Preeclampsia can be a horrifying experience. It can come on suddenly, it can come on strong and it can even happen up to six weeks after childbirth. Preeclampsia is a serious illness and accounts for a significant proportion of infant and maternal mortality.1 If a woman had preeclampsia in her first pregnancy, she might be afraid to get pregnant again. Here’s what she needs to know.

The dangers of preeclampsia

Preeclampsia is a blood pressure disorder occurring only in pregnancy. It can cause complications, including damage to vital organs, specifically the kidney and liver. Because many of its symptoms can be masked by common pregnancy complaints—such as swollen feet, headaches or nausea—a preeclampsia diagnosis is sometimes missed.

Preeclampsia usually begins after the 20th week. Unfortunately, the earlier it begins, the more severe the threat of:

  • preterm delivery
  • low birth weight, due to restricted blood flow through the arteries bringing less oxygen and nutrients to the foetus
  • placental abruption, where the placenta separates from the wall of the uterus causing severe blood loss
  • seizures (eclampsia)

The risk of preeclampsia the next time around

The risk of recurrence generally depends on how serious the preeclampsia was the first time. The rule of thumb is the earlier in the pregnancy the illness develops, the more severe it is—and the more likely a woman is to get it again.2 Up to 20% of women who had preeclampsia will suffer from it in a subsequent pregnancy.

Importantly, 10%–20% of severe preeclampsia cases also develop HELLP3—HELLP is short for hemolysis, elevated liver enzymes and low platelet count. It can cause red blood cells to break down, blood clots to form and acute liver damage. If a woman already had HELLP, the risk of it reappearing in a following pregnancy increases drastically.4

Tips for the next pregnancy

Researchers don’t know why some women get preeclampsia and others don’t. Some risk factors, however, are clear:

  • personal or family history
  • chronic hypertension or other conditions such as kidney disease, lupus or diabetes
  • age (younger than 20 or older than 40)
  • obesity
  • multiple pregnancy
  • having babies less than two years apart or more than 10 years apart
  • an in vitro fertilisation (IVF)-assisted pregnancy

No one can do much about these risk factors, but there are a few simple measures that can help keep a woman safe.

Get checked: If a woman who had preeclampsia plans to have more children, her doctor may first want to examine blood and kidney function, as well as check for clotting abnormalities or possible thromboses, which are correlated with the condition. If she is already pregnant, first-trimester screening can now accurately and non-invasively assess her personal risk of developing preeclampsia.

Start prenatal care right away: The best way to treat preeclampsia is to identify it as early as possible. A healthcare practitioner will likely ask for blood and urine samples to use as a baseline for comparisons throughout the pregnancy. Suspected preeclampsia can be screened with a simple blood test. The results reveal if it can be ruled out for the next four weeks.5

Shape up: Too much extra weight raises blood pressure levels and slows blood through the veins, increasing the risk of clots. As long as her doctor gives the green light for physical exercise, engaging in low-impact activity is important. But she has to be smart about her limitations.

Take charge of diabetes: Before becoming pregnant again, a preeclampsia survivor living with insulin-dependent diabetes must take extra care to help keep it under control. Likewise, all other health conditions should be disclosed and properly supervised.

Medication: In the case of preeclampsia risk, a doctor will probably prescribe a blood-thinning drug in the first trimester to lower blood pressure.6

Dr. med. Stefan Verlohren is specialist obstetrician & gynaecologist
Dr. Stefan Verlohren, Consultant and Senior Lecturer for Maternal–Fetal Medicine of the Charité University Medicine Berlin

Should she do it?

When asked what he would recommend to a woman afraid of reliving preeclampsia, Dr. Stefan Verlohren, Consultant and Senior Lecturer for Maternal–Fetal Medicine of the Charité University Medicine Berlin, said he would encourage her. With the new methods of diagnosis and monitoring, it is now decisively easier to predict the onset of preeclampsia. “We can now tell patients confidently if it will happen again, and later in pregnancy we can use [screening] again to adjust the risk.” The side effect? A reassured patient better able to enjoy her pregnancy.

References

  1. Verlohren, S., Galindo, A., Schlembach, D., Zeisler, H., Herraiz, I., et al. (2010). An automated method for the determination of the sFlt-1/PIGF ratio in the assessment of preeclampsia. Am J Obstet Gynecol. 202(2), 161.e1-161.e11.
  2. Ukah, U.V., Payne, B., Hutcheon, J.A., et al. (2018) Assessment of the fullPIERS Risk Prediction Model in Women With Early-Onset Preeclampsia. Hypertension. <http://hyper.ahajournals.org/content/early/2018/02/09/HYPERTENSIONAHA.117.10318>.
  3. Karakus, S., Bozoklu Akkar, O., Yildiz, C. et al. (2016). Serum levels of ET-1, M30 and angiopoietins-1 and -2 in HELLP syndrome and preeclampsia compared to controls. Arch Gynecol Obstet. 293 (2) 351-359.
  4. Malmström, O., Morken, N.H. (2018) HELLP syndrome, risk factors in first and second pregnancy: a population-based cohort study. AOGS. <http://onlinelibrary.wiley.com/doi/10.1111/aogs.13322/abstract>.
  5. Verlohren, S., Llurba, E., Chantraine, F. (2016). The Sflt-1/PLGF ratio can rule out preeclampsia for up to four weeks in women with suspected preeclampsia: Risk factors, prediction of preeclampsia. Pregnancy Hypertension. 6(3):140-141.
  6. Rolnik, D.L., Wright, D., Poon, L.C.Y., et ail. (2017) ASPRE trial: performance screening for preterm pre-eclampsia. Ultrasound in Obstet Gynecol. 50(4):492-495.

Tags: Patients, Women's Health