Ask an Expert: Preeclampsia risk in pregnancy

Q. “I am 40 and am, unexpectedly, expecting for the fourth time. In my last pregnancy seven years ago (same father), I gave birth three and a half weeks early due to preeclampsia. What is my risk of developing it again? Is there anything I can do to minimize my risk?”

Answer from Brian Drake, M.D., F.A.C.O.G., board-certified obstetrician/gynecologist with Rose City Women's Health:

I'm glad you asked. Preeclampsia – a condition that causes high blood pressure and other problems after 20 weeks of pregnancy – can be dangerous for mothers and babies, so it's important to understand your risks and to monitor your blood pressure regularly.

You've mentioned several factors that do put you at higher risk of developing preeclampsia again. These risk factors include:

  • Your history of preeclampsia: Having it once increases the risk of having it again.
  • Your age: Preeclampsia is more common in women who are older than 40 or younger than 18.
  • The amount of time between your last pregnancy and this one: Women who have a prolonged interval between pregnancies have a higher risk of preeclampsia.

In addition, there are other potential risk factors that you didn't mention. If any of these applies to you, it may elevate your risk further:

  • Prior preeclampsia that was severe and/or that developed early in the pregnancy
  • A history of preeclampsia in your mother or sister, or in your husband's mother or sister
  • High blood pressure between pregnancies
  • Other medical problems that can lead to high blood pressure, such as diabetes or polycystic ovary syndrome
  • A high body mass index
  • Small size for your gestational age when you were born

Assuming that only the three risk factors you mentioned apply in your case, and that your prior preeclampsia was moderate, then you probably have about a 25 to 35 percent chance of recurrence. That is higher than a woman with no risk factors, but it still means that there is a three or four times greater chance that you won't have a recurrence. So don't overdo the worrying – but do stay vigilant.

If we had talked before you became pregnant, I would have recommended these steps to minimize your risk of a preeclampsia recurrence:

  • Get medical conditions such as chronic hypertension or diabetes under control before trying to conceive.
  • If your BMI is above average, try to get it down to a normal level through exercise and a healthy diet before you become pregnant (I don't advise trying to lose weight during pregnancy).

Since you are “unexpectedly expecting,” however, the most important thing you can do now is to make sure that your doctor is keenly aware of your history and your risks, and that he or she is monitoring your blood pressure and your overall condition closely. Educate yourself about the signs of preeclampsia, and alert your doctor if you develop any of these symptoms:

  • Bad headaches
  • Visual changes
  • Belly pain
  • Rapid weight gain
  • Swelling of the face and hands
  • Breathing difficulty
  • Decreased urination

Be aware, however, that preeclampsia may not present any symptoms, so be sure to show up for all of your normally scheduled prenatal visits. Your doctor will monitor your blood pressure for any changes, and will check your urine for protein – an indicator that may show up before symptoms develop.

If there are other risk factors involved that put you in a high-risk category – particularly if your prior preeclampsia developed early and was severe – then you might want to talk to your doctor about low-dose aspirin therapy. Some studies suggest that this may reduce risks for women at high risk of recurrent preeclampsia.

On a reassuring note, I hope you'll remember what you've got going for you: First: The odds are in your favor that you probably won't develop preeclampsia again. Second: Most women who do have a recurrence develop only mild cases, late in their pregnancy, and the problem resolves itself after delivery. Third, and most importantly: You're going to have a baby. Congratulations.

January 2010

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