Ask the expert: What you need to know about postpartum preeclampsia

Postpartum recovery isn’t just about healing from birth—it’s also a critical time for monitoring your health. One often-overlooked but potentially serious condition that can emerge after delivery is postpartum preeclampsia, a complication involving high blood pressure that can develop days or even weeks after giving birth.

To help new parents understand the risks, symptoms, and treatment options, we spoke with two leading experts in maternal health:

• Dr. Olga Rodas, MD, a board-certified OB/GYN and Associate Medical Director at Oula, who is passionate about collaborative, whole-person care during all stages of the reproductive journey.
  
• Dr. Melissa Dennis, MD, MHA, FACOG, Chief Medical Officer at Partum Health, whose extensive experience in both clinical care and healthcare leadership makes her a trusted voice in postpartum wellness.

In this expert Q&A, they break down what postpartum preeclampsia is, how to recognize it, who’s most at risk, and what steps to take if you’re concerned. Whether you’re navigating your own postpartum recovery or supporting a loved one, this guide is here to help you stay informed and empowered.

Cradlewise: What is postpartum preeclampsia, and how is it different from preeclampsia during pregnancy?

Dr. Olga Rodas: Pre-eclampsia is a medical condition that can arise in pregnancy where the blood pressure increases and is usually accompanied with protein in the urine and other signs of organ damage. High blood pressure or hypertension in pregnancy is defined as having a blood pressure with a systolic reading of 140 or greater or a diastolic reading greater than 90. It is similar to preeclampsia, that happens during pregnancy, but it happens after the baby is born.

Cradlewise: What are the common warning signs and symptoms of postpartum preeclampsia?

Dr. Olga Rodas: Symptoms can be very subtle and can sometimes feel like normal postpartum symptoms. Things to watch out for include: headaches that do not improve with rest or tylenol, visual changes like blurry spots or flashing lights, pain in the right upper part of the belly, nausea, vomiting, difficulty breathing, and high blood pressure.

Dr. Melissa Dennis: Often, individuals with postpartum preeclampsia remain asymptomatic unless they have a more severe form of the disease. Warning signs and symptoms include excessive swelling, nausea and vomiting, heartburn, pain or discomfort in the right upper part of the abdomen, headache, visual changes, and seeing “floaters” or spots.

Some of these symptoms can be hard to spot for new parents who are dealing with lack of sleep and recovery from labor and delivery so it’s particularly important to be aware and on the lookout for these symptoms.

Cradlewise: When does postpartum preeclampsia typically develop, and how long can it last?

Dr. Olga Rodas: Maternal blood pressure tends to decrease or get lower after the baby is born. 

Blood pressures will start to increase 3-5 days after delivery. Postpartum preeclampsia is usually seen within the first 48-72 hours but can show up 6 weeks after birth!

According to the American Heart Association, the risk of maternal morbidity and mortality is highest the first week postpartum. Most patients will see their blood pressures return to baseline around 4-6 weeks after birth. Sometimes your health care provider will prescribe medications to lower blood pressures to a normal range to reduce the risk of causing lasting end-organ damage.

Cradlewise: Who is most at risk of developing postpartum preeclampsia?

Dr. Olga Rodas: You are at higher risk for preeclampsia if you have a history of preeclampsia or high blood pressure, if your female relatives had pre-eclampsia or high blood pressure, it is your first baby, you are over the age of 35, you have other medical conditions like kidney disease or diabetes, have a higher BMI, having a history of gestational hypertension.

Black, indigenous and other people of color are also at increased risk due to systemic racism and inequalities in healthcare. This is why it is important to find a provider like Oula that actively addresses this. Postpartum per-eclampsia can happen even if you do not have any of these risk factors.

Dr. Melissa Dennis: While postpartum preeclampsia can happen to anyone giving birth, we do know there are risk factors that place patients at higher risk.

These include a history of chronic hypertension or preeclampsia, diabetes, kidney disease, certain autoimmune disorders, obesity, extremes of age in the reproductive cycle, being pregnant for the first time, African American race, conceiving by In Vitro Fertilization (IVF), and delivering multiples

Cradlewise: How is postpartum preeclampsia diagnosed and treated?

Dr. Melissa Dennis: Postpartum preeclampsia is diagnosed when a postpartum person has high blood pressure. Usually, but not always, they will also have protein in their urine.
When a more severe form of preeclampsia is present, it can be diagnosed by symptoms, such as a headache or abnormalities in bloodwork that check the liver and kidney function.

The treatment for preeclampsia is twofold: bring down the patient’s blood pressure if it is severely elevated and prevent preeclampsia from worsening and becoming eclampsia, where women can have seizures.

To prevent preeclampsia from becoming eclampsia, an IV infusion of Magnesium will be given for up to 24 hours. Magnesium has some very common and unpleasant side effects, such as nausea, fatigue, and flushing. These symptoms are most common when the medication is first started and may not last the entire 24 hours.

Cradlewise: What are the possible complications if postpartum preeclampsia goes untreated, and how can it affect future pregnancies?

Dr. Olga Rodas: Untreated pre-eclampsia can lead to serious complications including seizures, stroke, organ damage, pulmonary edema, cardiomyopathy, and death in very rare cases. Having postpartum pre-eclampsia increases the risk of having high blood pressures or pre-eclampsia in the next pregnancies. IT is a good idea to consult with your health care provider prior to getting pregnant in order to discuss ways to reduce the risk. This may mean more monitoring or blood tests in the next pregnancy.

Dr. Melissa Dennis: Most individuals who develop postpartum preeclampsia do well; however, if postpartum preeclampsia goes untreated, they are at risk of having a stroke or a seizure, so warning signs and symptoms should not be ignored. Whether or not they are treated, they have a greater risk of developing preeclampsia in a subsequent pregnancy and/or chronic hypertension, so appropriate long-term follow-up is crucial.