11 Silent Signs of Preeclampsia Every Woman Should Know

Learning to recognize the subtle warning signs of this serious pregnancy complication could save your baby’s life—and your own.

Rising blood pressure

Preeclampsia is a serious pregnancy complication marked by high blood pressure and problems with the way certain organs, such as the kidneys and liver, are functioning. According to the Preeclampsia Foundation, preeclampsia develops in 5 to 8 percent of all pregnancies—and doctors still aren’t sure why. If not treated, preeclampsia can develop into full-blown eclampsia, which causes seizures and even death (this is what killed poor Sybil on Downtown Abbey). So even though you might not notice your blood pressure going up, it’s important to get it checked at every prenatal visit. “Blood pressure can sometimes increase without any warning,” says Sara Soto, MD, an ob-gyn for the PIH Health Women’s Center in Whittier, CA. “A blood pressure of 140/90 in a person who does not have high blood pressure could be a sign of preeclampsia.” It’s also important to know what’s normal for you—for example, if your blood pressure is usually on the low side but it’s suddenly on the high side of normal, it might not catch the attention of a nurse and may be up to you to point it out. Make sure you know the incredibly scary reason why women die in childbirth every year.

proteinuria urine test

Protein in urine

One of the classic preeclampsia symptoms or preeclampsia signs is protein in the urine—another symptom you’d only be able to detect in the doctor’s office, after peeing on a test strip. “Protein may be in the urine due to ‘leaky’ blood vessels in the kidneys, causing protein from the bloodstream to go into the urine,” says Patricia Pollio, MD, director of ob-gyn at Good Samaritan Hospital, a member of the Westchester Medical Center Health Network, in Suffern, NY. This can happen when blood vessels are constricting due to high blood pressure. But preeclampsia can be diagnosed without protein appearing in the urine—though a 2015 study found that preeclampsia that occurs with protein in the urine is more likely to result in a poor outcome for the pregnancy.

woman speaking on the phone in an office
iStock/Johnny Greig

Decreased urine output

Along with protein, your urine could hold more signs that your kidneys aren’t working properly—another indication of preeclampsia. If you notice that you’re not peeing much, it could be because of the constriction of your blood vessels from rising blood pressure. “When preeclampsia becomes severe a person can start to produce less urine or even stop making urine altogether,” Dr. Soto says. If this happens, call your doctor immediately. Don’t ignore this preeclampsia sign, but you can disregard these 9 pregnancy myths that doctors want you to ignore!

pregnant woman sitting on floor with laundry


Preeclampsia usually occurs in the third trimester—which is when pregnant women are most prone to normal swelling due to fluid retention, according to the American College of Obstetrics & Gynecology. But one of the preeclampsia symptoms can be swelling, so how can you tell the difference? Look to the face. Swelling in the face and hands is more worrisome because swelling of the feet and lower extremities are more common during pregnancy. “Swelling occurs during preeclampsia in part because of the relatively low protein level in the bloodstream, and also due to the leaking of water from the bloodstream into the tissues,” Dr. Pollio says.

pregnant woman with headache

Severe headache

Headaches are also common in pregnancy, so how can you know if yours is one of the preeclampsia signs? If it’s severe and won’t go away, it could be one of the signs of preeclampsia, according to Dr. Soto. A recent study from the Albert Einstein School of Medicine showed that among women who had a “secondary headache” (one that’s a symptom of another condition), 38 percent had preeclampsia—much higher than the five to eight percent of the general population of pregnant women. Other studies have shown that women who have preeclampsia are also prone to migraines, making things even more confusing. With preeclampsia symptoms, “ a headache can occur as a direct result of high blood pressure, or indirectly due to swelling of the brain,” Dr. Pollio says.

pregnant woman with nausea holding glass of water, hand over mouth

Nausea or vomiting

Morning sickness should disappear after the first trimester, so if you all of a sudden have nausea or vomiting in the second or third trimester, chances are it’s caused by something else. A study out of Norway showed that women who had nausea or vomiting in pregnancy had a greater chance of having preeclampsia. “Nausea or vomiting can occur due to stress on the liver from leaky blood vessels,” Dr. Pollio explains. Even so, doctors may write it off as being caused by other things like the flu or gallbladder issues, so make sure your doctor checks your blood pressure and urine for other signs of preeclampsia. Your tastebuds during pregnancy can get pretty strange.

pregnant woman standing on scale

Sudden weight gain

As with puffiness of hands and face, a buildup of fluids in your body can lead to rapid weight gain with preeclampsia. “Sudden weight gain is a function of water retention and swelling,” Dr. Pollio says. Studies have shown that gaining too much weight during pregnancy, especially if you are overweight or obese, is linked to developing preeclampsia. But even if you previously were within the recommended weight gain guidelines, if you’re experiencing sudden gain within a couple of days, or more than two pounds a week, call the doctor.

close-up of brown eye

Changes in vision

Some 25 to 50 percent of preeclamptic patients reported visual symptoms, including blurriness, flashing lights, spots, or light sensitivity. Although these changes resolve after pregnancy, they are among the most serious of preeclampsia symptoms. “Changes in vision occur due to swelling of the optic nerve, a sign of brain swelling,” Dr. Pollio says. This swelling of the brain (cerebral edema) is life-threatening, so “any persistent vision changes should be evaluated by your doctor immediately,” Dr. Soto says. These 9 unexpected beauty changes during pregnancy aren’t something to worry about.

close-up of doctor testing knee reflex with rubber hammer

Unusually strong reflexes

Hyperreflexia, one of the preeclampsia signs, would be difficult to diagnose at home. You know when the doctor tests your reflexes with a rubber hammer? With hyperreflexia, you’d kick him over—or at least have a really strong reflex. “Hyperreflexia occurs due to central nervous system irritability because of brain swelling,” Dr. Pollio says. Unusually strong reflexes could be a precursor to the start of seizures, so your doctors will let you know upon their exam whether immediate action should be taken.

pregnant woman in tank top lying on bed

Shortness of breath and anxiety

Late in pregnancy, it’s typical to feel short of breath as the internal organs get pushed together from the growing baby. But shortness of breath does also make the list for preeclampsia symptoms. “Shortness of breath can occur due to fluid accumulating in the lungs [pulmonary edema], which can also lead to anxiety from poor lung air exchange, and/or low oxygen levels,” Dr. Pollio says. The feeling that “something is wrong” could, in fact, be anxiety over trouble breathing, and shouldn’t be ignored.

pregnant woman sitting on desk in office

Pain in the upper right abdomen

You might think that pain under your ribs is heartburn or soreness from the baby kicking, but it could be one of the preeclampsia signs indicating a problem with your liver. “Constant pain in the right upper side of the abdomen can be a sign of liver swelling in severe forms of preeclampsia,” says Dr. Soto, and it can lead to liver rupture or stroke if not treated. According to the National Institutes of Health, a variant of preeclampsia called HELLP syndrome, marked by pain in the upper right abdomen (where your liver is) and sometimes also shoulder or lower back pain, affects 10 to 20 percent of women with preeclampsia. If you notice this or any of the symptoms listed here, don’t wait to call your doctor—it could mean saving your baby’s life, and your own. Make sure you know these 7 ways you can protect your baby from birth defects before and during your pregnancy.

Medically reviewed by Tia Jackson-Bey, MD, on August 09, 2019

Tina Donvito
Tina Donvito is a writer, editor, and blogger who writes about health and wellness, travel, lifestyle, parenting, and culture. Her work has been published online in The New York Times, The Washington Post, Cosmopolitan, Good Housekeeping, and Parents, among others. Chosen by Riverhead Books and author Elizabeth Gilbert, her writing appears in the anthology Eat Pray Love Made Me Do It: Life Journeys Inspired by the Bestselling Memoir. Tina was previously editor-in-chief of TWIST magazine, a celebrity news title for teen girls with an emphasis on health, body image, beauty, and fashion.