Pre-eclampsia: The deadly condition many mothers never see coming

Pre-eclampsia is among the most dangerous complications of pregnancy, yet many women remain unaware of its risks until it strikes. Globally, it affects between two and eight per cent of pregnancies, contributing to an estimated 46,000 maternal deaths and 500,000 infant deaths annually, according to the World Health Organisation.

In Kenya, the picture is equally concerning. Studies show that five to six per cent of expectant women develop pre-eclampsia, making it the second leading cause of maternal death after bleeding.

With a maternal mortality ratio of 355 to 375 deaths per 100,000 live births, hypertensive disorders in pregnancy remain a major challenge to safe motherhood.

“Pre-eclampsia is new-onset of high blood pressure after 20 weeks of pregnancy, usually accompanied by protein in urine or changes in kidney and liver function,” explains Dr Felix Oindi, consultant obstetrician and gynaecologist at Aga Khan University Hospital (AKUH).

“It can cause severe headaches, blurred vision, swelling, and abdominal pain, but sometimes it develops quietly without obvious signs, which is why regular check-ups are so important.”

Dr Sikolia Wanyonyi, consultant obstetrician gynaecologist and foetal medicine specialist at (AKUH), adds that the exact causes remain unclear.

“Researchers suspect factors such as poor nutrition, high body fat and insufficient blood flow to the uterus may play a role,” he says. “Genetic composition can also contribute, meaning the condition may run in families.”

Both mother and baby are at risk. For the mother, uncontrolled pre-eclampsia can lead to seizures, stroke, kidney failure, liver damage or excessive bleeding. “It’s a silent killer,” says Dr Oindi.

“When pressure becomes extremely high, it can rupture a vessel in the brain, leading to stroke or even death.”

For the baby, the condition limits the flow of oxygen and nutrients through the placenta, often resulting in low birth weight, stillbirth, or premature delivery. Pre-eclampsia limits blood flow to the placenta,” explains Dr Wanyonyi.

“This affects the baby’s growth and can lead to life-threatening complications if not detected early.

The condition can affect any expectant mother, but certain women face higher risk. First-time mothers and those with long gaps between pregnancies, more than 10 years, are particularly vulnerable.

Other risk factors include chronic high blood pressure, diabetes, kidney disease, obesity, family history and multiple pregnancies such as twins or triplets.

Dr Oindi adds that there is also a curious link to new sexual partners. “Traditionally, prolonged cohabitation protects against pre-eclampsia,” he says.

“Women are more likely to develop it with a new partner because the body hasn’t built tolerance to their genetic material. Studies, including in Kenya, have shown this pattern.”

The symptoms can vary widely, but doctors urge women to look out for sudden swelling of the face, hands or feet, severe headaches, blurred vision and upper abdominal pain. Some women may experience rapid weight gain or shortness of breath due to fluid retention.

Diagnosis is confirmed through blood pressure measurement, urine tests for protein, and blood tests to assess liver and kidney function.

“Routine antenatal check-ups are essential,” says Dr Wanyonyi. “Most hospitals begin by checking blood pressure before any other procedure, and that can save a life.”

There is no permanent cure for pre-eclampsia except delivery of the baby and placenta. “The disease starts from the placenta,” explains Dr Oindi. “Once it’s removed, the mother begins to recover.”

Inadequate screening

Still, early detection allows doctors to manage symptoms and prolong pregnancy safely. Blood pressure-lowering medication, bed rest and a high-protein diet are common in mild cases.

In more severe cases, doctors may administer drugs to stabilise blood pressure, support kidney and liver function, and give steroids to speed up the baby’s lung development if premature delivery becomes necessary.

“If you’re close to your due date and the baby is mature enough, doctors often prefer to deliver immediately,” adds Dr Wanyonyi. “If the baby isn’t yet ready, we aim to stabilise the mother and support the pregnancy for as long as possible.”

Many women present late to hospital, which delays diagnosis. “We still see cases where expectant mothers skip antenatal visits or only seek care when symptoms become unbearable,” says Dr Oindi. “That delay can be fatal.”

Inadequate screening at smaller facilities also contributes to missed cases. Blood pressure checks and urine tests are not always done consistently, especially in rural areas. Both doctors emphasise prevention through preconception and antenatal care.