Pregnancy After Preeclampsia

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Catherine O'Connell knows firsthand how quickly a pregnancy can go from textbook to terrifying. O'Connell, of Little Rock, Arkansas, was 35 weeks pregnant with her second child when she developed severe preeclampsia, a disorder of pregnancy characterized by swelling, high blood pressure, and the presence of protein in the urine. After an emergency C-section, her new daughter, Lucy, was in the NICU, while O'Connell continued to struggle with complications of the disease, even requiring dialysis for a short period. Thankfully, both mother and baby made a full recovery.

Having another baby was definitely not on the family's agenda. "My husband was telling everyone that we were done even in the hospital, and they would nod in enthusiastic agreement," says O'Connell. However, fate had other plans, and O'Connell learned she was expecting again. "I was both afraid and overjoyed," says O'Connell, who would go on to have a healthy pregnancy.

For many couples, thoughts of getting pregnant after having dealt with preeclampsia are darkened by worry. Unfortunately, their concerns have a basis in fact. "Women at the highest risk [to have preeclampsia] are women who have had preeclampsia in a prior pregnancy," says Anne Garrett, founder and spokesperson for the Preeclampsia Foundation.

Preeclampsia Reoccurrence Rates

If you've already had preeclampsia, will you have it again in a subsequent pregnancy? "The earlier in pregnancy that preeclampsia occurs and the more severe it is, the more likely that it's going to recur," says Dr. John T. Repke, MD, professor and chairman of the Department of Obstetrics and Gynecology at Penn State Milton S. Hershey Medical Center, and a maternal-fetal medicine specialist. "The reoccurrence rate for somebody that has mild preeclampsia at term is about 15 to 20 percent. At the other end of the spectrum, for somebody who had very severe preeclampsia in the middle trimester, the reoccurrence rate may be in the 60 to 70 percent range."

However, Dr. Repke notes that reoccurrence rates only indicate the chances of having preeclampsia again, not how early or severely it will strike. "[If you had] severe preeclampsia at 24 weeks, that 60 to 70 percent reoccurrence risk doesn't necessarily mean it is 60 to 70 percent likely that you're going to have severe preeclampsia at 24 weeks again. It just means you're probably going to have preeclampsia at some level. It might be just as severe and just as early, it might be more severe and even earlier, or it might be very mild and at term—or you might have a 30 to 40 percent chance of not having it at all."

Other factors increase the chances of preeclampsia reoccurrence. Dr. Repke cites insulin-dependent diabetes, underlying chronic hypertension, and multiple gestation (pregnancy with twins, triplets, or more) as the leading culprits. In addition, conditions such as thrombophilias (blood clotting disorders), autoimmune disorders, and obesity can raise reoccurrence risks.