Preeclampsia is a serious pregnancy disorder occurring only during pregnancy. To mark World Preeclampsia Day (May 22), I would like to share some insights on how to make pregnancy after preeclampsia as safe as possible for women and babies.
One of the questions we hear most frequently from women who have experienced preeclampsia is: ‘Is it safe to have another baby?’
To address this, let’s consider the risks associated with preeclampsia before exploring what it means for subsequent pregnancies and births.
The dangers of preeclampsia
Preeclampsia usually begins after the 20th week. Unfortunately, the earlier it begins, the more severe the threat of preterm delivery, low birth weight, placental abruption, and seizures (eclampsia).
The risk of recurrence generally depends on how serious the preeclampsia was the first time. 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 HELLP syndrome – haemolysis, elevated liver enzymes and low platelet count. It can cause red blood cells to break down, blood clots to form and liver dysfunction. If a woman already had HELLP, the risk of it reappearing in a following pregnancy increases drastically.
Tips for the next pregnancy
Some of the risk factors for preeclampsia are well-established: personal or family history; chronic hypertension or other conditions such as kidney disease, lupus erythematosus 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; and in vitro fertilisation (IVF)-assisted pregnancy.
I would like to share a few simple measures that can help assess woman’s risk for preeclampsia.
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 other risks for possible thromboses, which are related 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 within the next four weeks.
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.
Take charge of diabetes: Before becoming pregnant again, a woman who was previously affected by preeclampsia 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 and treated.
New methods of diagnosis and monitoring can help. These technologies allow doctors to say whether preeclampsia will occur again, and to confidently predict the onset of preeclampsia. These tools are helpful to ensuring safe pregnancies and to reassuring women that any risk is being adequately managed.
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.