Beyoncé, Serena Williams, and Kim Kardashian are just a few of the well-known figures who have experienced preeclampsia, a potentially life-threatening form of hypertension, or high blood pressure, that occurs in pregnancy and postpartum. Preeclampsia can cause a range of complications and should always be treated seriously.
Beyond the celebrities who have brought attention to it, preeclampsia and other types of hypertensive disorders of pregnancy, which include a spectrum of diseases from gestational hypertension to a severe form of preeclampsia called HELLP Syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets), are on the rise.
These disorders affect more than twice as many non-Hispanic Black women compared to non-Hispanic White women and are significant contributors to the high rate of maternal mortality (death) in the United States. There were 1,205 deaths in 2021, which translates to 32.9 deaths per 100,000 live births, an increase from 861 deaths, or 23.8 per 100,000 live births, in 2020.
Because preeclampsia can occur postpartum, or after delivery, it can have a long-lasting impact on maternal health. Both the American College of Cardiology and the American Heart Association list it as a major risk factor for cardiovascular disease, even far in the future.
“In the past, the medical community believed preeclampsia to be a disease of pregnancy that would not necessarily affect a patient’s future health,” says Sarah Goldstein, MD, a Yale Medicine cardiologist and a specialist in cardio-obstetrics. “But we now know from many studies that there is a strong association of preeclampsia with a future risk of chronic hypertension, stroke, heart failure, heart attack, and peripheral vascular disease.”
Women who have had preeclampsia are at least twice as likely to have heart disease later in life. Cardiovascular disease was responsible for one in five deaths in women in the U.S.—more than any other cause, including deaths from all types of cancer combined, in 2021.
“We now think of preeclampsia as a red flag or a ‘canary in the coal mine’ type of diagnosis that should be considered an indication for earlier cardiovascular risk factor assessment, which typically may not be pursued until later in life,” Dr. Goldstein says.
Patients diagnosed with preeclampsia would likely benefit from earlier cardiovascular risk factor screening, including cardiometabolic testing, which involves checking cholesterol levels, markers of type 2 diabetes and other diseases, within a year after delivery, she adds.
Below, Yale Medicine physicians talk more about preeclampsia and how it can affect an individual’s health during pregnancy and beyond.
1. What is preeclampsia, and how is it treated?
In addition to high blood pressure, an individual with preeclampsia often also has high levels of protein in their urine (called proteinuria). Preeclampsia affects small blood vessels throughout the body, which can lead to organ malfunction. As a result, the kidneys, which filter out waste products and excess water, allow protein, which should remain in the blood, to leak into the urine. Preeclampsia can also affect the development of the placenta, which can impact fetal growth.
The exact cause of preeclampsia is unknown, but experts believe abnormalities in the development of the placenta are an important factor. This is why delivery is the treatment for preeclampsia.
Symptoms of preeclampsia include persistent headache; vision problems, such as seeing spots or blurry vision; upper abdominal pain; swelling of the face, hands, and feet; decreased urine output; and trouble breathing.
Preeclampsia can occur at any time after 20 weeks of pregnancy, though it is typically diagnosed after 34 weeks and can occur postpartum. The severity of the preeclampsia determines when delivery should occur. Mild preeclampsia requires monitoring the mother’s blood pressure, symptoms, and blood work, as well as the baby’s well-being until delivery, which may be delayed until 37 weeks to allow the baby to grow and develop.
For severe preeclampsia, characterized by very high blood pressure, proteinuria, and kidney, liver, or other organ damage (as detected with bloodwork), a patient may require hospitalization and medications to manage blood pressure and prevent other complications like seizures. Preterm delivery may be necessary for the safety of the mother and baby.
It can be difficult for medical providers to predict which women will develop severe preeclampsia. Last June, the Food and Drug Administration (FDA) approved a blood test that can help, but it is still considered investigational and has not yet been adopted for widespread use, says Annalies Denoble, MD, a Yale Medicine maternal-fetal medicine specialist.
2. How can preeclampsia develop postpartum?
Although delivery often cures preeclampsia, many cases arise or worsen postpartum, Dr. Denoble explains.
“The thought is that there is an abnormal development of the placenta early in pregnancy that causes an inflammatory cascade affecting the blood vessels throughout the body,” Dr. Denoble says. “This may partly explain why some patients develop preeclampsia after their delivery, because even though the placenta is gone, the inflammation it caused remains.”
Even though postpartum preeclampsia is less common, it can still be severe, Dr. Denoble adds. In fact, because a new mother is not being monitored as frequently as she was before delivery, there is a danger that it can develop to a more advanced stage without detection.
3. What can be done to address long-term cardiovascular risks associated with preeclampsia?
Women often don’t realize that having preeclampsia puts them at a higher risk of cardiac health problems later in life. Drs. Denoble and Goldstein hope this is beginning to change.
Some health care institutions, including Yale New Haven Hospital, provide postpartum blood pressure monitoring, education, evaluation, and treatment to women who experienced preeclampsia during pregnancy. Such programs are important in the first year after delivery, Dr. Goldstein says.
A patient living in an area where postpartum programs are not available should talk to their primary care physician, Dr. Goldstein advises.
“Primary care physicians are extremely well-versed in how to screen for cardiovascular risk factors,” she says. “Women should feel empowered to talk to their primary care doctor and say, ‘I had preeclampsia. I learned this is a risk factor for cardiovascular disease. What additional testing is available to better understand my cardiovascular risk, and what can I do to reduce that risk now instead of waiting until the future?’”
It is also reasonable for patients to ask their primary care doctor for a referral to a preventative or general cardiologist or, if available, someone who specializes in cardio-obstetrics to further expand that care, she adds.
But providers also need more education about hypertensive disorders in pregnancy, Dr. Denoble says.
“If you look at all the media attention around maternal deaths related to preeclampsia and other conditions, it's not that patients didn't seek medical care. Often, they sought it multiple times, but their symptoms were dismissed, or the severity of their presentation was underestimated,” she says. “We have to educate providers to quickly recognize and treat women who are pregnant or who have recently delivered when they present with high blood pressure or symptoms of preeclampsia.”
Ideally, underlying medical conditions need to be addressed better prior to pregnancy, she adds.
“If women come into pregnancy with high blood pressure, and especially if it’s unrecognized or untreated, they are more likely to develop complications in pregnancy,” Dr. Denoble says. “We need to think about pregnancy as not just the nine months when a patient is pregnant, but all the time that leads up to that pregnancy, and the medical care and attention needed going into it. And the same is true after delivery.”