coagulation problem in pregnancy

[expert@preeclampsia.org]

I have recently discovered that I carry the PAI-1 4G/5G gene mutation, and understand that this can be a risk factor for preeclampsia, thrombosis, and fetal loss. Both my Ob/Gyn and my hematologist are unsure how to go forward with a pregnancy as this coagulation disorder is not widely studied.

In my first pregnancy, we induced at 38 weeks due to rising blood pressure and a couple of positive dipstick readings. I did not do a 24 hour urine sample, so I do not know if I met the diagnostic criteria for PE. My blood pressure returned to normal after the birth of my son, but 6 days later it spiked at 202/115 with no protein in the urine. I remained on antihypertensives until 4 months postpartum.

I am currently a healthy BMI, 31 years old, blood pressure is 110/70, and will be watched very closely by a OB/Gyn who sees a lot of hypertensive pregnancies. I am not currently pregnant, but would like to have one more child.

My question is, the age old -- what are my chances of getting PE again, and how would you manage my next pregnancy based on my history and this PAI-1 4G/5G mutation we've discovered? I've heard everything from, just watch closely, do low dose aspirin, and even daily Lovenox injections.

I would love an expert opinion on this matter since my local doctors are unsure how to proceed.

**Thank you so much for the service you provide to the women of the preeclampsia foundation. The information I have found here has made a huge impact on me and countless others.

[expert@preeclampsia.org]

I am not an expert on PAI-1 but it is my understanding that it is a polymorphism, therefore not rare. It is associated with preeclampsia (1.27x risk per a metaanalysis : Arch Gynecol Obstet 2006 273:322-4) and has also been reported associated with fetal loss. As far as I know we do not screen patients with preeclamsia for this and therefore the issue of treatment in future pregnancies does not come up.