Preeclampsia
Also known as: Toxemia of pregnancy, preeclampsia-eclampsia spectrum
60%
Higher incidence in Black women vs. white women
Overview
Preeclampsia is a serious hypertensive disorder of pregnancy, defined as new-onset blood pressure at or above 140/90 mmHg on two occasions at least 4 hours apart after 20 weeks of gestation, accompanied by proteinuria or other signs of maternal organ dysfunction (thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or new-onset severe headache or visual disturbances). Without timely treatment, preeclampsia can progress to eclampsia (seizures), stroke, HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), and maternal or fetal death. Preeclampsia complicates 2–8 percent of pregnancies globally and remains a leading cause of maternal and perinatal mortality worldwide.
How Preeclampsia affects Black patients
Black women are approximately 60 percent more likely to develop preeclampsia than white women, are more likely to experience severe disease, and are significantly more likely to die from it. This disparity is a central driver of the Black maternal mortality crisis: according to CDC data, Black women die from pregnancy-related causes at 2.6 times the rate of white women, and hypertensive disorders of pregnancy are among the leading causes. These outcomes are not explained by pre-existing health status alone — research documents that Black women's preeclampsia-related symptoms are more frequently dismissed or undertreated, and that implicit bias in pain management and vital sign monitoring contributes directly to worse outcomes. ACOG and the Society for Maternal-Fetal Medicine have both issued statements identifying racism in healthcare as a structural cause of these disparities.
Symptoms
- Severe headache not relieved by acetaminophen
- Visual disturbances: blurring, seeing spots or flashing lights
- Pain in the upper right abdomen (epigastric or right upper quadrant pain)
- Sudden swelling of the face, hands, or feet beyond normal pregnancy swelling
- Shortness of breath or new difficulty breathing
- Nausea or vomiting in the second half of pregnancy
- Decreased fetal movement (warrants separate evaluation)
- Rapidly rising blood pressure readings at home
When to see a doctor
Report any of the above symptoms to your obstetric provider immediately — do not wait for a scheduled appointment. If you cannot reach your provider within minutes, go directly to the emergency room. Preeclampsia can worsen rapidly; delay in evaluation and treatment can be fatal.
Postpartum preeclampsia — which can develop for up to 6 weeks after delivery — is frequently unrecognized. Any postpartum patient with severe headache, visual changes, or blood pressure above 140/90 mmHg should seek emergency care immediately, even days or weeks after discharge.
Screening
ACOG recommends that high-risk patients — those with prior preeclampsia, chronic hypertension, diabetes, kidney disease, autoimmune disease, multifetal pregnancy, or first pregnancy — begin low-dose aspirin (81 mg daily) at 12–28 weeks of pregnancy, ideally by 16 weeks. Per USPSTF 2021 guidance, this approach reduces the risk of preeclampsia by approximately 24 percent and preterm preeclampsia by up to 60 percent. Black race itself is recognized as a risk factor for preeclampsia, and many clinicians and guidelines now support discussing aspirin prophylaxis with Black pregnant patients. Blood pressure monitoring at every prenatal visit and provision of home BP monitoring devices is recommended for all at-risk patients.
Treatment overview
The only definitive treatment for preeclampsia is delivery. Management depends on gestational age, disease severity, and maternal/fetal status. For preeclampsia without severe features at 37 weeks or later, delivery is recommended. For severe preeclampsia, intravenous magnesium sulfate prevents eclamptic seizures and is a standard of care. Antihypertensive medications (labetalol IV, hydralazine IV, oral nifedipine) are used for blood pressure above 160/110 mmHg. HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a severe complication requiring delivery regardless of gestational age. After delivery, blood pressure monitoring must continue for at least 6 weeks postpartum, with provider-specified thresholds for re-evaluation. Women with history of preeclampsia have elevated lifetime cardiovascular risk requiring annual monitoring.
Questions to ask your doctor
Bring this list to your next appointment.
- Am I at high risk for preeclampsia given my history, race, or medical conditions?
- Should I be taking low-dose aspirin starting at 12 weeks?
- What blood pressure readings at home should prompt me to call or go to the ER?
- What warning symptoms of preeclampsia should I never wait to report?
- What is my delivery plan if I develop preeclampsia before 37 weeks?
- How long after delivery should I monitor my blood pressure, and what numbers concern you?
- Given this pregnancy's outcome, what is my long-term cardiovascular risk?
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This content is for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. If you are experiencing a medical emergency, call 911 or your local emergency number immediately.