Preparing for pregnancy after preeclampsia

Preeclampsia is a high blood pressure disorder that affects about 5% to 8% of pregnancies in the United States. Preeclampsia is thought to come from abnormal development of the placenta, which is the organ connecting mother and baby to deliver oxygen and nutrients. When the blood vessels supplying the placenta do not develop properly, this can lead to the development of preeclampsia.

Preeclampsia is a serious pregnancy complication that can affect many parts of the body. If left untreated, it can eclampsia, a life-threatening condition characterized by seizures. Preeclampsia is typically diagnosed after 20 weeks of pregnancy, when a woman shows symptoms like:

• High blood pressure
• Protein in the urine
• Swelling in hands or face
• Headaches that won’t go away
• Visual disturbances, like streaks of light
• Pain in the upper abdomen or shoulder
• Chest pains
• Shortness of breath

Preeclampsia creates a high-risk pregnancy, and the only cure is delivering baby. The goal is to get the woman as far along in her pregnancy as possible before the baby must be delivered.

For a woman with mild preeclampsia that doesn’t have severe symptoms, the doctors will try to help her get the baby to 37 weeks in gestational age before delivery. This may include admitting her the hospital, monitoring her blood pressure, ordering blood and urine tests and giving injections of betamethasone, a steroid that helps the baby’s lungs mature. For more severe cases of preeclampsia, the medical team offers similar treatments to get the mother to at least 34 weeks before delivering the baby, unless sooner delivery becomes necessary.

Who’s at risk for preeclampsia?

Women who had preeclampsia during a previous pregnancy are more likely to experience it again than other mothers, especially if preeclampsia happened early in the previous pregnancy.

“The recurrence risk for preeclampsia largely depends on when you develop it,” said Dr. Kyle Mackey, an OBGYN at IU Health. “The overall risk of recurrence is about 15% to 20%, but it’s a different ballgame for someone who has preeclampsia at 40 weeks and four days versus someone who develops it at 26 weeks. The earlier preeclampsia occurs, the more likely it may occur in a subsequent pregnancy.”

Other risk factors for preeclampsia include having:

• High blood pressure or chronic hypertension
• Having a family history of preeclampsia, such as a mother or sister who had it
• Diabetes Type 1 or 2
• Chronic kidney disease or renal disorders
• Pregnancies that are the product of reproductive technology, like in vitro fertilization (IVF)
• Pregnancies that occur before the age of 18 or after the age of 35
• Twin, triplet or other high-order pregnancies
• Obesity (a body mass index of 30 or more)
• More than 10 years between pregnancies
• Socioeconomic challenges, such as having a low income or substance use disorder

A doctor will want to discuss any risk factors you may have when planning your prenatal care.

Preeclampsia in second pregnancies

While you may be more likely to have preeclampsia again if you’ve had it in a past pregnancy, it’s not a guarantee. Some women have a normal pregnancy after experiencing preeclampsia the first time.

If you’ve had preeclampsia before, your doctor will talk with you about plans for your care going forward. Some women who’ve had preeclampsia with severe symptoms or who have a combination of severe chronic illnesses or past HELLP syndrome (a rare, life-threatening pregnancy complication) may need to consider the likelihood of critical problems in future pregnancies. But for most second-time mothers, a history of preeclampsia simply means more proactive monitoring and testing.

“We have very detailed discussions with our patients about all their pregnancies and any complications. We want to identify anything that will put them at risk,” Dr. Mackey said. “For example, if someone had preeclampsia at 36 weeks and had to be induced at 37, we would talk about prevention techniques and medications we use to prevent recurrence. We’d also begin baseline monitoring with blood and urine tests to make sure they don’t have any initial concerns.”

Preventing preeclampsia

While some women experience preeclampsia without any obvious risk factors, there are some ways to reduce the likelihood of developing this complication:

• Low-dose aspirin. The American College of Obstetricians and Gynecologists recommends women with a high risk of preeclampsia start taking daily low-dose aspirin (81 milligrams per day) at about 12 weeks in their pregnancy, continuing until delivery to reduce their risk.
• Weight loss. Even a 10% reduction in body weight for someone with obesity can significantly lower the likelihood of preeclampsia.
• Regular exercise. Exercise can help reduce blood pressure and improve overall health. Regular exercise is recommended throughout most pregnancies.
• Balanced diet. A high intake of fruit, vegetables and healthy fats, like in the Mediterranean diet, has been associated with lower risks for preeclampsia.

While preeclampsia is a pregnancy complication that needs to be carefully considered, it does not mean a woman cannot have healthy subsequent pregnancies. Communicating with your doctor and taking steps toward a healthy lifestyle can help you prevent preeclampsia or manage it successfully throughout additional pregnancies.