Can You Have Preeclampsia Without High BP?

Preeclampsia almost always involves high blood pressure.

Doctors usually diagnose it when blood pressure rises after 20 weeks of pregnancy. According to the ACOG diagnostic criteria for preeclampsia, they also look for protein in the urine or signs that the kidneys, liver, blood, brain, or other organs may be affected.

So, if your blood pressure is truly normal every time it is checked, typical preeclampsia is less likely.

Still, one normal reading does not always rule out a problem. Blood pressure can change during the day. Symptoms may also appear before a high reading is found.

Preeclampsia can also happen without protein in the urine. This is why doctors do not rely on urine alone.

They look at the full picture, including:

• Blood pressure
• Symptoms
• Urine results
• Blood tests
• The baby’s condition

Call your doctor if you have warning signs such as:

• Severe headache
• Vision changes
• Pain under the right ribs
• Sudden swelling of the face or hands
• Shortness of breath
• Chest pain
• Unusual nausea

If you are unsure whether your symptoms may be related to preeclampsia, you can use the Preeclampsia Symptom Checker to organize what you are feeling before contacting your doctor. It does not replace medical care, especially during pregnancy.

Preeclampsia can feel different for each person.

Some people feel almost normal. Others feel suddenly very unwell.

A preeclampsia headache may feel strong, unusual, or hard to ignore. It may come with blurry vision, flashing lights, floaters, or dark spots.

Pain may also appear in the upper abdomen, especially under the right ribs.

This pain can feel like:

• Pressure
• Burning
• Tightness
• Deep aching

Some people mistake it for heartburn or stomach pain.

Other possible symptoms include:

• Sudden swelling in the face or hands
• Shortness of breath
• Chest discomfort
• Dizziness
• Vomiting after mid-pregnancy
• Peeing less than usual

Mild foot swelling is common in pregnancy.

But sudden swelling, face swelling, or swelling with headache or vision changes should be checked.

Doctors check for preeclampsia by looking at several signs together.

They usually start with blood pressure. If the reading is high or symptoms are concerning, they may repeat the check.

They may also compare it with your earlier pregnancy readings.

A urine test may be done to look for protein. Protein can be a sign that the kidneys are under stress.

But preeclampsia can still be possible without protein in the urine. That is why blood tests may also be needed.

Blood tests can check:

• Platelets
• Kidney function
• Liver enzymes
• Other signs of organ stress

Research on preeclampsia and organ stress also explains why doctors may look beyond urine protein and check several body systems.

Your doctor may also ask about symptoms such as headache, vision changes, upper belly pain, shortness of breath, and swelling.

The baby may be checked too. Doctors may monitor growth, movement, heart rate, or fluid levels.

Do not try to manage possible preeclampsia alone at home.

Call your doctor the same day if symptoms seem concerning. Go to urgent care or labor and delivery triage right away for severe headache, vision changes, chest pain, trouble breathing, confusion, seizure, or severe pain under the ribs.