You feel fine.
Your prenatal appointment is completely routine.
Then your midwife takes your blood pressure and pauses.
She takes it again.
"Your blood pressure is higher than I want it to be."
Sometimes that's how the evaluation for preeclampsia begins.
Other times, it's a headache that won't go away. Strange flashing lights in your vision. Pain under your ribs. Sudden swelling in your face or hands.
And sometimes there are no noticeable symptoms at all.
Preeclampsia is one of the reasons seemingly boring prenatal things—blood pressure checks, urine testing, symptom questions and lab work—actually matter.
So let's talk about what preeclampsia is, what we watch for, and what happens when we're concerned about it.
What Is Preeclampsia?
Preeclampsia is a pregnancy-related hypertensive disorder that typically develops after 20 weeks of pregnancy.
Most people associate it with two things:
High blood pressure + protein in the urine.
That's one possible presentation, but it's an incomplete definition.
Preeclampsia can involve high blood pressure along with evidence that other organ systems are being affected—even when significant proteinuria isn't present.
That may include changes involving the:
Kidneys
Liver
Platelets
Brain and nervous system
Lungs
Placenta
This is why diagnosing preeclampsia isn't as simple as dipping someone's urine and looking for protein.
We have to look at the whole picture.
What Blood Pressure Is Considered High During Pregnancy?
A blood pressure of 140/90 mm Hg or higher is abnormal during pregnancy and deserves evaluation.
That doesn't necessarily mean one isolated 140/90 reading equals preeclampsia.
Blood pressure can temporarily rise because of pain, anxiety, activity, an incorrectly sized cuff, talking during the measurement or other factors.
When we get an unexpected elevated reading, we generally want to repeat it correctly and determine whether the elevation persists.
A blood pressure reaching the severe range—160 systolic or 110 diastolic—is different.
Severe-range hypertension requires prompt medical assessment.
Don't wait until tomorrow's prenatal appointment to mention it.
Gestational Hypertension Isn't Exactly the Same as Preeclampsia
This distinction can be confusing.
Gestational hypertension means new high blood pressure developing after 20 weeks without the additional findings required for a diagnosis of preeclampsia.
Preeclampsia involves hypertension plus specific additional clinical or laboratory findings.
But gestational hypertension isn't something we shrug off because "at least it isn't preeclampsia."
Someone with gestational hypertension requires closer monitoring because the condition can progress.
What Causes Preeclampsia?
We don't have one simple answer.
Preeclampsia is closely connected to placental development, maternal blood vessels and the complex relationship between the placenta and the maternal cardiovascular system.
It's not caused because you ate too much salt.
It's not because you didn't drink enough water.
And someone developing preeclampsia does not mean she failed to have a healthy pregnancy.
There are recognized risk factors, but people without obvious risk factors can develop it too.
Who Is at Higher Risk?
Risk factors associated with preeclampsia include:
Previous preeclampsia
Chronic hypertension
Pregestational type 1 or type 2 diabetes
Kidney disease
Autoimmune conditions such as lupus or antiphospholipid syndrome
Multifetal pregnancy
There are also moderate risk factors including first pregnancy, maternal age 35 or older, BMI over 30, family history of preeclampsia, IVF pregnancy and certain previous pregnancy outcomes.
Having a risk factor doesn't mean you will develop preeclampsia.
It means we may monitor differently or discuss preventive strategies earlier in pregnancy.
Can Preeclampsia Be Prevented?
There is no guaranteed way to prevent preeclampsia.
There is, however, an intervention with good evidence for certain higher-risk pregnancies:
Low Dose Aspirin
ACOG and SMFM recommend 81 mg of aspirin daily for pregnant people who meet specific high-risk criteria and recommend or consider it for certain combinations of moderate risk factors.
When indicated, it is generally started between 12 and 28 weeks, ideally before 16 weeks, and continued until delivery.
The important phrase is:
when indicated.
Baby aspirin isn't something every pregnant person should automatically start because they read that it prevents preeclampsia.
Your individual risk factors and contraindications matter.
What About Nutrition, Protein, Hydration and Supplements?
Good nutrition matters enormously during pregnancy.
Adequate protein, micronutrients, hydration and regular movement support overall maternal health.
But we need to be careful about turning that into:
"Eat enough protein and you won't get preeclampsia."
We don't have evidence supporting that promise.
Likewise, beetroot, magnesium, herbs or other supplements should not be presented as established treatments or guaranteed prevention for preeclampsia.
We can absolutely discuss nutrition as part of supporting a healthy pregnancy.
We just shouldn't confuse supporting general health with preventing a serious placental hypertensive disorder.
Warning Signs of Preeclampsia
Some people with preeclampsia have no symptoms.
That's one reason blood pressure is checked at every prenatal visit.
When symptoms do occur, important warning signs can include:
A persistent or severe headache
Vision changes, flashing lights, spots or blurred vision
Pain in the upper abdomen, particularly under the right ribs
Sudden or significant swelling of the face or hands
Shortness of breath
New nausea or vomiting later in pregnancy
A general feeling that something is very wrong
Swollen feet alone aren't diagnostic of preeclampsia.
Pregnancy is exceptionally good at producing swollen feet.
We're interested in the entire clinical picture.
What Happens If My Blood Pressure Is High?
First, we confirm what we're seeing.
That may include repeating your blood pressure after you've been sitting quietly and ensuring the cuff size and positioning are appropriate.
If your blood pressure remains elevated or you have concerning symptoms, additional evaluation may include:
Serial blood pressure measurements
Complete blood count and platelet count
Kidney function testing
Liver enzymes
Urine protein assessment
Fetal assessment
Depending on your blood pressure, symptoms, gestational age and clinical picture, that evaluation may happen in our office or we may send you directly to Labor & Delivery triage.
Sometimes hospital evaluation is simply the fastest and safest way to get serial blood pressures, labs and fetal assessment and determine whether we're actually dealing with preeclampsia.
A referral to triage doesn't necessarily mean:
"You have preeclampsia and you're having a baby today."
It means we need better information.
What Are "Severe Features"?
You may hear providers use the phrase preeclampsia with severe features.
These findings significantly change management.
Severe features can include:
Blood pressure of 160/110 or higher
Significant platelet abnormalities
Impaired liver function
Significant kidney dysfunction
Persistent severe headache or certain neurologic symptoms
Visual disturbances
Pulmonary edema
Persistent severe upper abdominal pain associated with liver involvement
This is no longer something appropriate for routine community monitoring.
It requires hospital based obstetric management.
Does Preeclampsia Mean I Can't Have a Home or Birth Center Birth?
Confirmed preeclampsia changes the risk assessment substantially.
This isn't because hospital birth is somehow morally superior or because you "failed" at having a low risk pregnancy.
It's because preeclampsia can worsen unpredictably and may require resources that simply aren't available in an out of hospital setting.
Those resources can include:
Continuous maternal and fetal surveillance
IV antihypertensive medication
Magnesium sulfate for seizure prevention
Frequent laboratory testing
Immediate obstetric intervention
Neonatal support if early delivery becomes necessary
Good community midwifery includes recognizing when someone's needs have moved beyond what community birth can safely provide.
When Is Delivery Recommended?
Delivery is ultimately the definitive treatment for preeclampsia, although the condition can persist or even first appear postpartum.
For preeclampsia without severe features, current obstetric guidance generally recommends delivery at 37 weeks.
With severe features, delivery is generally recommended at 34 weeks or later once the mother is stabilized, and sometimes earlier if maternal or fetal status requires it.
Before that point, management becomes highly individualized and generally involves hospital-based obstetric and maternal-fetal medicine care.
Wait,You Can Get Preeclampsia AFTER the Baby Is Born?
Yes.
And this is incredibly important.
Preeclampsia does not magically disappear when the placenta comes out.
Postpartum preeclampsia can occur after birth, including in people who had normal blood pressure during pregnancy.
A severe persistent headache, vision changes, shortness of breath, significant upper abdominal pain or markedly elevated blood pressure after birth deserves prompt evaluation.
Don't dismiss concerning symptoms because:
"But I'm not pregnant anymore."
How to Take Your Blood Pressure at Home
If we've asked you to monitor at home, technique matters.
Before taking your blood pressure:
Sit quietly for approximately five minutes.
Keep your back supported.
Place both feet flat on the floor.
Don't cross your legs.
Support your arm so the cuff is approximately at heart level.
Use an appropriately sized upper-arm cuff.
Avoid talking while the machine is measuring.
And write the numbers down.
If you receive an unexpectedly high reading, follow the individualized instructions your care team has given you regarding repeating the measurement and when to call.
At DFW Community Birth & Wellness, we want clients to contact us for readings 140/90 or higher so we can determine the appropriate next step.
A severe-range reading—160 systolic or 110 diastolic or higher—requires prompt medical assessment.
The Bottom Line
Most prenatal blood pressure checks are completely uneventful.
That's exactly what we want.
But checking blood pressure at every visit gives us an opportunity to notice when something changes before a client necessarily feels sick.
Preeclampsia isn't something you can reliably prevent through willpower, perfect nutrition or drinking enough water.
And it isn't something we want families trying to diagnose themselves from a list on the internet.
Know the warning signs.
Come to your prenatal appointments.
Tell us when something feels different.
And if your blood pressure starts changing, we'll take it seriously.
Sometimes the evaluation tells us everything is fine.
Sometimes it tells us we need to watch more closely.
And sometimes good midwifery means recognizing that the safest place for your care has changed.