How early can preeclampsia start? I have/had certain symptoms early on. Are/were they signs?
Our Admin, Jennifer Hohulin Heiniger, writes:
Preeclampsia as we currently understand it is caused by chemical-proteins released by the placenta. There is a shift in the way the placenta functions that happens around 20 weeks. Before that shift happens, preeclampsia as we understand it cannot happen.
Just like some people walk earlier or later than average, or go through puberty earlier or later than average, some placentas will make the shift earlier than average. But we are talking about days to a week early, not months. Also, sometimes dates may be off. Women diagnosed in week 19 are counted as close enough.
HELLP syndrome is a related condition that follows a different pathway of development. It can occur as early as 16 weeks. Some doctors use the term "preeclampsia" as a general catch-all word for any related condition, and some diagnose preeclampsia along with HELLP even when it is not there on the assumption that you *would* develop PE if you stayed pregnant long enough. So we do sometimes see cases of "preeclampsia" in the 16-20 week range that are really HELLP syndrome.
I went through the research literature and pulled out all the case studies of women developing preeclampsia before 19 weeks. After eliminating those who actually had HELLP, there were 15 cases total. Eight had fetuses with severe genetic abnormalities incompatible with life. Four had severe autoimmune disorders; these were way worse than the run-of-the-mill lupus, etc, we see commonly around here. Three had no known explanation. All were confirmed with kidney biopsy. All resulted in fetal demise. The sample size is so small, we simply do not have enough data to understand why these cases happened.
If one of these women (or one of the early HELLP survivors) is reading this, I am so sorry. When we reassure women that preeclampsia hardly ever happens this early, we are not trying to diminish your experience. What you went through was horrible. I wish we had more answers for you. And someday case number 16 will happen, so while no one should be overly anxious, it is good to be aware.
One of the tricky things about preeclampsia is that many of the symptoms could be preeclampsia but could also be a number of other things. We see women in early pregnancy who have high blood pressure (from unmasked chronic hypertension), and protein in their urine (from preexisting kidney damage), and headaches (from shifting hormones), and swelling (which is common in pregnancy), and upper right quadrant pain (from gallbladder), and, and, and, and it looks like preeclampsia but it's not actually preeclampsia. It is a coincidental cluster of symptoms. It is important to make this distinction, because women with a coincidental cluster of symptoms can go on to have long pregnancies with happy endings. Women with true early-onset preeclampsia do not. Having said that, some of those conditions raise the risk for developing preeclampsia later on, so it is important to keep monitoring closely, but it is probably not preeclampsia that early.