Pre-eclampsia

During pregnancy your blood pressure and urine will be checked at every antenatal appointment. This is because a rise in blood pressure or protein in the urine can be the first sign of pre-eclampsia.

Although pre-eclampsia usually presents as high blood pressure (pregnancy-induced hypertension) and protein in the urine (pre-eclamptic toxaemia), it can present in other ways. 

Pre-eclampsia affects mum and baby

Pre-eclampsia can run in families, and affects around 3-5% of pregnancies. Problems usually start towards the end of pregnancy, after around week 28, but can occur earlier. It can also happen after the birth. It is likely to be more severe if it starts earlier in pregnancy.  

Although most cases of pre-eclampsia are mild and cause no trouble, the condition can get worse and be serious for both mother and baby.

It can cause fits (seizures) in the mother, which is called eclampsia. It can also affect the baby's growth. If you develop pre-eclampsia, you will be offered regular ultrasound scans to check your baby's growth and health. 

Pre-eclampsia is life threatening for mother and baby if left untreated. That is why routine antenatal checks are so important to look for pregnancy-induced hypertension and protein in your urine (proteinuria).

Many women with high blood pressure can hope for a vaginal delivery after 37 weeks. But if you have severe pre-eclampsia, it may be necessary to deliver your baby early, possibly by caesarean section.

Risk factors for pre-eclampsia

If you are at higher risk of pre-eclampsia, you should be advised to take 75mg of aspirin a day from 12 weeks of pregnancy until your baby is born to reduce your risk of developing pre-eclampsia.

You are considered higher risk if you have one or more of the following risk factors:

  • this is your first pregnancy
  • you are aged 40 or over
  • your last pregnancy was more than 10 years ago
  • you are very overweight
  • you have a family history of pre-eclampsia
  • you are carrying more than one baby

Your risk of pre-eclampsia is also higher if any of the following apply to you:

  • you had high blood pressure before you became pregnant
  • you had high blood pressure in a previous pregnancy
  • you have chronic kidney disease, diabetes, or a disease that affects the immune system, such as lupus

Symptoms of pre-eclampsia

There are usually no symptoms to warn you that you have hypertension or pre-eclampsia, and often the only way it can be detected is during the routine blood pressure and urine checks made by your midwife.

If you do have pre-eclampsia, you will probably feel well. If you get symptoms, these might include:

  • bad headaches
  • problems with vision, such as blurred vision or lights flashing before your eyes
  • pain just below the ribs
  • vomiting
  • sudden swelling of the face, hands and feet

However, you can have severe pre-eclampsia without any symptoms at all. If you get any of the symptoms listed above, or have any reason to think you have pre-eclampsia, contact your midwife, doctor or the hospital immediately.

Treatment of pre-eclampsia

Women with pre-eclampsia need admission to hospital, and often medicines to lower their high blood pressure. Occasionally, pre-eclampsia is a reason to deliver the baby early – you may be offered induction of labour or a caesarean section.  

Monitoring pre-eclampsia

It is vital to go to all of your antenatal appointments, or to reschedule them if you can't make them, as severe pre-eclampsia can affect both your health and your baby's health.

If left untreated, it can put you at risk of a stroke, impaired kidney and liver function, blood clotting problems, fluid on the lungs, and seizures. Your baby may also be born prematurely or small, or even stillborn.

While the root cause of pre-eclampsia is not known, studies suggest the risk is higher if you are overweight when you become pregnant, so it's a good idea to reach a healthy weight before trying for a baby.

It is also more common if you have high blood pressure before becoming pregnant, or have had pre-eclampsia in a previous pregnancy. If this applies to you, attending regular check-ups to have your blood pressure and urine tested is even more important.

healthtalk.org has videos of women talking about their experiences of pre-eclampsia

Obstetric cholestasis

Itching is common in pregnancy. Usually it's thought to be caused by raised levels of certain chemicals in the blood, such as hormones.

Later on, as your bump grows, the skin of your tummy (abdomen) is stretched and this may also feel itchy.

However, itching can be a symptom of a liver condition called intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC).

ICP needs medical attention. It affects 1 in 140 pregnant women in the UK, around 5,500 a year.

Mild itching

Wearing loose clothes may help prevent itching, as your clothes are less likely to rub against your skin and cause irritation.

You may also want to avoid synthetic materials and opt for natural ones, such as cotton, instead. These are "breathable" and allow the air to circulate close to your skin.

You may find having a cool bath or applying lotion or moisturiser can help soothe the itching.

Some women find that products with strong perfumes can irritate their skin, so you could try using unperfumed lotion or soap.

Mild itching is not usually harmful to you or your baby, but it can sometimes be a sign of a more serious condition, particularly if you notice it more in the evenings or at night.

Let your midwife or doctor know if you are experiencing itching so they can decide whether you need to have any further investigations.

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a potentially serious liver disorder that can develop in pregnancy.

Normally, bile acids flow from your liver to your gut to help you digest food.

In ICP, the bile acids don't flow properly and build up in your body instead. There's no cure for ICP, but it should go once you've had your baby.

ICP seems to run in families, but it can occur even if there is no family history. It is more common in women of South American, Indian and Pakistani origin.

If you have had ICP in a previous pregnancy, you have a high chance of developing it again in a subsequent pregnancy.

Some studies have found that babies whose mothers have ICP have a higher chance of being born prematurely or stillborn.

The most recent research suggests the risk of stillbirth is between 1 and 2 in 100 for those women whose bile acid levels are greater than 40µmol/L.

The risk of stillbirth rises to between 4 and 5 in 100 when the bile acids are 80µmol/L.

Because of the link with stillbirth, you may be offered induction of labour at around 37-38 weeks of pregnancy if you have ICP.

Some specialists might advise earlier induction than this if the condition is severe (defined as bile acids over 40µmol/L).

If you have ICP, you will probably be advised to give birth in hospital under a consultant-led maternity team.

Symptoms of ICP

Symptoms of ICP typically start from around 30 weeks of pregnancy, but it is possible to develop the condition as early as eight weeks.

The main symptom is itching, usually without a rash. The itching is often more noticeable on the hands and feet, but can be all over the body.

For many women with ICP, the itching is unbearable and can be worse at night, preventing sleep. For others, the itching is mild.

Other symptoms can include dark urine, pale bowel movements (poo) and, less commonly, yellowing of the skin and whites of the eyes (jaundice).

Diagnosis and treatment of ICP

ICP is diagnosed by excluding other causes of the itch. Your doctor will probably talk to you about your medical and family history, and order a variety of blood tests.

These will include tests to check your liver function (LFT) and measure your bile acid levels (BA).

Monitoring your condition

If you are diagnosed with ICP, you will have regular liver function tests so your doctor can monitor your condition.

There is no agreed guideline on how often these tests should happen, but the Royal College of Obstetricians and Gynaecologists (RCOG) and the British Liver Trust advise weekly tests.

The UK's largest research group investigating ICP also recommends weekly bile acid measurements. These readings help doctors recommend when your baby should be born.

If your LFTs and bile acids are normal and you continue to have severe itching, the blood tests should be repeated every week or two to keep an eye on them.

Creams and medications for ICP

Creams, such as aqueous cream with menthol, are safe to use in pregnancy and can provide some relief from itching.

There are some medications, such as ursodeoxycholic acid (UDCA), that help reduce bile acids and ease itching.

UDCA is considered safe to take in pregnancy, although it is prescribed on what is known as an "informed consent" basis as it hasn't been properly tested in pregnancy.  

You may also be offered a vitamin K supplement. This is because ICP can affect your absorption of vitamin K, which is important for healthy blood clotting.

Most experts on ICP only prescribe vitamin K if the mother-to-be reports pale stools, has a known blood clotting problem, or has very severe ICP from early in pregnancy.

If you are diagnosed with ICP, your midwife and doctor will discuss your health and your options with you.

Further information

The Royal College of Obstetricians and Gynaecologists (RCOG) has more information about obstetric cholestasis, including what it means for you and your baby, and the treatment that's available. You can also get information from the British Liver Trust.

Hyperemesis gravidarum

Sickness in pregnancy is common. Around 7 out of every 10 pregnant women experience nausea and/or vomiting, and this doesn't just occur in the morning.

For most women, this improves or disappears completely by around week 14, although for some women it can last longer.

Some pregnant women experience excessive nausea and vomiting. They might be sick many times a day and be unable to keep food or drink down, which can have a negative effect on their daily life.

This excessive nausea and vomiting is known as hyperemesis gravidarum (HG), and often needs hospital treatment.

Exactly how many pregnant women get HG is not known as some cases may go unreported, but it's thought to be around 1 in every 100.

If you are being sick frequently and can't keep food down, tell your midwife or doctor, or contact the hospital as soon as possible. There is a risk you may become dehydrated, and your midwife or doctor can make sure you get the right treatment.

Symptoms of hyperemesis gravidarum

HG is much worse than the normal nausea and vomiting of pregnancy ("morning sickness").

Signs and symptoms of HG include:

  • prolonged and severe nausea and vomiting – some women report being sick up to 50 times a day
  • dehydration – not having enough fluids in your body because you can't keep drinks down; if you're drinking less than 500ml a day, you need to seek help
  • ketosis – a serious condition that results in the build-up of acidic chemicals in the blood and urine; ketones are produced when your body breaks down fat, rather than glucose, for energy
  • weight loss
  • low blood pressure (hypotension) when standing

Unlike regular pregnancy sickness, HG may not get better by 14 weeks. It may not clear up completely until the baby is born, although some symptoms may improve at around 20 weeks.

See your GP or midwife if you have severe nausea and vomiting, ideally before you start suffering from dehydration and weight loss.

There are other conditions that can cause nausea and vomiting, and your doctor will need to rule these out first.

See the healthtalk.org website for videos and written interviews of women talking about their experiences of hyperemesis gravidarum and how they coped.

What causes hyperemesis gravidarum?

It's not known what causes HG, or why some women get it and others don't. Some experts believe it is linked to the changing hormones in your body that occur during pregnancy.

There is some evidence that it runs in families, so if you have a mother or sister who has had HG in a pregnancy, you may be more likely to get it yourself.

If you have had HG in a previous pregnancy, you are more likely to get it in your next pregnancy than women who have never had it before, so it's worth planning in advance.

Treating hyperemesis gravidarum

There are medications that can be used in pregnancy, including the first 12 weeks, to help improve the symptoms of HG. These include anti-sickness (anti-emetic) drugs, vitamins (B6 and B12) and steroids, or combinations of these.

Evidence suggests that the earlier you start treatment, the more effective it will be. You may need to try different types of medication until you find what works best for you.

The UK teratology information service has a website called bumps (best use of medicines in pregnancy) where you can find out about the safety of specific medicines in pregnancy.

If your nausea and vomiting cannot be controlled, you may need to be admitted to hospital. This is so doctors can assess your condition and give you the right treatment to protect the health of you and your baby.

Treatment can include intravenous fluids, which are given directly into a vein through a drip. If you have severe vomiting, the anti-sickness drugs may also need to be given via a vein or a muscle.

Will hyperemesis gravidarum harm my baby?

HG is unpleasant with dramatic symptoms, but the good news is it's unlikely to harm your baby, if treated effectively.

However, if it causes you to lose weight during pregnancy, there is an increased risk that your baby may be born smaller than expected (have a low birth weight). 

Other symptoms you may experience

Pregnancy Sickness Support is in touch with many women who have had HG, and who report having some or all of the following symptoms in addition to the main symptoms listed above: 

  • extremely heightened sense of smell
  • excessive saliva production (ptyalism)
  • headaches and constipation from dehydration
  • pressure sores from long periods of time in bed
  • episodes of urinary incontinence as a result of vomiting combined with the pregnancy hormone relaxin

If you experience these symptoms, you are not alone. Many women have them and, although they can be distressing, they will go away when the HG stops or the baby is born.

How you might feel

The nausea and vomiting of HG can have a huge impact on your life at a time when you were expecting to be enjoying pregnancy and looking forward to the birth of your baby.

It can affect you both emotionally and physically. The symptoms not only make your life a misery, but may lead to further health complications, such as depression or tears in your oesophagus.

Severe sickness can be exhausting and stop you doing everyday tasks, such as going to work or even getting out of bed.

In addition to feeling very unwell and tired, you might also feel:

  • anxious about going out or being too far from home in case you need to vomit
  • isolated because you don't know anyone who understands what it's like to have HG
  • confused as to why this is happening to you
  • unsure whether you can cope with the rest of the pregnancy if you continue to feel very ill

If you feel any of these, don't keep it to yourself. Talk to your midwife or doctor, and explain the impact HG is having on your life and how it is making you feel. You could also talk to your partner, family and friends if you want to.

Bear in mind that HG is much worse than regular pregnancy sickness. It is not the result of anything you have or haven't done, and you do need treatment and support.

Another pregnancy

If you have had HG before, it's likely you will get it again in another pregnancy.

If you decide on another pregnancy, it can help to plan ahead, such as arranging child care so you can get plenty of rest.

Think back to what helped you last time – for example, specific drinks – and make sure you implement these measures this time around.

Talk to your doctor about starting medication early.  

Blood clots and hyperemesis gravidarum

Because HG can cause dehydration, there's also an increased risk of having a blood clot (deep vein thrombosis), although this is rare. 

If you are dehydrated and immobile, there is treatment that you can be given to prevent blood clots.

Read more about how to prevent deep vein thrombosis