Predisposing/underlying condition

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nov_mum
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Re: Predisposing/underlying condition

Postby nov_mum » Mon May 02, 2011 05:05 pm

That is an interesting way to look at 'Chronic'. I guess I never thought of it that way as it was only in a perinatal context that it was up.

I'm not so sure my bp took all that while to come down really as I was on meds and was told that it is best to gradually reduce them rather than have stop them and havea rebound effect. It is difficult to know if my bp was remaining high but medication was controlling it or if it was relatively normal and the meds were making little difference. Who knows!

I guess if something pops up in the future I will always question if I have had it in the back ground during my pregnancies. I have looked in to auto immune disorders and whiel there are many ofthem and I haven't researched any specifically, as a group I don't meet any criteria except the elevated BP but not sure it counts as it was pregnacy related.

alexa5
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Re: Predisposing/underlying condition

Postby alexa5 » Mon May 02, 2011 09:02 am

In reading your post, one of my first thoughts is that though your bp is fairly normal outside of pregnancy, you could very well be considered "chronic" because of your elevated pressures that took a while to come down (you had mentioned a few months in your post). I only mention that because I didn't consider myself chronic either until someone here told me that elevated pressures that linger a while can put you in the "chronic" category. My pressures are fine now, but if I were to have a second pregnancy I would go into it knowing that bp could very likely become an issue, and that a second pregnancy could also bring hypertension into my life sooner than it otherwise might.

As for other underlying conditions, without the extensive bloodwork it would be really hard to know if you had any of them....as stated above, most people don't have symptoms or know they have those conditions. That all said, many pre-e cases happen to people without underlying conditions.

nov_mum
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Re: Predisposing/underlying condition

Postby nov_mum » Sun May 01, 2011 11:52 pm

Thank you for your replies ladies.

I am not sure if I spill outside of pregnancy as I have never really tested. My first few MW appointments were negative for protein this time around and in my second they were until about 30 weeks. First, around 33 weeks. I am just kind of figured that if my uterus has stretched and my boobs have stretched then perhaps my kidney filter was also suffering from third pregnancy. I will look in to auto immune disorders as I haven't felt any symptoms but something I have written off as pregnancy related could be AI related???

I am thinking any kidney damage would probably show up on KFTs?? Even when I was at the height of my PE my KFT and LFTs were fine aside from the Protein Creatine Ratio. I think we measure it differently here. Under 18 is normal, up to 30 is tolerated in pregnancy. In my first pregnancy I reached over 600 after being admitted at 95. In saying that, my bp of 170/115 also swayed factors. In my second pregnancy my bp got up to 150/105 which was when I got induced but my PCR rose to 50 ish and stayed there. I know I'm testing 1+ for protein and I am thinking it will show up this time at the MW appointment as it is consistently at home. I am thinking she might send me for a spec or perhaps a 24hr urine. I know that they are not too fond of the 24 collections here and in my pregnancy they started me on one only to tell me that it was essentially useless as they knew I had PE and would not induce on that alone and would be guided by my BP anyway. I will talk to her about it.

I really appreciate the feed back.

My friend I mentioned earlier, stated she had LFTs and KFTs that read like a text book but her BP was sky rocketing and she had an emergency section after mag sulphate and other meds were not cutting the mustard. Of course hindsight is a wonderful thing now she has been diagnosed with the condition she has but no doctor would have looked at that. She was a previously well woman who was pregnant with high bp and high protein. No one would suspect an incredibly rare (3 people in NZ have it) heart lung condition. I really don't think I have anything to worry about in comparison but I just wonder about these conditions and if PE will not even exist once we understand the illness and how it comes about. It might be one of those names given to a wide range of disorders that give a cluster of similar symptoms.

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Re: Predisposing/underlying condition

Postby kara » Sun May 01, 2011 10:09 pm

I'm one of those gals who spills protein outside of pregnancy. In pregnancy they would expect me to spill higher amounts of protein, but that's because I havee existing kidney damage. Theoretically, PE doesn't cause permanent organ damage, so they think my kidney issue predated my pregnancy and probably contributed to me getting preeclampsia. Any kidney issues can predispose you to pe. I spill about 300mg outside of pregnancy, but now take meds to control that and protect my future kidney function. if you are spilling at 17 weeks chances are you spill outside pregnancy. Which may mean they may allow you to spill higher amounts before getting concerned. Did they do a 24 hour baseline before pregnancy?

blythe
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Re: Predisposing/underlying condition

Postby blythe » Sun May 01, 2011 06:43 pm

I've heard the same thing you have - that since I've had late-onset mild PE in all three of my pregnancies it's just likely I'll have chronic hypertension when I'm older.

That you're still spilling protein / already spilling protein in this pregnancy worries not-a-doc me just a little, though. From doctor visits I've read about, our Experts seem to like to have women get as healthy as possible before conceiving again. If their bp runs a little high they want that under control, if they're spilling protein they'll want to reduce that spillage to as close to zero as possible, they'll want any autoimmune flares under control, etc. Anything you start out with that's not quite "normal" - especially in the realm of bp, kidneys, autoimmune, clotting disorders - puts you at higher risk of complications. Not guaranteed, just higher risk.

One thing I've seen docs here do is have women like you, already pregnant and already spilling protein, do a baseline 24-hour urine collection, that way you can tell more clearly if / when that spillage increases. I've read explanations that suggest that moms like you have possibly always spilled a little protein from an underlying mild kidney disease / damage that would never give you trouble outside of pregnancy, or that the physical stress of pregnancy "unmasked' the same kind of mild kidney disease / damage in the same way that gaining weight or getting older could "unmask" a disease.

It is possible that your kidneys are still just a little "leaky" from when you first developed PE, but my understanding is that is unlikely. One of our members was spilling 17,000mg (300mg meets the diagnostic criteria for mild PE, 5000mg meets the diagnostic criteria for severe PE) and as far as I know she doesn't spill anything outside of pregnancy.

To respond to one of your specific comments, I believe that quite a few mild autoimmune disorders have no symptoms in everyday life - it could be that they are just very mild, or that pregnancy "unmasks" them in the way pregnancy can unmasks a lot of other health issues. Same with thrombophillas (clotting disorders) though the link between clotting disorders and PE seems to be getting weaker in the research, though many docs will treat them when mom has had very severe early onset.

Sorry for the book-length response! Please keep reading our archives and asking questions!
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH

nov_mum
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Re: Predisposing/underlying condition

Postby nov_mum » Sat Apr 30, 2011 11:02 pm

Thanks for your reply. I know I don't have any chronic HT issues although having PE does place you at higher risk for it in the future I believe. I know I don't have any clotting problems. I must look more in to autoimmune issues but I am generally a well person and aside from the odd cold have hardly ever been ill. I just wondered if there were links to condiions people were unaware they are walking around with.

I think we take quite a relaxed approach to pregnancy and PE here in NZ. Doctors are not that interested unless you are symptomatic and then your MW refers you to the outpatient clinic for OB review. At no time my placental flows were compromised so I feel happy with this approach. As you say, they know very little about this illness anyway. Even the LDA is unproven to be beneficial.

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kerisue
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Re: Predisposing/underlying condition

Postby kerisue » Sat Apr 30, 2011 08:36 pm

Underlying conditions- I think part of the problem is that docs don't totally know what causes preeclampsia so if you are prone to it they'd like to treat any underlying conditions you might have so that you are as healthy as possible going into pregnancy. Some of these underlying conditions might be chronic high blood pressure, auto-immune disease, or thrombophilias. Midwives are great, but if you've had preeclampsia twice, I would def. sugest you consult with a doctor- specifically a maternal fetal medicine specialist. I've heard of women getting PE worse in a subsequent pregnancy and I know personally how devastating this disease can be so it really isn't something you want to take lightly for your health or your baby's. My MFM said, "there is no such thing as mild preeclampsia; only severe preeclampsia, and preeclampsia that is not severe yet." Good luck and I hope this pregnancy remains PE free for you.
Mama to Millie
born June 2010 @ 24 wks. gestation due to my severe PE and CHF
lived 25 days, loved and missed

nov_mum
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Predisposing/underlying condition

Postby nov_mum » Sat Apr 30, 2011 07:11 am

Hi there

After reading a number of posts on this forum I have noticed that when someone has recurrent PE there is an assumption there is an underlying condition. I had it in both previous pregnancies and am pregnant again (17 weeks). I am interested in finding out more about what conditions might be underlying. I haven't got chronic BP issues, my BP returned to normal after a few months from both pregnancies once I weaned from the BP meds I started in pregnancy. In all three pregnancies my BP stayed at 120/70 until approx 33 weeks, when it rose and protein appeared. This time around my BP is still stable, when I pee on urinalysis sticks I get 1+ but I think this may be due to damage in previous pregnancies so they are a bit leaky?? Just my assumptions - I haven't seen a Dr about it.

A friend had PE at the same time I did (we met in a postnatal group) and 8 mths later was diagnosed with an extremely rare heart/lung condition which is threatening her life and impaired her quality of life. I don't think I have anything obvious such as this but it has made me start thinking about if I have an underlying condition. I have been told it is likely PE will show this time around but probably later and more mildly so my MW thinks we might be able to avoid inductions and medical input. I'm optimistic but not preparing for my home birth just yet.

Any advice on underlying conditions or what I could be investigating?


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