Preeclampsia is defined as new-onset high blood pressure after 20 weeks of pregnancy — systolic 140 or higher, or diastolic 90 or higher — together with either protein in the urine or signs that another organ is being affected. Before 20 weeks, high BP is usually chronic hypertension, not preeclampsia.

The condition starts in the placenta. When the placenta does not implant deeply or its blood vessels do not remodel properly in early pregnancy, it releases signals that cause the mother's blood vessels to tighten and leak. The result is rising BP, protein leaking into the urine, and slowly the brain, liver, kidneys and clotting system come under strain.

Mild preeclampsia is usually managed with close monitoring and timed delivery at or near term. Severe preeclampsia — BP at 160 over 110 or higher, or signs of organ damage — needs hospital admission and urgent treatment. Eclampsia is preeclampsia with seizures and is a life-threatening emergency.

Knowing where you are in your pregnancy week-by-week makes BP changes easier to interpret — see what to expect week by week for the normal arc of antenatal milestones.

Hypertensive disorders of pregnancy are among the top three causes of maternal death in India, alongside haemorrhage and sepsis. Most of these deaths are preventable when BP is checked at every antenatal visit and warning signs are treated as emergencies, not anxieties.

Late antenatal booking — first visit after 20 weeks — is one of the biggest reasons preeclampsia is caught late. Many women across rural and semi-urban India still book only after the baby starts moving, by which time the early window for aspirin prevention has closed.

Access to magnesium sulphate, the cornerstone drug that prevents seizures in severe preeclampsia, has improved through government programmes, but ICU beds for severe cases still vary sharply by city and district. Knowing where the nearest facility with obstetric ICU and blood-bank support is, before the third trimester, is part of safe planning.

• First pregnancy — the immune-system encounter with placental tissue is new, and the risk is roughly two to three times higher than later pregnancies.
• Maternal age above 35, and to a lesser extent below 18.
• Pre-pregnancy obesity (BMI 30 or higher) or significant weight gain before conception.
• Family history of preeclampsia in mother or sister.
• Chronic hypertension, type 1 or 2 diabetes, kidney disease, autoimmune conditions like lupus or antiphospholipid syndrome.
• Prior preeclampsia — risk in the next pregnancy is around one in five and higher if the earlier episode was severe.
• Multiple pregnancy — twins or triplets roughly triple the risk.
• Conception through IVF or other assisted reproductive techniques.
• Long gap between pregnancies (over 10 years) and a new partner for a subsequent pregnancy.

• A severe headache that does not settle with paracetamol and water — especially with high BP at home.
• Vision changes — blurry vision, flashing lights, spots, sensitivity to light or temporary loss of part of the visual field.
• Severe pain in the upper abdomen, especially under the right ribs — this is the liver, not indigestion.
• Sudden swelling of the face, around the eyes or in the hands — distinct from the gradual ankle swelling that is normal in pregnancy.
• A clear drop in your baby's movements compared to the usual daily pattern.
• Difficulty breathing, chest tightness or a feeling that you cannot lie flat.
• Vomiting in the third trimester that is new and severe, especially with any of the above.
• A seizure — call an ambulance immediately and lie the person on their side.

Diagnosis begins with a properly measured blood pressure, taken in a seated, rested position on the correct cuff size, in both arms at the first visit. A single high reading is repeated after 15 minutes — preeclampsia is confirmed when two readings 4 hours apart are both 140 over 90 or higher after 20 weeks.

Urine is checked at every visit with a dipstick for protein. A reading of 1 plus or more is followed up with a spot urine protein-creatinine ratio or a 24-hour urine collection. Significant proteinuria is defined as 300 mg or more in 24 hours, or a protein-creatinine ratio of 0.3 or higher.

Blood tests for severity include a full blood count looking at platelets, liver enzymes (AST, ALT, LDH), kidney function (urea, creatinine), uric acid and a coagulation screen if HELLP is suspected. Falling platelets, rising liver enzymes or rising creatinine push diagnosis from mild to severe.

Fetal assessment includes an ultrasound for growth, amniotic fluid volume and umbilical artery Doppler — see understanding scans, labs and reports for what the numbers on each report mean and which findings need urgent follow-up.

For women at high risk, low-dose aspirin between 75 and 150 milligrams once daily, started ideally between 12 and 16 weeks of pregnancy and continued until around 36 weeks, reduces the risk of early preeclampsia by roughly half. This is supported by ACOG, NICE and FOGSI guidelines.

High risk is defined as one major factor — prior preeclampsia, chronic hypertension, type 1 or 2 diabetes, kidney disease, autoimmune disease — or two or more moderate factors such as first pregnancy, age over 35, BMI 30 or above, family history or a twin pregnancy.

Calcium supplementation of 1.5 to 2 grams a day is recommended where dietary calcium is low, which is common across many Indian diets. It reduces the risk of preeclampsia in low-intake populations and complements existing iron and folic-acid supplementation.

Aspirin should be started only after discussing your history with your obstetrician. It is not a self-prescription drug in pregnancy, even though the dose is small.

Delivery is the only definitive cure, but blood pressure does not always normalise the day the baby is born. BP can stay high or even rise for the first one to two weeks after delivery, and postpartum preeclampsia or eclampsia can occur in women who had completely normal pregnancies.

Most units check BP at days 1, 3 to 5 and again at 1 to 2 weeks postpartum, then at the 6-week postnatal visit. If BP is still high at six weeks, you need referral to a physician — this is no longer pregnancy hypertension.

Warning symptoms continue to count postpartum. A severe headache, vision changes, abdominal pain or seizure in the first six weeks after delivery means going back to hospital, even if you felt fine on the day you were discharged.

Breastfeeding is safe with most antihypertensive medicines used after delivery — labetalol, nifedipine, enalapril and methyldopa among them. Check with your obstetrician before stopping any BP medication on your own.

Women who have had preeclampsia carry a two to four times higher lifetime risk of high blood pressure, heart disease and stroke compared with women whose pregnancies were uncomplicated. The risk is highest in those with early-onset or severe preeclampsia.

This makes annual blood pressure checks, a lipid profile and a fasting blood sugar from around five years postpartum — earlier if you have other risk factors — a standard part of follow-up, not optional. Diet, weight, exercise and not smoking matter more here than in the average population.

If a diagnosis of preeclampsia was given but never discussed in detail, ask your gynaecologist or family physician to record it clearly in your medical history. Future pregnancies and future cardiovascular screening both depend on this single line being written down.

If you previously had gestational diabetes along with preeclampsia, the cardiovascular and type 2 diabetes risks compound — so both need long-term tracking, not just one.

Janani Suraksha Yojana (JSY) provides cash support for institutional delivery in government facilities and is particularly important for women below the poverty line — this matters because severe preeclampsia almost always needs an institutional delivery with IV access, magnesium sulphate and neonatal support.

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) offers a free comprehensive antenatal check on the ninth of every month at participating government health facilities. For women in rural areas without easy private-doctor access, this is the most reliable BP and urine check schedule available — and the place where preeclampsia is most often caught early.

A balanced Indian pregnancy diet supports overall maternal health, but it does not by itself prevent preeclampsia. Iron, folic acid, calcium and protein intake matter; salt restriction alone does not change preeclampsia risk meaningfully.

If you feel your BP readings or warning signs are being brushed aside — "this is normal in pregnancy, don't worry" — push for a written reading and a urine check, and seek a second opinion. Body literacy and persistence save lives here; see when doctors don't listen for practical scripts when you feel dismissed.

Preeclampsia is one of the few pregnancy complications where catching the early signs changes outcomes dramatically. A BP cuff at home from 20 weeks onwards, a dipstick at every antenatal visit and a clear list of warning symptoms taped to the fridge can turn a potential emergency into a planned hospital admission.

If you are in a higher-risk group, ask about aspirin before 16 weeks. If you ever feel unwell with the warning signs above, go to a hospital with obstetric services — not a small clinic — and ask for BP, urine and bloods.

Preeclampsia is serious, but it is also one of the most studied and most treatable parts of pregnancy care. A short admission, the right medicines and timely delivery bring the vast majority of mothers and babies through safely.