Preeclampsia and Hypertensive Disorders: Recognizing Warning Signs and Understanding the Care Team’s Role

By Birth & Baby University · Last updated: October 2026 · 4 min read

Hypertensive disorders of pregnancy can progress quickly, and warning signs can appear during pregnancy or after birth. Doulas do not diagnose, but they are often the person who hears about a headache or sees swelling first. This article covers what is known, what clinicians do and how to respond.

Key takeaways

• ACOG describes hypertensive disorders as a leading cause of maternal and perinatal mortality worldwide, with preeclampsia complicating an estimated 2 to 8 percent of pregnancies.
• Low-dose aspirin after 12 weeks reduced preeclampsia and related risks in people at high risk, according to the USPSTF. It is prescribed by a clinician.
• Magnesium sulfate more than halved the risk of eclampsia in a Cochrane review, with flushing the main side effect.
• CDC lists severe headache, vision changes, severe belly pain, trouble breathing and extreme swelling among warning signs that need immediate medical care during pregnancy and for up to a year after birth.

What the research says

Scale of the problem

ACOG Practice Bulletin 222 states that hypertensive disorders constitute one of the leading causes of maternal and perinatal mortality worldwide, that preeclampsia complicates an estimated 2 to 8 percent of pregnancies, and that the U.S. rate of preeclampsia rose by 25 percent between 1987 and 2004. The summary available for this article does not include diagnostic criteria or management details, so refer to the full bulletin for those.

Prevention and treatment

The 2021 USPSTF recommendation concludes with moderate certainty that daily low-dose aspirin (81 mg) after 12 weeks substantially reduces preeclampsia, preterm birth, small-for-gestational-age babies and perinatal mortality in people at high risk, and notes that non-Hispanic Black women face higher rates of preeclampsia and worse outcomes. A Cochrane review of magnesium sulfate including six trials with 11,444 women found it more than halved the risk of eclampsia (RR 0.41, 95% CI 0.29 to 0.58), reduced placental abruption, slightly increased cesarean, and caused flushing in 24 percent versus 5 percent. It found no clear difference in outcomes after discharge.

Timing of birth

The HYPITAT trial randomized 756 women with gestational hypertension or mild preeclampsia at 36 to 41 weeks to induction or expectant monitoring. Poor maternal outcome was lower with induction (31 percent versus 44 percent, RR 0.71, 95% CI 0.59 to 0.86), and the authors advised induction beyond 37 weeks for mild hypertensive disease. The trial was open-label (no masking was possible), conducted in the Netherlands, and the primary composite included progression to severe hypertension.

After the birth

A 2025 meta-analysis of four randomized trials with 714 people found that remote postpartum blood pressure monitoring was not superior to standard care for preventing hypertension-related readmission (5.3 percent versus 11.8 percent, not significant) and was associated with more emergency visits. The trials were small and so the result does not mean monitoring is useless, only that benefit was not shown.

Warning signs

The CDC’s Hear Her warning sign list (checked October 2026) includes headache that will not go away or gets worse, changes in vision, dizziness or fainting, extreme swelling of hands or face, trouble breathing, chest pain or a fast heartbeat, severe belly pain that does not go away, and severe nausea and vomiting. It advises seeking medical care immediately for these signs during pregnancy and up to a year after delivery, and to talk with a provider if something feels wrong or you are unsure.

What this means for doulas

• Know the list and share it. Give clients the warning signs in writing in pregnancy and again after birth, and tell them to call their provider or go to emergency care without waiting.
• Do not reassure away symptoms. Avoid “it’s probably normal” for headaches, vision changes, severe pain or breathing trouble.
• Do not measure and interpret blood pressure for diagnosis. Blood pressure assessment and thresholds belong to clinicians. If a client has a home cuff, encourage them to report readings to their provider.
• Support the care plan. Help clients understand why more visits, labs, medications, induction or magnesium may be recommended, and what questions to ask.

Putting the evidence into practice

• Include a one-page warning sign handout in your client packet with the care team’s phone numbers filled in.
• If a client reports symptoms, ask whether they have contacted their provider, and offer to help them call or get transport.
• After hospital discharge, remember that warning signs can appear days or weeks later and ask about them at postpartum visits.
• Offer emotional support for the fear and disruption of a high-risk diagnosis.

The bottom line

Hypertensive disorders are serious, treatable and time sensitive. Doulas serve families by teaching warning signs, encouraging prompt contact with clinicians and supporting the care plan without trying to diagnose or manage it.

This article is for professional education. It is not medical, legal or tax advice. Check the standards of your certifying organization and the rules where you work.

Sources and further reading

• American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin No. 222. Obstetrics & Gynecology 2020. Read the source
• US Preventive Services Task Force. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: US Preventive Services Task Force Recommendation Statement. JAMA 2021. Read the source
• Duley L, et al. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database of Systematic Reviews 2010. Read the source
• Koopmans CM, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet 2009. Read the source
• Zullo F, et al. Postpartum remote blood pressure monitoring and risk of hypertensive-related readmission: systematic review and meta-analysis of randomized controlled trials. Journal of Perinatal Medicine 2025. Read the source
• Centers for Disease Control and Prevention. Urgent Maternal Warning Signs, Hear Her campaign. Web page, read 16 October 2026. Read the source

Recognizing when to escalate to the care team is a core professional skill. See the doula training and mentorship options on the For Doulas page.

More for professionals: the Professionals Blog.