When most people hear “preeclampsia,” they immediately associate it with high blood pressure, but what happens when the condition develops without elevated BP? Surprisingly, preeclampsia can occur even when blood pressure readings remain normal, making it harder to detect and more concerning for expectant mothers and their care teams. In these cases, proteinuria (protein in the urine), headaches, swelling, vision changes, and other subtle symptoms may signal a serious issue that requires prompt attention. Understanding this less common variant of preeclampsia is crucial for early detection, accurate diagnosis, and effective management. This guide will help you recognise the signs, explore possible causes, and learn how to protect both mother and baby through every stage of pregnancy.
What Is Preeclampsia without High Blood Pressure?
Preeclampsia is commonly associated with high blood pressure during pregnancy. However, in some rare cases, a person can develop preeclampsia even if their blood pressure remains within normal limits. This is often referred to as preeclampsia without high blood pressure or proteinuria-only preeclampsia. In these cases, other symptoms and clinical markers, such as elevated protein levels in the urine (proteinuria), abnormal liver enzymes, or low platelet count, may signal the condition, even in the absence of elevated blood pressure.
No-High-BP Preeclampsia, Proteinuria-Only Cases
Preeclampsia without high blood pressure means that while blood pressure stays below the diagnostic threshold (140/90 mmHg), other signs of organ dysfunction develop. The most common indicator is proteinuria, excess protein spilling into the urine, caused by impaired kidney function during pregnancy. Other laboratory abnormalities, like elevated liver enzymes or reduced platelets, may also appear. These changes reflect the body’s stress response, even when blood pressure is not elevated.
How Common Is This Variant?
Preeclampsia without hypertension is relatively uncommon compared to traditional preeclampsia. Estimates suggest that it occurs in a small percentage of pregnancies, often leading to delayed diagnosis due to the absence of high blood pressure. However, increased awareness and routine prenatal testing for proteinuria and other lab markers have helped doctors identify these cases earlier.
Is It Serious if Blood Pressure Is Normal?
Yes, even without high blood pressure, preeclampsia can still pose serious risks. The absence of elevated BP does not reduce the potential harm to the mother or baby. If left untreated, it may progress to severe complications, including HELLP syndrome, preterm delivery, and problems with placental function. This is why regular monitoring and early detection are critical, even if blood pressure appears normal.
Signs & Symptoms When Blood Pressure Isn’t Elevated
When preeclampsia develops without high blood pressure, symptoms can be subtle and easily mistaken for normal pregnancy changes. This makes careful monitoring crucial. Pregnant individuals may experience proteinuria, swelling, headaches, vision changes, nausea, or upper abdominal pain, even while their blood pressure readings stay within the normal range. Identifying these non-BP symptoms early is key to managing the condition and protecting both maternal and fetal health.
Proteinuria in Pregnancy Without Hypertension
One of the hallmark signs of preeclampsia without high blood pressure is proteinuria, the presence of excess protein in the urine. Normally, kidneys filter waste while retaining important proteins. But in preeclampsia, this filtration process is impaired, allowing proteins to leak into the urine. Routine prenatal urine tests help identify proteinuria even before any outward symptoms occur. If proteinuria levels reach or exceed 300 mg in a 24-hour urine collection (or show a protein/creatinine ratio above 0.3), this may confirm preeclampsia, even without elevated blood pressure.
Headaches or Nausea Even with Normal BP
Persistent headaches, especially those unrelieved by rest or medication, may signal preeclampsia, even if blood pressure appears normal. These headaches are often due to underlying vascular changes or brain swelling linked to the condition. Nausea or vomiting after mid-pregnancy may also be a warning sign, as liver dysfunction and other systemic changes occur. If headaches or nausea are persistent or severe, medical evaluation is essential, regardless of BP readings.
Other Warning Signs: Swelling, Vision Changes, Pain
Swelling (edema), particularly in the face, hands, and around the eyes, may suggest fluid retention linked to preeclampsia. Vision changes such as blurred vision, flashing lights, or seeing spots are also common warning signs. Right upper abdominal pain (due to liver involvement) and unexplained shortness of breath may further indicate organ stress. These symptoms should prompt immediate medical attention, even when blood pressure is not elevated.
When Can Preeclampsia Occur Without High Blood Pressure?
Though high blood pressure is often the first sign of preeclampsia, this condition can emerge at various stages of pregnancy or postpartum without any BP elevation. Understanding when and how this atypical presentation happens helps patients and doctors stay vigilant for early warning signs beyond routine BP checks.
Early Pregnancy Cases (12–13 Weeks)
While most cases of preeclampsia develop after 20 weeks, rare instances can occur as early as 12–13 weeks. Early-onset cases without high blood pressure may present with elevated proteinuria, abnormal blood work, or organ dysfunction before hypertension appears. These cases often signal a more severe form and require close monitoring due to higher risks for both mother and baby.
Postpartum Onset Without Pre-Birth Hypertension
Some women develop preeclampsia after delivery, a condition known as postpartum preeclampsia, which can occur days or even weeks following childbirth. In some postpartum cases, proteinuria and organ symptoms may arise while blood pressure remains stable, particularly early in its onset. Prompt recognition is critical to prevent serious complications like seizures or organ failure.
First Pregnancy vs Subsequent Pregnancies
Preeclampsia is more likely to occur during a first pregnancy, but it can also develop during subsequent pregnancies, even if previous pregnancies were problem-free. The risk of atypical or no-high-BP presentations can vary based on maternal age, pre-existing conditions, and other risk factors. Women with a history of preeclampsia should remain vigilant for symptoms in all pregnancies.
Diagnosing Preeclampsia with Normal Blood Pressure
Diagnosing preeclampsia without elevated blood pressure requires a careful evaluation of various biomarkers, symptoms, and organ functions. Since high BP is often the primary screening tool, cases without hypertension can easily be missed unless healthcare providers remain alert to other clinical signs.
Proteinuria Tests: How and Why
Proteinuria, or protein in the urine, is one of the earliest markers of preeclampsia, even in the absence of high blood pressure. Routine urine dipstick tests can detect protein levels, but more accurate methods like 24-hour urine collection or spot urine protein-to-creatinine ratio may be used for confirmation. Persistent proteinuria in pregnancy always warrants further investigation, as it indicates kidney stress and possible early preeclampsia.
When Blood Pressure May Still Fluctuate
Even if resting blood pressure remains normal, some patients may experience temporary spikes or fluctuations. Stress, activity, or positional changes can cause BP readings to rise intermittently. Monitoring blood pressure at different times and positions may help capture hidden variability that could indicate an evolving preeclampsia picture.
Other Diagnostic Signs & Lab Markers
Beyond proteinuria and blood pressure, doctors often evaluate liver enzymes, platelet counts, and kidney function to assess preeclampsia. Elevated liver enzymes, low platelets (thrombocytopenia), or impaired kidney function can signal organ involvement. Imaging, fetal monitoring, and Doppler studies may also help assess placental health and rule out other pregnancy complications.
Risk Factors & Potential Causes
While the exact causes of preeclampsia without high blood pressure remain unclear, certain underlying conditions and risk factors increase susceptibility. Understanding these helps both patients and healthcare providers stay vigilant during pregnancy.
Underlying Conditions That Trap It
Conditions like autoimmune diseases (such as lupus), kidney disorders, and metabolic syndromes may predispose individuals to develop proteinuria and other preeclampsia features without a noticeable rise in blood pressure. Genetic predisposition, endothelial dysfunction, and abnormalities in placental development can also contribute to this atypical form.
Can You Prevent Preeclampsia?
Complete prevention may not always be possible, but managing risk factors can lower the chance of developing preeclampsia. Maintaining a healthy weight, managing chronic conditions, following prenatal care guidelines, staying active, and taking prescribed supplements (such as low-dose aspirin for high-risk individuals) are some steps that may reduce risk.
Is There a Connection to Hypertension Later?
Yes, even if preeclampsia presents without high blood pressure during pregnancy, it may increase the mother’s risk of developing chronic hypertension or cardiovascular disease later in life. This makes long-term follow-up and blood pressure monitoring crucial even after delivery, to manage any future cardiovascular risks.
Health Risks for Mother and Baby
Even without elevated blood pressure, preeclampsia poses serious risks to both the mother and the baby. Recognising these risks helps ensure timely intervention and better outcomes.
Is Preeclampsia Dangerous Without BP Rise?
Yes, even in the absence of high blood pressure, preeclampsia can still be dangerous. The condition may still impair kidney and liver function, cause blood clotting issues, and disrupt placental function. Without proper care, this can lead to reduced oxygen and nutrient supply to the fetus, increasing the risk of growth restriction or preterm birth.
Potential Complications (HELLP Syndrome, etc.)
Preeclampsia can sometimes progress to more severe complications like HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count), even without prior hypertension. HELLP can threaten maternal health with liver rupture, bleeding, or organ failure if not promptly managed. Other risks include placental abruption, seizures (eclampsia), and fluid buildup in the lungs.
Long-Term Impact on Maternal Health
Women who experience preeclampsia, even without high blood pressure, face elevated long-term risks for chronic hypertension, kidney disease, and cardiovascular disorders. Continuous postpartum monitoring and regular health assessments are essential to mitigate these risks and ensure ongoing wellness after delivery.
What to Do If You Suspect It
If you notice symptoms of preeclampsia without high blood pressure, it’s critical to take them seriously. Early detection greatly improves outcomes for both mother and baby.
How to Know If You Have Preeclampsia
Pay attention to persistent symptoms like proteinuria, swelling (especially sudden or severe), headaches, vision changes, upper abdominal pain, or nausea. Even if your blood pressure remains normal, these signs may suggest preeclampsia. Regular prenatal appointments and urine tests are essential to identify early warning signals.
Monitoring Protocol During Normal-Tension Preeclampsia
Your healthcare provider may recommend frequent urine protein tests, blood tests (liver enzymes, platelet count), and fetal growth ultrasounds. Non-stress tests or Doppler studies may also be used to assess placental blood flow. In some cases, daily fetal movement counts and home monitoring can supplement in-office care.
When to See Your OB-GYN Immediately
Seek immediate medical attention if you experience severe headaches, vision disturbances (flashing lights, blurry vision), significant swelling, reduced fetal movement, upper abdominal pain, or sudden weight gain. Prompt evaluation ensures early intervention to prevent complications for both you and your baby.
Managing and Treating Normal-BP Preeclampsia
Management of preeclampsia without high blood pressure requires careful balancing between monitoring maternal health and protecting the baby’s development. Because this form can be subtle, close surveillance is critical.
Can It Resolve on Its Own?
In rare cases, mild forms of normal-BP preeclampsia detected early may stabilise temporarily with close monitoring. However, true resolution typically only occurs after delivery. The placenta plays a central role in preeclampsia, and once delivered, most symptoms begin to subside. Ongoing monitoring will ensure that maternal and fetal health remain stable while allowing pregnancy to progress as safely as possible.
Hospital Monitoring and Delivery Protocols
If symptoms worsen or complications arise, hospitalisation may be necessary for close observation of both mother and baby. Your care team will monitor lab markers, urine protein levels, fetal growth, and overall maternal wellbeing. Delivery, often by induction, may be recommended if maternal or fetal risks increase, even if the pregnancy hasn’t reached full term. The timing depends on gestational age, severity of symptoms, and fetal development.
Medication and Postpartum Care
While blood pressure medications may not be required if BP remains normal, some patients may receive medications like corticosteroids to help fetal lung maturity if early delivery is needed. After delivery, ongoing postpartum monitoring ensures resolution of preeclampsia symptoms, as some complications can emerge after birth. Long-term follow-up is important to watch for future hypertension or cardiovascular issues.
Frequently Asked Questions
Here we address some of the most common questions pregnant individuals have about preeclampsia without high blood pressure. These answers can help provide reassurance and clarify confusing aspects of this unique condition.
Can You Have Preeclampsia Without Being Pregnant?
Preeclampsia is a pregnancy-specific condition and does not occur in people who are not pregnant. However, some preeclampsia-like symptoms, such as proteinuria or elevated liver enzymes, can occur with other medical conditions like lupus, kidney disease, or autoimmune disorders. These may sometimes be confused with preeclampsia but require different diagnostic approaches.
Do Symptoms Come and Go?
Yes, in some cases, symptoms like headaches, nausea, or swelling may appear intermittently, especially in mild or early-stage preeclampsia without high blood pressure. However, even if symptoms seem to improve temporarily, the underlying condition may still progress. Continuous monitoring is crucial to ensure both maternal and fetal safety.
Will Baby Be Affected?
If diagnosed and managed early, many babies are born healthy. However, untreated or severe cases can lead to complications such as growth restriction, preterm birth, or placental insufficiency. That’s why early recognition and proactive management greatly improve outcomes for both mother and baby.
Monitoring and Postpartum Care
Even after delivery, preeclampsia without high blood pressure requires ongoing attention to ensure full recovery and reduce long-term risks.
Postpartum Watch for Late-Onset Symptoms
Preeclampsia can sometimes develop after childbirth, known as postpartum preeclampsia. Even if blood pressure was normal during pregnancy, symptoms like proteinuria, headaches, visual changes, and abdominal pain may appear days or weeks after delivery. Regular postpartum checkups and clear communication with your healthcare provider help catch these late-onset issues early.
Long-Term Risk: Develop Hypertension Later?
Women who experience preeclampsia, even without high blood pressure during pregnancy, are at higher risk of developing chronic hypertension, cardiovascular disease, or kidney problems later in life. Lifestyle modifications, including a heart-healthy diet, weight management, and regular exercise, can help lower these risks. Long-term follow-up with a primary care doctor or cardiologist is often recommended.
Tools & Apps to Track Proteinuria and BP
Home monitoring tools can offer peace of mind. Devices that track protein levels in urine and blood pressure can help identify early changes before symptoms worsen. Apps such as the Aspedan Health Checker App can assist in logging results, sharing data with healthcare providers, and staying proactive about your health both during pregnancy and postpartum.