Pre-eclempsia testing in London

Certain factors significantly increase the risk of developing pre-eclampsia during pregnancy. High-risk factors include having had pre-eclampsia in a previous pregnancy (15-25% recurrence risk), chronic hypertension, diabetes (type 1 or 2), chronic kidney disease, or autoimmune conditions such as lupus or antiphospholipid syndrome. Women with multiple pregnancies (twins, triplets, or more) are also at elevated risk, as are first-time mothers, women over 40 years old, and those with a family history of pre-eclampsia. A BMI over 35 at the start of pregnancy is another significant risk factor.

According to NHS and NICE guidelines, women with one or more high-risk factors should be offered low-dose aspirin (150mg daily) from 12 weeks of pregnancy to reduce their risk of developing pre-eclampsia. Moderate risk factors include maternal age over 40 or a pregnancy interval of more than 10 years, BMI of 35 or more at first visit, and first pregnancy. If you have two or more moderate risk factors, you may also be advised to take prophylactic aspirin. Discussing your individual risk profile with your midwife or obstetrician early in pregnancy allows for appropriate monitoring and preventive measures to be put in place.

Pre-eclampsia is diagnosed through a combination of blood pressure measurements and urine tests during routine antenatal appointments. A diagnosis is typically made when blood pressure readings are consistently 140/90 mmHg or higher after 20 weeks of pregnancy, accompanied by protein in the urine (proteinuria). Your midwife or doctor will also check for other signs such as swelling, review your symptoms, and may order additional blood tests to assess liver and kidney function, platelet count, and other markers of organ involvement.

Modern diagnostic approaches now include biomarker testing using PlGF (Placental Growth Factor) and sFlt-1 levels to help predict the likelihood of developing pre-eclampsia or assess disease severity. The PlGF/sFlt-1 ratio provides valuable information about placental function and can help clinicians determine whether pre-eclampsia is likely to develop within the next few weeks, allowing for more targeted monitoring and management. If pre-eclampsia is suspected or confirmed, you’ll be monitored more frequently with regular blood pressure checks, urine tests, blood tests, and ultrasound scans to assess your baby’s growth and wellbeing.

Pre-eclampsia can lead to serious complications for both mother and baby if left unmanaged. Maternal complications include eclampsia (seizures), which affects around 1 in 4,000 pregnancies in the UK; HELLP syndrome (a severe form affecting the liver and blood clotting system); stroke; kidney or liver failure; pulmonary oedema (fluid on the lungs); and placental abruption, where the placenta separates from the uterine wall. These complications can be life-threatening and account for pre-eclampsia being one of the leading causes of maternal mortality worldwide, responsible for approximately 10-15% of maternal deaths globally.

For the baby, pre-eclampsia can cause intrauterine growth restriction (IUGR) due to reduced blood flow through the placenta, resulting in a smaller baby with potential long-term health implications. The condition is also a leading cause of preterm birth, as early delivery may be necessary to protect the mother’s health, which can lead to complications associated with prematurity. In severe cases, pre-eclampsia can result in stillbirth. However, with appropriate monitoring, early detection, and timely intervention, most women with pre-eclampsia deliver healthy babies, particularly when the condition is identified and managed properly by experienced healthcare professionals.

The only definitive cure for pre-eclampsia is delivery of the baby and placenta, but management depends on the severity of the condition and how far along you are in your pregnancy. For mild pre-eclampsia detected near term (after 37 weeks), your obstetrician may recommend induction of labour or planned delivery. If diagnosed earlier in pregnancy, the focus shifts to careful monitoring to allow the baby more time to develop whilst keeping the mother safe. This typically involves more frequent antenatal appointments, regular blood pressure monitoring, blood tests to check organ function, urine tests for protein levels, and ultrasound scans to monitor fetal growth and amniotic fluid levels.

Medication may be prescribed to manage symptoms and prevent complications. Antihypertensive medications help control high blood pressure, whilst magnesium sulphate may be given to prevent eclamptic seizures if pre-eclampsia becomes severe. In some cases, corticosteroids are administered to help mature the baby’s lungs if early delivery is anticipated. Women with severe pre-eclampsia typically require hospital admission for close monitoring and may need emergency delivery regardless of gestational age to prevent life-threatening complications. After delivery, blood pressure usually returns to normal within days to weeks, though some women require ongoing monitoring and medication during the postnatal period, as pre-eclampsia can occasionally develop or worsen after birth.

Whilst pre-eclampsia cannot be entirely prevented, evidence-based interventions can significantly reduce the risk in high-risk women. The most effective preventive measure is low-dose aspirin (150mg daily), which NICE recommends for women with high-risk factors, starting from 12 weeks of pregnancy until delivery. Studies show that aspirin can reduce the risk of pre-eclampsia by up to 15-20% in high-risk populations by improving blood flow to the placenta. Women should take aspirin at bedtime for optimal effectiveness, and it’s safe to use throughout pregnancy when prescribed for this purpose.

Beyond aspirin, maintaining a healthy lifestyle can support overall pregnancy health, though it won’t guarantee prevention of pre-eclampsia. This includes attending all scheduled antenatal appointments for regular blood pressure and urine monitoring, maintaining a balanced diet rich in fruits and vegetables, staying physically active within recommended guidelines for pregnancy, and managing pre-existing conditions like diabetes or hypertension before and during pregnancy. Early pregnancy screening and risk assessment allow healthcare providers to identify women who would benefit from increased monitoring and preventive treatment. If you’ve had pre-eclampsia in a previous pregnancy, speak with your GP or obstetrician before conceiving again to discuss personalised prevention strategies and optimal management for future pregnancies.