The first signs of preeclampsia are often high blood pressure or protein in the urine found during a prenatal visit, because many people have no symptoms at first. When symptoms occur, they may include a lasting headache, vision changes, pain under the ribs, sudden swelling of the face or hands, nausea, or trouble breathing. These warning signs need prompt medical assessment, during pregnancy or after birth.
What are the earliest warning signs of preeclampsia?
Preeclampsia is a pregnancy-related condition involving high blood pressure that can affect organs such as the kidneys, liver, and brain. It usually develops after 20 weeks of pregnancy, although it can also occur after delivery. Some people feel completely well when it begins, so the first indication may come from a blood pressure measurement or urine test during routine prenatal care.
According to the American College of Obstetricians and Gynecologists (ACOG), warning signs can include persistent headaches, changes in eyesight, upper abdominal or shoulder pain, sudden swelling, and difficulty breathing. These symptoms can have other causes during pregnancy, but new or unusual symptoms should not be ignored.
Which symptoms may appear first?
When preeclampsia causes noticeable symptoms, they may begin gradually or develop over a short period. The following are examples of warning signs that can occur during pregnancy or shortly after birth. Not everyone experiences them, and some people have no obvious symptoms.
- A persistent or unusual headache: A headache that does not go away, becomes worse, or feels different from usual may need urgent assessment, particularly during the second half of pregnancy.
- Changes in vision: Blurred vision, flashing lights, seeing spots, double vision, or temporary loss of vision can occur when preeclampsia affects the body.
- Pain in the upper abdomen: Pain or tenderness under the ribs, especially on the right side, may be associated with liver involvement. Pain may sometimes spread toward the shoulder.
- Sudden swelling of the face or hands: Swelling can be normal during pregnancy, but a sudden increase, especially around the eyes or in the hands, deserves medical attention.
- Nausea or vomiting: New nausea or vomiting in the second half of pregnancy, particularly when it occurs alongside other warning signs, should be assessed.
- Shortness of breath: New or unexplained difficulty breathing can indicate a serious complication and requires immediate medical attention.
- Sudden weight gain: A rapid increase in weight over a short period may reflect fluid retention, especially if it occurs alongside swelling.
The Mayo Clinic explains that preeclampsia can also be associated with changes in kidney function, liver blood tests, and platelet levels. These changes may be detected through medical testing even when a pregnant person does not notice symptoms.
Can preeclampsia begin without any symptoms?
Yes. Preeclampsia can develop without a noticeable headache, swelling, or other clear warning signs. High blood pressure may be the first finding, while protein in the urine or changes in blood tests can provide additional evidence that the condition is affecting the body. This is one reason regular prenatal appointments are important, even when pregnancy seems to be progressing normally.
Swelling alone does not establish that preeclampsia is present. Swollen feet and ankles are common during pregnancy, particularly later on. However, sudden swelling of the face or hands, or swelling accompanied by a persistent headache or visual changes, needs prompt assessment. A person should not wait for several symptoms to appear before contacting a healthcare professional.
When should you seek medical help?
Contact your obstetrician, midwife, or maternity unit immediately if you develop a persistent or severe headache, visual changes, pain under the ribs, sudden swelling of the face or hands, or new nausea and vomiting that concerns you. Do not wait until your next scheduled prenatal appointment to report these symptoms. Your maternity team can advise where you should be assessed.
Seek emergency medical care for severe difficulty breathing, severe or persistent abdominal pain, a sudden severe headache, significant changes in vision, or other rapidly worsening symptoms. These warning signs may indicate a serious pregnancy-related complication that needs urgent treatment.
The Centers for Disease Control and Prevention (CDC) identifies persistent headaches, vision changes, severe abdominal pain, and breathing difficulties as urgent maternal warning signs during pregnancy and after delivery. Prompt assessment is important even if you have not previously been told that you have high blood pressure.
Can preeclampsia start after childbirth?
Yes. Postpartum preeclampsia can develop after a baby is born, including in people who did not have a preeclampsia diagnosis during pregnancy. It often appears in the first few days after delivery but can develop in the following weeks. Going home after birth does not mean that the risk has completely passed.
After delivery, pay attention to a persistent headache, visual disturbances, upper abdominal pain, sudden facial or hand swelling, nausea or vomiting, and difficulty breathing. These symptoms warrant urgent medical evaluation. The CDC's guidance on high blood pressure during pregnancy also emphasizes that symptoms of postpartum preeclampsia require immediate medical attention, even in someone without a previous diagnosis.
How do healthcare professionals check for preeclampsia?
Assessment usually starts with blood pressure measurement and a review of symptoms, pregnancy history, and when the symptoms began. A healthcare professional may test a urine sample for protein and order blood tests to assess kidney function, liver function, and platelet levels. Depending on the findings and stage of pregnancy, additional checks may be needed to assess the baby's growth and well-being.
According to the NHS, suspected preeclampsia may require hospital assessment and further tests. The results help the maternity team decide what monitoring or treatment is needed. Because the condition can be present without obvious symptoms, routine prenatal checks remain important even when you feel well.
Frequently Asked Questions
Frequently Asked Questions
Common questions about recognizing the first warning signs of preeclampsia and knowing when to seek help.
Can preeclampsia start with just a headache?
A persistent headache can be an early warning sign, but it does not automatically mean preeclampsia is present. Because a continuing or severe headache during pregnancy or after delivery can signal a serious problem, contact your maternity team promptly for assessment.
Is swelling in the feet an early sign of preeclampsia?
Swollen feet and ankles are common during pregnancy and are not enough to identify preeclampsia. Sudden swelling of the face or hands is more concerning, especially when accompanied by a persistent headache, visual changes, or upper abdominal pain. Report new or worrying swelling to your healthcare professional.
At what stage of pregnancy can preeclampsia begin?
Preeclampsia usually develops after 20 weeks of pregnancy, although it can first become apparent after delivery. Since it may begin without noticeable symptoms, regular prenatal blood pressure checks and recommended urine tests are important throughout pregnancy.
Can you develop preeclampsia after giving birth?
Yes. Postpartum preeclampsia can occur in the days or weeks after delivery, even without a previous diagnosis during pregnancy. A persistent headache, vision changes, upper abdominal pain, or difficulty breathing after birth needs urgent medical assessment.