Question about my vital Stats and risks of PE

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julie f
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Re: Question about my vital Stats and risks of PE

Postby julie f » Mon Jun 06, 2011 00:43 am

Lornarose,

I'm so glad that Emma is home and healthy! I haven't been on the Forums in some time but it still seems like, "What are my chances and when..." are the bazillion dollar questions...! I must've asked this question to a dozen doctors and hundreds of women here. If I remember correctly - and I hope a moderator will step in and correct me here if things have changed - is that the earlier your preeclampsia presents in the first pregnancy, the higher the risk of recurrence in a subsequent pregnancy. There are so many things that can factor into this though - was an underlying disorder discovered that can be treated, did risk factors change (significant increase in maternal age for example), etc. I have experienced that there can be no rhyme or reason with this disease, that what happens in one pregnancy may be light years from what happens in another - so in response to your question: "Would there be a chance of getting early onset with my stats?" my non-expert opinion is to say that yes, anything is possible - but that does not necessarily mean that it's probable.

From 100 women, you may find 100 different stories, but here is a bit of my history in case it can be of any help. I was 26 and healthy in my first pregnancy (no underlying disorders and no family history) and was diagnosed preeclampsia at 25 weeks, delivered at 26 weeks. My bp and labs returned to normal within days of delivery, vision loss and facial numbness took much longer. In my second pregnancy, I was on LDA and medication for high cardiac output from weeks 15-30 and at 36 weeks I began to shows signs of heading towards preeclampsia (bp jump, decrease in amniotic fluid, slow down in growth, etc.) and we went ahead and delivered safely before any diagnosis could be made. In my third pregnancy, my bp was actually so low that my doctor would laugh when taking it, and while rechecking... no medication (aside from LDA), and no signs of preeclampsia. I had a scheduled repeat C-section at 38 weeks and 2 days but we all joked that I probably could have gone a lot longer - I never expected such an easy, "normal" pregnancy.

I wish you the very best, please feel free to email me if I can be of any help!
Julie
Zachary 07/22/03-/7/27-03; 26 weeks
Jackson, January '05; 36 weeks
Ellie Jayne, August '09; 38 weeks

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caryn
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Re: Question about my vital Stats and risks of PE

Postby caryn » Mon Jun 06, 2011 00:11 am

Short answer: your risk of recurrence is most tightly pegged to the week in which you developed preeclampsia in your first pregnancy. But it isn't pegged all that well. Most people, regardless of what they do, will get it more mildly and later in subsequent pregnancies if they develop it again. That's because in subsequent pregnancies, your vasculature has already been remodeled somewhat by the first pregnancy and some immunological tolerance for the foreign proteins of a fetus has been established.

That said, some people are unlucky and develop it at the same gestational age, or sooner. Low dose aspirin and weight loss between pregnancies are the only empirically supported prophylaxes, and they are of mild benefit (IIRC population risk drops from 14.7% to 13% in one large aspirin supplementation study in women with a history, for example.)

Here are some links to comments from our Expert medical board on recurrence and on theraputic strategies:
http://www.preeclampsia.org/forum/viewt ... 19&t=21003
...To the best of my knowledge there are no industry standards for assigning specific risks for the individual patient to develop preeclampsia again. They vary according to the author, to the type of preeclampsia under study, and the patient. In general and according to my experience and understanding, the earlier a prior instance of preeclampsia occurred during gestation, and if severe, increases the chance of a patient to have it in a subsequent gestation...


http://www.preeclampsia.org/forum/viewt ... 19&t=18151
...Recurrence risk for PRE is generally considered to be considerable if the prior pregnancy was associated with severe AND early (late second trimester, very early third) disease. A patient presenting at 24 weeks with severe preeclampsia probably has a recurrence risk of approximately 40-50% at most... Consider each pregnancy to be a unique event, consisting of a genetic combination from both parents that are impacted by the mother's health and other soft factors such as nutritional status. She can do something about the latter, and she should. The former is out of her control (her genes and those of her partner). Counting upon the uniqueness of each pregnancy, a potential mother is encouraged to focus upon what she can do to maximize her health (exercise, diet, elimination of obesity, etc.) and then to undertake pregnancy with the medical assistance of a competent provider wherever she may live (an OBGYN that is board certified in OBGYN or subspecialty certified in MFM)...

and one of the most-read links on our forum, "Will It Happen Again?"
http://www.preeclampsia.org/forum/viewt ... f=19&t=331
If patient developes severe preeclampsia before 28 weeks, recurrence
rate in subsequent pregnancy is 60%. One third of those will be
before 28 weeks again.

If she develops severe disease at 28-36 weeks, recurrence rate is
about 40%. One third will be at same gestational age.

Preeclampsia at term, recurrence rate is at 15-20%.

Based on our studies with HELLP, recurrence rate is always <5% even
for those who develop it at <28 weeks. However, these women remain at high risk for preeclampsia.


http://www.preeclampsia.org/forum/viewt ... 19&t=17822
Aspirin may help a few women, we just do not know clearly who they are... Aspirin in meta-analyisis of 35,000 women had a small effect to improve outcome. However the effect is quite small and was not demonstrated in studies of high or low risks groups in the US...

http://www.preeclampsia.org/forum/viewt ... 19&t=33452
Will treatment with Lovenox reduce your risk for preeclampsia and IUGR to that of a woman who has never had preeclampsia? - probably not. You clotting disorder may have worsened your preeclampsia, but it is probably not the complete cause... Lovenox should not be expected to be a magic bullet that makes your pregnancy risk free - but it may make it better. Studies are very limited.

http://www.preeclampsia.org/forum/viewt ... 19&t=26729
Currently, from what I've read, I wouldn't prescribe, or even suggest, heparin outside the confines of a clinical trial. The data around antiphospholipids and pre-eclampsia get weaker over time, not stronger... The bottom line is that, generally, if pre-eclampsia does recur, it will tend to milder and later than last time.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

nov_mum
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Re: Question about my vital Stats and risks of PE

Postby nov_mum » Sun Jun 05, 2011 04:15 am

Your story sounds kinda similar to mine. In my first pregnancy my PE started 33 weeks, admitted at 34 weeks and induced at 35 weeks with a wee boy (who was not IUGR though). It took me about 6-8 weeks to wean of labetalol and nifidepine and my BP had returned to normal 110-120/70-80. My booking BPS are usually around 116/76. My weight was slightly over what I was pre pregnancy but in range of BMI. I got pregnant 7 mths after my first was born as all the research I had read said that closer age gaps meant less chance of PE and less severe. It was a little quicker than planned but we were happy : ) It showed again around 33 weeks but the proteinuria was no where as troublesome, it raised above diagnostic levels but settled (first time around was 600+, 2nd time 50 ish - we use different measurements in NZ but over 30 is diagnostic). BP was 170/115 in first pregnancy, it only got to 150/110 in second. I got to 38 weeks before being induced and had no meds prior to being induced but had to start 4 or 5 days later and only took low dose labetalol for a few weeks.

This time around I will wait and see. I am hoping it won;t show at all and I will get my home birth but I'm not counting any chickens. What I do know is that research suggests that each time it gets less severe and less of an issue so I doubt I will need any meds this time. Good luck with your pregnancy

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riehlism
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Re: Question about my vital Stats and risks of PE

Postby riehlism » Sat Jun 04, 2011 08:22 pm

The stats show, the healthier you are prior to pregnancy outcomes are better. Of course, as you said, preeclampsia does not seem to discriminate. Between the healthiest people and the unhealthiest, it doesn't really care. Your ultimate question, it seems, is how much sooner you can get it. The crappy answer(s) we hate to hear: no one knows and, it depends.

No one knows: statistically, preeclampsia should be less severe in a future pregnancy. Anecdotally, some ladies on this forum (who did nothing different between pregnancies) have noted symptoms that occurred earlier, and more severe. Because a lot of us are active here on this site, many of our plans for #2 involve medication and/or some definite changes between first and second pregnancies. There have been some posters here who became members after a second pregnancy. In a first pregnancy, these ladies either had no preeclampsia, or had late term and mild preeclampsia. Buuut, the second pregnancy was much more complicated, which is why they became members. I haven't seen some of these posters in some time. Actually, I don't think I've seen them since we moved to the new site. But I was very interested in their stories because of how they went against the grain. In short, no one knows.

It depends: Future outcomes depend on lots of factors when looking at research. It seems that in the last few years, more and more providers are recommending some kind of prophylactic interventions vs. trying and crossing our fingers. It seems that some of the published studies look at recurrence rate from the perspective of no prophylaxis. Then again, there is more and more research looking at interventions, like Baby Aspirin. It is looking more and more like women on a prophylactic regimen have milder complications in a future pregnancies. Of course, there are always outliers...but that goes with most studies.

My personal answer to your question: 1) Being really healthy does not guarantee security, unfortunately. 2) No one knows. 3) It depends.

Have you spoken to your provider about #2? If so, how did that go?
Jasmin: Severe PE/HELLP and delivered at 24+6 & PCOS (29) Hubby Bubby, Frank (29)
Baby Blue stopped in to say hello and goodbye on 6/3/10
Baby Lucas was born on 10/13/11, PE and HELLP-free! Thank you baby aspirin and Lovenox
http://www.ehd.org/pregnancy-calendar.php?id=18192

lornarose
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Question about my vital Stats and risks of PE

Postby lornarose » Fri Jun 03, 2011 06:24 pm

Just a quick question. I am 34 years old. I am 8 months post partum. My bp in the 6 weeks post partum period was 110/70 with labetolol, 300mg per day. I stopped meds at 6 weeks pp. My bp is currently 110's/70's, systolic sometimes dipping to 106. I have a BMI of 24 and am very active everyday. I Understand that PE can strike both fit and healthy and less active people, it doesn't really discriminate.I do not take any medication and have no known underlying conditions. My bp is always lower than my DH, who is the healthiest person I know. I haven't made the final decision to ttc again and understand that you are not allowed give medical advice and I need to consult, Gp etc. Experts, in your opinion and vast experience of PE, what are the chances of getting PE much sooner in a subsequent pregnancy. It's not really a question of severity as I had the severe case with off the chart bp's but the critical question is how much sooner could I get it. Would there be a chance of getting early onset with my stats? Thankyou. I know each case is unique but opinions are much appreciated.
Momma to Emma born 34wplus 3 ,October, 2010,due to severe preeclampsia and IUGR.In NICU due to low birth weight and suspected sepsis, home after nearly 4 weeks.


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