Preeclampsia is estimated to impact 5–7 % of pregnancies worldwide [1] and is a major cause of complications for pregnant individuals and their infants [2], [3]. Due to the potentially severe and/or fatal sequelae of unrecognized preeclampsia, patients with signs or symptoms (s/s) suggestive of preeclampsia often warrant intensive monitoring. Evaluation and surveillance for suspected preeclampsia imposes a financial burden on the healthcare system [4], [5], and may impart emotional and financial stress on pregnant individuals and their family [6].

Preeclampsia diagnosis is based on evidence of common and non-specific indicators, including hypertension, proteinuria, new-onset cerebral or visual symptoms, impaired liver function, and/or laboratory abnormalities [7], [8], [9]. Diagnostic revisions for preeclampsia over the past decade have increased the reported prevalence of the disease [10]. The systemic symptoms included in the diagnostic criteria may also occur with comorbidities, e.g., hypertension, diabetes, renal disease, and obesity [11]. As the prevalence of these comorbidities is rising in parallel with preeclampsia [4], [12], [13], it is difficult to identify which patients with s/s of suspected preeclampsia will develop the disease based on existing criteria.

In previous studies, 15–26 % of patiens with gestational hypertension ultimately developed preeclampsia [14], [15], suggesting a role for regular blood pressure monitoring during pregnancy [16]. In general, the prevalence of the s/s of suspected preeclampsia, or the costs and outcomes among women with suspected disease who do not ultimately develop preeclampsia, is poorly described. Although preeclampsia diagnostic strategies incorporating angiogenic biomarkers have shown promise in international trials [17], [18], [19], [20], and are incorporated into the definition of preeclampsia in the latest International Society for the Study of Hypertension (ISSHP) guidelines [21], in the US a preeclampsia diagnosis relies on non-specific clinical criteria that contribute to difficulty in risk stratification.

Our purpose was to investigate the prevalence, outcome, clinical characteristics, and healthcare costs of patients with s/s of suspected preeclampsia and/or a preeclampsia diagnosis versus those without s/s, or a diagnosis. Secondary objectives were to stratify findings by race, geographic location, and payer type to identify which patient groups might benefit most from improved preeclampsia risk assessments.