia is also more common in pregnancies resulting from egg donation, donor insemination, or in vitro fertilization.

The U.S. Preventative Services Task Force recommends that women who are at high risk for preeclampsia take low-dose aspirin starting after 12 weeks of pregnancy to prevent preeclampsia.17 Women who are pregnant or who are thinking about getting pregnant should talk with their health care provider about preeclampsia risk and ways to reduce the risk.

Citations

  1. Duley, L. (2009). The global impact of pre-eclampsia and eclampsia. Seminars in Perinatology, 33(3), 130–137. Retrieved June 23, 2016, from https://www.sciencedirect.com/science/article/pii/S0146000509000214 external link
  2. Ananth, C. V., Keyes, K. M., & Wapner, R.J. (2013). Pre-eclampsia rates in the United States, 1980-2010: Age-period-cohort analysis. British Medical Journal, 347, f6564. Retrieved June 23, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898425
  3. Ngoc, N. T., Merialdi, M., Abdel-Aleem, H., Carroli, G., Purwar, M., Zavaleta, N., et al. (2006). Causes of stillbirths and early neonatal deaths: Data from 7993 pregnancies in six developing countries. Bulletin of the World Health Organization, 84(9), 699–705. Retrieved January 4, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627466
  4. Haram, K., Svendsen, E., & Abildgaard, U. (2009). The HELLP syndrome: Clinical issues and management. A review. BMC Pregnancy & Childbirth, 9, 8. Retrieved June 6, 2016 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654858/
  5. Duckitt, K., & Harrington, D. (2005). Risk factors for pre-eclampsia at antenatal booking: Systematic review of controlled studies. British Medical Journal,330(7491), 565. Retrieved December 30, 2016, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC554027/
  6. Boghossian, N. S., Yeung, E., Mendola, P., Hinkle, S. N., Laughon, S. K., Zhang, C., & Albert, P. S. (2014). Risk factors differ between recurrent and incident preeclampsia: A hospital-based cohort study. Annals of Epidemiology,24(12), 871–877e3. Retrieved December 13, 2016, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355246
  7. Lim, K.-H., Steinberg, G., & Ramus, R. M. (2016). Preeclampsia. Retrieved June 6, 2016, from http://emedicine.medscape.com/article/1476919-overview external link
  8. Sanchez, S. E., Qiu, C., Williams, M. A., Lam, N., & Sorensen, T. K. (2008). Headaches and migraines are associated with an increased risk of preeclampsia in Peruvian women. American Journal of Hypertension, 21(3), 360–364.
  9. Rosenberg, T. J., Garbers, S., Lipkind, H., & Chiasson, M. A. (2005). Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: Differences among 4 racial/ethnic groups. American Journal of Public Health, 95(9), 1545–1551.
  10. Lin, H. C., Chen, S. F., Lin, H. C., & Chen, Y. H. (2010). Increased risk of adverse pregnancy outcomes in women with rheumatoid arthritis: A nationwide population-based study. Annals of the Rheumatic Disease, 69, 715–717.
  11. Clowse, M. E. B. (2007). Lupus activity in pregnancy. Rheumatic Disease Clinics of North America, 33, 237.
  12. National Heart, Lung, and Blood Institute. (n.d.). High blood pressure in pregnancy. Retrieved June 6, 2016, from https://www.nhlbi.nih.gov/files/docs/guidelines/hbp_preg_archive.pdf (PDF 250 KB)
  13. Conde-Agudelo, A., Villar, J., & Lindheimer, M. (2008). Maternal infection and risk of preeclampsia: Systematic review and metaanalysis. American Journal of Obstetrics and Gynecology, 198(1), 7–22.
  14. Sibai, B. M. (2012). Hypertension. In S. G. Gabbe, J. R. Niebyl, J. L. Simpson, M. B. Landon, H. L. Galan, E. R. M. Jauniaux, & D. A. Driscoll (Eds.), Obstetrics: Normal and problem pregnancies (6th ed., pp. 631–666). Philadelphia: W. B. Saunders.
  15. Veltman-Verhulst, S. M., van Rijn, B. B., Westerveld, H. E., Franx, A., Bruinse, H. W., Fauser, B. C., et al. (2010). Polycystic ovary syndrome and early-onset preeclampsia: Reproductive manifestations of increased cardiovascular risk. Menopause, 17(5), 990–996.
  16. Preeclampsia Foundation. (2013). FAQs. Retrieved June 6, 2016, from https://www.preeclampsia.org/health-information/faqs external link
  17. U.S. Preventive Services Task Force. (2015). Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: Recommendation statement. American Family Physician, 91(5). Retrieved August 8, 2016, from http://www.aafp.org/afp/2015/0301/od1.html external link

What are the symptoms of preeclampsia, eclampsia, & HELLP syndrome?

Recognize the symptoms of preeclampsiaPossible symptoms of preeclampsia include:

  • High blood pressure
  • Too much protein in the urine
  • Swelling in a woman's face and hands (a woman's feet might swell too, but swollen feet are common during pregnancy and may not signal a problem)
  • Systemic problems, such as headache, blurred vision, and right upper quadrant abdominal pain

The following symptoms are cause for immediate concern:1

  • Seizures
  • Severe headache
  • Vision problems, such as temporary blindness
  • Abdominal pain, especially in the upper right area of the belly
  • Nausea and vomiting
  • Smaller urine output or not urinating very often

HELLP syndrome can lead to serious complications, including liver failure and death.1

A pregnant woman with HELLP syndrome might bleed or bruise easily and/or experience abdominal pain, nausea or vomiting, headache, or extreme fatigue. Although most women who develop HELLP syndrome already have high blood pressure and preeclampsia, sometimes the syndrome is the first sign. In addition, HELLP syndrome can occur without a woman having either high blood pressure or protein in her urine.

Citations

  1. Sibai, B. M. (2012). Hypertension. In S. G. Gabbe, J. R. Niebyl, J. L. Simpson, & M. B. Landon (Eds.), Obstetrics: Normal and problem pregnancies (6th ed.). Philadelphia: Saunders.

How do health care providers diagnose preeclampsia, eclampsia, and HELLP syndrome?

A health care provider will check a pregnant woman's blood pressure and urine during each prenatal visit. If the blood pressure reading is considered high (140/90 or higher), especially after the 20th week of pregnancy, the health care provider will likely perform blood tests and more extensive lab tests to look for extra protein in the urine (called proteinuria) as well as other symptoms.

The American College of Obstetricians and Gynecologists provides the following criteria for a diagnosis of gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome.

Gestational hypertension is diagnosed if a pregnant woman has high blood pressure but no protein in the urine. Gestational hypertension occurs when women whose blood pressure levels were normal before pregnancy develop high blood pressure after 20 weeks of pregnancy. Gestational hypertension can progress into preeclampsia.1

Mild preeclampsia is diagnosed when a pregnant woman has:2,3

  • Systolic blood pressure (top number) of 140 mmHg or higher or diastolic blood pressure (bottom number) of 90 mmHg or higher and either
    • Urine with 0.3 or more grams of protein in a 24-hour specimen (a collection of every drop of urine within 24 hours) or a protein-to-creatinine ratio greater than 0.3 
      or
    • Blood tests that show kidney or liver dysfunction
    • Fluid in the lungs and difficulty breathing
    • Visual impairments

Severe preeclampsia occurs when a pregnant woman has any of the following:

  • Systolic blood pressure of 160 mmHg or higher or diastolic blood pressure of 110 mmHg or higher on two occasions at least 4 hours apart while the patient is on bed rest
  • Urine with 5 or more grams of protein in a 24-hour specimen or 3 or more grams of protein on 2 random urine samples collected at least 4 hours apart
  • Test results suggesting kidney or liver damage—for example, blood tests that reveal low numbers of platelets or high liver enzymes
  • Severe, unexplained stomach pain that does not respond to medication
  • Symptoms that include visual disturbances, difficulty breathing, or fluid buildup4

Eclampsia occurs when women with preeclampsia develop seizures. The seizures can happen before or during labor or after the baby is delivered. 

HELLP syndrome is diagnosed when laboratory tests show hemolysis (burst red blood cells release hemoglobin into the blood plasma), elevated liver enzymes, and low platelets. There also may or may not be extra protein in the urine.5

Some women may also be diagnosed with superimposed preeclampsia—a situation in which the woman develops preeclampsia on top of high blood pressure that was present before she got pregnant. Health care providers look for an increase in blood pressure and either protein in the urine, fluid buildup, or both for a diagnosis of superimposed preeclampsia.

In addition to tests that might diagnose preeclampsia or similar problems, health care providers may do other tests to assess the health of the mother and fetus, including:

  • Blood tests to see how well the mother's liver and kidneys are working
  • Blood tests to check blood platelet levels to see how well the mother's blood is clotting
  • Blood tests to count the total number of red blood cells in the mother's blood
  • 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 as well as abdominal tenderness or an enlarged liver

Citations

  1. Saudan, P., Brown, M. A., Buddle, M. L., Jones, M. (1998). Does gestational hypertension become pre-eclampsia? British Journal of Obstetrics and Gynaecology, 105(11), 1177–1184.
  2. ACOG Committee on Practice Bulletins, Obstetrics. (2020). Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin Number 222 https://pubmed.ncbi.nlm.nih.gov/32443079/
  3. ACOG Committee on Practice Bulletins, Obstetrics. (2019). Chronic Hypertension in Pregnancy: ACOG Practice Bulletin Number 203 https://pubmed.ncbi.nlm.nih.gov/30575676/
  4. Sibai, B. M. (2012). Hypertension. In S. G. Gabbe, J. R. Niebyl, J. L. Simpson, M. B. Landon, H. L. Galan, E. R. M. Jauniaux, & D. A. Driscoll (Eds.), Obstetrics: Normal and problem pregnancies (6th ed., pp. 631–666). Philadelphia: W. B. Saunders.
  5. Haram, K., Svendsen, E., & Abildgaard, U. (2009). The HELLP syndrome: Clinical issues and management. A review. BMC Pregnancy & Childbirth, 9, 8. Retrieved June 6, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654858/ external link

What are the treatments for preeclampsia, eclampsia, & HELLP syndrome?

Delivering the fetus can help resolve preeclampsia and eclampsia, but symptoms can continue even after delivery, and some of them can be serious.

Treatment decisions for preeclampsia, eclampsia, and HELLP syndrome need to take into account how severe the condition is, the potential for maternal complications, how far along the pregnancy is, and the potential risks to the fetus. Ideally, the healthcare provider will minimize risks to the mother while giving the fetus as much time as possible to mature before delivery.

The U.S. Preventive Services Task Force recommends that women at high risk for preeclampsia take low-dose aspirin starting after 12 weeks of pregnancy to prevent the condition from occurring.1

If the pregnancy is at 37 weeks or later, the healthcare provider will usually want to deliver the fetus to treat preeclampsia and avoid further complications.

If the pregnancy is at less than 37 weeks, however, 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. A healthcare provider may consider the following options:

  • If the preeclampsia is mild, it may be possible to wait to deliver. To help prevent further complications, 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.
  • Close monitoring of the woman and her fetus will be needed. Tests for the mother might include blood and urine tests to see if the preeclampsia is progressing, such as tests to assess platelet counts, liver enzymes, kidney function, and urinary protein levels. Tests for the fetus might include ultrasound, heart rate monitoring, assessment of fetal growth, and amniotic fluid assessment.
  • Anticonvulsive medication, such as magnesium sulfate, might be used to prevent a seizure.
  • In some cases, such as with severe preeclampsia, the woman will be admitted to the hospital so she can be monitored closely and continuously. Treatment in the hospital might include intravenous medication to control blood pressure and prevent seizures or other complications, as well as steroid injections to help speed up the development of the fetus's lungs.

When a woman has severe preeclampsia and is at 34 weeks of pregnancy or later, the American College of Obstetricians and Gynecologists recommends delivery as soon as medically possible. If the pregnancy is at less than 34 weeks, healthcare providers will probably prescribe corticosteroids to help speed up the maturation of the fetal lungs before attempting delivery.2

Preterm delivery may be necessary, even if that means likely complications for the infant, because of the risk of severe maternal complications.

The symptoms of preeclampsia usually go away within 6 weeks of delivery.3

Eclampsia—the onset of seizures in a woman with preeclampsia—is considered a medical emergency. Immediate treatment, usually in a hospital, is needed to stop the mother's seizures, treat blood pressure levels that are too high, and deliver the fetus.

Magnesium sulfate (a type of mineral) may be given to treat active seizures and prevent future seizures. Antihypertensive medications may be given to lower the blood pressure.

HELLP syndrome, a severe complication of preeclampsia and eclampsia, can lead to serious complications for the mother, including liver failure and death, as well as the fetus. The healthcare provider may consider the following treatments after a diagnosis of HELLP syndrome:

  • Delivery of the fetus
  • Hospitalization to provide intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs4

As mentioned earlier, some women develop preeclampsia or eclampsia after they deliver their babies. The American College of Obstetricians and Gynecologists recommends that healthcare providers closely monitor women who had high blood pressure or preeclampsia during pregnancy for 72 hours after delivery, either at home or in the hospital.5 Because postpartum preeclampsia and eclampsia can progress quickly and can have serious effects, it is important to get treatment immediately.

Depending on a woman’s specific health situation, treatment may include medications to prevent blood pressure from reaching dangerously high levels and causing stroke or other problems associated with extremely high blood pressure. It may also include medications to treat or prevent seizures.

One study looked at women who came to the emergency room with a diagnosis of postpartum preeclampsia. The most common warning symptoms in these cases were headache, vision changes, and nausea or abdominal pain. Nearly all of these women had high blood pressure when admitted, and some had already had seizures at home before coming to the hospital. Treatment for postpartum preeclampsia follows the guidelines used to treat preeclampsia during pregnancy. The women in the study received magnesium sulfate to treat or prevent seizure and, if needed, additional treatment for their high blood pressure.6

Citations

  1. U.S. Preventive Services Task Force. (2015). Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: Recommendation statement. American Family Physician, 91(5). Retrieved August 8, 2016, from http://www.aafp.org/afp/2015/0301/od1.html external link
  2. March of Dimes. (2013). Premature babies. Retrieved June 6, 2016, from http://www.marchofdimes.org/complications/premature-babies.aspx external link
  3. Sibai, B. M. (2012). Hypertension. In S. G. Gabbe, J. R. Niebyl, J. L. Simpson, M. B. Landon, H. L. Galan, E. R. M. Jauniaux, & D. A. Driscoll (Eds.), Obstetrics: Normal and problem pregnancies (6th ed., pp. 631–666). Philadelphia, PA: W. B. Saunders.
  4. Haram, K., Svendsen, E., & Abildgaard, U. (2009). The HELLP syndrome: Clinical issues and management. A review. BMC Pregnancy & Childbirth, 9, 8. Retrieved June 6, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654858/
  5. Leeman, L., Dresang, L. T., & Fontaine, P. (2016). Hypertensive disorders of pregnancy. American Family Physician, 93(2), 121–127. Retrieved November 15, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/26926408
  6. Yancey, L. M., Withers, E., Bakes, K., & Abbott, J. (2011). Postpartum preeclampsia: Emergency department presentation and management. Journal of Emergency Medicine, 40(4), 380–384. Retrieved November 14, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/18814997

NICHD Preeclampsia and Eclampsia Research Goals

Advances in understanding preeclampsia and eclampsia and the complications they cause contribute directly to NICHD’s mission.

Complications of preeclampsia, such as kidney failure, hemorrhage, and stroke, can lead to lasting health problems. Worldwide, preeclampsia is one of the leading causes of maternal death. NICHD aims to maintain a global perspective while pursuing a better understanding of hypertensive disorders in pregnancy to prevent the poor health outcomes and deaths caused by this condition.

NICHD research addresses:

  • 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

Preeclampsia and Eclampsia Research Activities and Advances

Studies conducted by researchers at NICHD and elsewhere have found markers in the blood of pregnant women that seem to signal the later development of preeclampsia. Identifying such substances—related to the apparent biochemical basis for preeclampsia—is an important step in developing treatments for the condition as well as better ways to identify who is at risk.

Researchers at NICHD's Division of Intramural Population Health Research (DIPHR) found strong evidence that an imbalance of two proteins produced by the placenta is responsible for the symptoms of preeclampsia. Abnormally high levels of these proteins appear to deprive the blood vessels of substances needed to keep the lining of the blood vessels healthy. Deprived of these essential substances, the cells lining the blood vessels begin to sicken and die. As a result, blood pressure increases, and the blood vessels leach protein into the tissues and urine. Both proteins appear to contribute to the development of preeclampsia. Severe disease usually occurs in women with high levels of both measures and not in women with high levels of only one or the other. (PMID: 16957146)

Other DIPHR researchers are investigating the relationship of angiogenic factors to the pathogenesis of preeclampsia and their potential for identifying women at high risk of developing preeclampsia. Several studies are currently exploring this area of research. In addition, a recent study found that elevated blood pressure in pregnancy is linked to an increased risk for cardiovascular disease, chronic kidney disease, and diabetes later in life. (PMID: 23401113)

Previous studies have shown that low-dose aspirin during pregnancy reduced the rate of preeclampsia in high-risk women.1 The U.S. Preventative Services Task Force cited these studies in its recommendation for using low-dose aspirin to prevent preeclampsia in high-risk women. The NICHD-led Effects of Aspirin in Gestation and Reproduction (EAGeR) Study found that low-dose aspirin initiated before pregnancy did not reduce preterm births or pregnancy complications, such as preeclampsia, in women who previously had one or two pregnancy losses. The EAGeR Study also found that aspirin use was not harmful during pregnancy. The investigators recommended against the general use of low-dose aspirin to improve pregnancy outcomes but said that more research is needed on subsets of women at high risk for pregnancy loss or complications. (PMID: 24702835)

NICHD's Pregnancy and Perinatology Branch (PPB) funds and oversees research grants to independent researchers throughout the U.S. and abroad to study medical management and prevention of preeclampsia. Some avenues of research related to preeclampsia include the impact of obesity on the condition, the potential role of autoimmunity, and fetal genetic contributions.

Although the exact mechanisms of preeclampsia are unknown, it appears that the condition is due to poor blood flow from the uterus to the placenta. In a normal pregnancy, placental cells known as trophoblastic cells migrate to uterine blood vessels and increase their size. In preeclampsia, the trophoblastic cells fail to migrate completely towards the uterine blood vessels, resulting in less uterine blood flow to the placenta. In turn, the poorly nourished placenta releases factors into the maternal circulation that result in the systemic symptoms of the disease.

PPB-supported research has helped determine the source and role of proteins and other chemical factors that are important in establishing sufficient blood flow to the placenta. (PMID: 20948996, PMID: 18093648).

In addition, researchers in the Program in Perinatal Research and Obstetrics, in NICHD's Division of Intramural Research, are investigating preeclampsia as part of a larger effort to prevent preterm birth. Efforts have included examining the possibility that infection contributes to preeclampsia. Researchers also are calibrating measurements of growth factors in the blood and testing the reliability of these measurements as a way of predicting when women will develop preeclampsia. Their clinical findings indicate that this approach has promise for predicting when a woman will develop preeclampsia that requires delivery before the pregnancy reaches full term. Read more about the Program's research in the Division's annual report.

Additional NICHD research on preeclampsia has found:

  • Immune system protein at high levels in women with preeclampsia (PMID: 26510395)
  • Race and pre-pregnancy body mass index affect the risk of preeclampsia (PMID: 25453345)
  • Higher levels of copeptin could identify women at risk for preeclampsia (PMID: 25225209)
  • Stillbirth risk for mothers with preeclampsia is highest at 26 weeks of gestation (PMID: 25730226P)
  • Pregnancy-associated plasma protein A2 is elevated in women with preeclampsia (PMID: 26748159)
  • Women with elevated blood pressure during labor are at risk for hypertensive disorders in a second pregnancy (PMID: 25673041)

The PPB created the Maternal-Fetal Medicine Units Network in 1986 to focus on clinical questions in maternal-fetal medicine and obstetrics, particularly with respect to the continuing problem of preterm birth. Several studies affiliated with the network have investigated preeclampsia. For instance, the Combined Antioxidants and Preeclampsia Prediction Studies, co-funded by the National Heart, Lung, and Blood Institute, were designed to see if antioxidants (vitamins C and E) could prevent preeclampsia in women at low risk for the condition. The results showed that antioxidants neither decrease the incidence of preeclampsia nor reduce the risk of complications associated with pregnancy-related hypertension.2

NICHD's Health Equity Seminar Series is a forum for raising awareness of maternal and child health issues that affect diverse populations and for exploring directions for future research aimed at reducing health disparities in NICHD mission areas. The September 2014 seminar focused on vitamin D deficiency, which is a risk factor for preeclampsia that occurs disproportionately in racial/ethnic minority populations. The seminar reviewed the status of basic research on vitamin D deficiency's role in placental development and preeclampsia and discussed research directions.

Citations

  1. LeFevre, M. L. (2014). Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 161(11), 819–826. Retrieved January 4, 2017, from http://annals.org/aim/article/1902275/low-dose-aspirin-use-prevention-morbidity-mortality-from-preeclampsia-u external link
  2. Roberts, J. M., Myatt, L., Spong, C. Y., Thom, E. A., Hauth, J. C., Leveno, K. J., et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. (2010). Vitamins C and E to prevent complications of pregnancy-associated hypertension. New England Journal of Medicine, 362(14), 1282–1291.
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