Pregnancy After Preeclampsia
How to plan for the next time around
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.
What You Can Do
Norlisa and Gordon Keffer of Lynnwood, Washington, were undergoing infertility treatments when Norlisa was diagnosed with chronic hypertension. Her doctor immediately referred her to a perinatologist, or maternal-fetal medicine specialist, who stabilized Keffer’s blood pressure and followed her during her pregnancy.
Keffer gave birth to full-term twins—Mary Frances and Samuel—with no problems. However, in the month after delivery, she was twice hospitalized with postpartum preeclampsia. Today, both she and her babies are doing well. “I think it’s really important to find the right doctor,” says Keffer, who feels that her perinatologist’s careful monitoring and treatment was essential in getting her through a high-risk pregnancy.
The Keffers have always wanted a large family and plan to try for another baby—or two—soon. They’ve also been to their perinatologist for a preconception visit—a good idea for anyone planning a pregnancy, but doubly important if you’ve had preeclampsia. While there are no treatments available today that can guarantee a preeclampsia-free pregnancy, preconception planning can help you tilt the odds a little more in your favor.
What You Can Expect
Your preconception appointment will include a thorough history of your past pregnancies and other health issues. Your doctor may want to test you for underlying conditions such as hypertension, kidney issues, or autoimmune disorders, although there’s no conclusive, “one-size-fits-all” list of tests. If you do have an underlying condition that could raise your risk of pregnancy complications, your doctor will be working closely with you to get your health under control before you become pregnant again.
Your obstetrician may also refer you to a perinatologist for testing and specialized care. In fact, “if a woman has had a particularly traumatic experience with preeclampsia, such as the loss of a baby, a very early delivery, or a near death experience, we strongly encourage she go straight to a perinatologist,” says Garrett.
For a list of specialists in your area, check the Society for Maternal-Fetal Medicine or the North American Society for the Study of Hypertension in Pregnancy.
Finally, note that it’s important to feel comfortable with your medical team. “I would actually ‘shop around’ if needed,” says Keffer. “If you have that comfort level in your doctor, you’re not going to have to spend as much time thinking, ‘Oh my gosh—what if something goes wrong?’”
Coping with Uncertainty
Although Mada Harpster, of Evergreen, Colorado, had preeclampsia in her first pregnancy, her second was problem-free. Today, Harpster and her husband are planning a third child—but the decision hasn’t been easy. “I am still very nervous about getting preeclampsia again,” says Harpster. “I do have a little less worry in that I know what symptoms to look for, and given my prior history, my obstetrician is also on the lookout.”
Being afraid is a very normal response to a difficult pregnancy, says Garrett. “Educating yourself, finding support, and proactively planning your pregnancy all help to alleviate the fear.” Garrett notes that the Preeclampsia Foundation encourages women and their partners to consider counseling if they are coping with a loss or post-traumatic stress syndrome, as it’s important to address these issues before starting a new pregnancy.
Your Doctor’s Advice
What if you’ve been told not to try again—not by your best girlfriend or your mother-in-law, but by your physician? “I try to avoid counseling someone to get pregnant or not to get pregnant,” says Dr. Repke. “What I try to do, as best I can, is give them an estimate of the risks that are involved, and then help them arrive at a decision that’s right for their family. Because there are some people that are very risk averse—any risk is too great—and there are others that are willing to take sometimes significant risks in the hope that they’ll achieve the outcome they want.”
“Personally, I would get a second and third opinion from a high-risk specialist before believing a doctor’s advice to ‘not try again,’” says Garrett. “Sometimes this comment from doctors is more indicative of their own feelings of competence in handling your case, and sometimes it is entirely valid. To really know, get a few different opinions.”
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