Questions & Answers

Pre-eclampsia is an illness you can only get during pregnancy or soon after your baby is born. It can affect you and your unborn baby.

Pre-eclampsia involves changes in blood vessels all over your body. As a result; 

• blood pressure rises
• protein from the blood may leak into the urine
• different systems in the body can be affected including the liver, kidneys, brain and blood clotting
• the baby’s growth may be reduced

High blood pressure in pregnancy affects around 1 in 10 pregnancies. Not all women with high blood pressure in pregnancy have pre-eclampsia. Pre-eclampsia affects around 1 in 20 pregnancies. Approximately 46,000 women and 500,000 babies die each year from pre-eclampsia and its complications. 

Pre-eclampsia can be very dangerous. Every day mothers and babies die from pre-eclampsia around the world. Most deaths are preventable with good quality care.

No one can predict with certainty who will be affected by pre-eclampsia. Every pregnant woman is at risk. You are at higher risk if:

• you are pregnant for the first time
• you have previously suffered with pre-eclampsia
• any close relatives (mother, sisters) have had pre-eclampsia
• you already had high blood pressure (before pregnancy)
• you have diabetes or kidney disease
• you are aged 40 years or more or you are very young
• you are expecting twins or triplets
• you are overweight

• Pre-eclampsia is caused by problems in the placenta. The placenta is the pregnancy organ that brings the baby oxygen and nutrients in the mother’s blood. Placentas affected by pre-eclampsia can’t get as much blood and oxygen as they need, this can affect the mother and baby in different ways. 
• The exact cause of pre-eclampsia is still not fully understood. 
• Developing pre-eclampsia is not your fault. 
• Pre-eclampsia is not caused by stress or diet. 
• There is ongoing research to try and understand this disorder better.

Pre-eclampsia can be unpredictable and variable. Different women may have different problems and symptoms. Some mothers don’t have any symptoms which is why regular blood pressure checks are so important, to detect problems early. Blood vessels can become leaky with pre-eclampsia. This can cause swelling (oedema) in the face and hands. Some swelling is common in normal pregnancy, particularly in the ankles. Swelling affecting the face and hands or a sudden increase in swelling may indicate pre-eclampsia. 

Some women with pre-eclampsia will become seriously unwell with problems affecting their brain (including seizures or eclampsia), liver, kidneys, lungs or blood clotting systems. 

Pre-eclampsia can get worse very quickly, that is why it’s important to have regular antenatal check-ups throughout pregnancy, particularly towards the end. Women with symptoms or concerns should seek help at a health facility as soon as possible.

• Pre-eclampsia can happen without a women having any symptoms. This is why it is so important to have antenatal care and BP checks regularly. 
• Headaches – these are usually persistent (don’t go away), they may be accompanied by vomiting, blurred vision, flashing lights or spots in the vision.
• Swelling – especially affecting the hands and face. Swelling in the legs and ankles is common in normal, healthy pregnancy but if this suddenly get worse this can also be a signs of a problem. It is best to have your blood pressure check and see a midwife or doctor. 
• Abdominal pain – sudden or severe pain with or without bleeding from the vagina needs urgent  medical attention and can be related to pre-eclampsia. Pre-eclampsia can also cause upper right sided abdominal pain. 
• Seizures in pregnancy or eclampsia, is a serious, life-threatening complication related to pregnancy. Women who suffer seizures should be taken immediately to a health facility. 
• Reduced baby movements – if your baby is less active this can be a sign of a problem. It may be related to pre-eclampsia. You should see a midwife or doctor as soon as possible. 

The symptoms listed above are not always serious but you should see a midwife or doctor as soon as possible. They may indicate a serious problem, that can be helped if identified and treated quickly. The health professional you see should always check your blood pressure, and ideally your urine. If they are unable to do this, ask to be referred to another facility where this is possible. Pre-eclampsia is a serious, life-threatening problem related to pregnancy. It can be unpredictable and things can change quickly. 

There is no known cure for pre-eclampsia. Pre-eclampsia will begin to resolve once the baby and placenta are delivered. However, it is important to know that problems related to pre-eclampsia can develop after the baby is born. This includes seizures or eclampsia and other serious problems. Sometimes the problems related to pre-eclampsia may appear or worsen after delivery, before they get better. 

Mothers should be admitted to a health facility or hospital if they have pre-eclampsia. This is to enable doctors and midwives to monitor the progress of mother and baby as closely as possible so that a safe induction or delivery, if necessary is carried out before complications set in. Pre-eclampsia is progressive – it doesn’t get better and usually gets worse. So, once admitted, mothers are not normally allowed home until after their baby has been born. Antihypertensive drugs, which reduce high blood pressure, are often prescribed; although they do not affect the underlying disease, they can reduce the risk of some complications, such as bleeding in the brain or stroke. Anticonvulsant drugs may also be prescribed to reduce the risk of eclampsia or seizures.

Pre-eclampsia does not get better until after delivery, because it is related to the placenta. This may take some time. 

Many women with pre-eclampsia have their babies early. The doctors and midwives should monitor mothers and babies carefully. They may advise early delivery if continuing pregnancy is too risky. 

Your baby may be growing too slowly, because not enough blood is getting to through the placenta. There is a risk your baby will die before it is born if you have pre-eclampsia. The doctor or midwife may advise early delivery to reduce risks for you or your baby.

For the great majority of mothers, the birth of her baby reverses all the effects of pre-eclampsia, although recovery may be preceded by a final crisis. For an unfortunate few, however, some organ damage remains after the disease itself is cured. It is not uncommon for women who have suffered pre-eclampsia in one or more pregnancies to develop chronic high blood pressure later on in life. But this is thought to reflect an inbuilt tendency to blood pressure problems rather than a history of pre-eclampsia. There are no known health problems for babies and children who have been affected by pre-eclampsia unless they suffered extreme starvation of oxygen in the womb or had to be delivered very prematurely.

If you have had pre-eclampsia once, you may be affected again. It is important in future pregnancies that you have careful monitoring and see a doctor or midwife regularly for blood pressure checks. 

Make sure your blood pressure, and ideally urine, are checked at every antenatal appointment. These should be recorded in your maternity card or notes at every antenatal visit. 

There is no hard evidence that pre-eclampsia can be prevented by what you eat, how hard you work or how much rest you take. However, there is some evidence that small daily doses of aspirin, taken under medical supervision, may be able to prevent or delay the onset of the disease in some high-risk mothers. This is because aspirin works directly on specialised blood cells known as platelets, which help with clotting and are involved in the disease process.

Women with low dietary calcium intake may benefit from supplementation in pregnancy to reduce the risk of developing pre-eclampsia. 

Taking aspirin in a next pregnancy may reduce your risk of developing pre-eclampsia. This treatment should be discussed with your midwife or doctor. 

Having regular antenatal check up and blood pressure monitoring in subsequent pregnancies can help to detect problems early. 

Take an active interest in your antenatal checks; never miss an appointment; make sure you are monitored more frequently if your blood pressure is raised, and admitted to a health facility or hospital if protein appears in your urine or you’ve been diagnosed with pre-eclampsia. Always report any worrying signs or symptoms to your midwife or doctor and do not allow him or her to dismiss you without first checking your blood pressure and urine.