What is the earliest and most reliable clinical manifestation of pre-eclampsia?

• A. Onset of proteinuria.
• B. Elevation of blood pressure.
• C. Excessive weight gain and edema.
• D. Headache and visual disturbances.

Answer: (B)

Elevated blood pressure is the earliest and most reliable clue because it is an objective change that appears first after 20 weeks of gestation as placental problems begin. New-onset hypertension signals the systemic effects of preeclampsia on the maternal vasculature. Edema and rapid weight gain are common in normal pregnancy and are nonspecific; proteinuria may develop as the disease progresses and is not always the first sign. Headache or visual disturbances indicate progression to severe features rather than the initial presentation. So, rising blood pressure is the initial hallmark that clinicians monitor to detect preeclampsia early.