preeclampsia w/ 3rd pregnancy & BP Question

[aplummer9999]

I developed preeclampsia w/ my 1st & 2nd pregnancies. With my first pregnancy, I did not show signs or symptoms until five months. I was naive about the situation and nothing was ever mentioned about “toxemia” until I was admitted into the hospital on bedrest and ended up with an emergency delivery. My second pregnancy started out with my protein count at 4+. I was sent to see a nephrologist every month, with 24-hour urine collections and blood work every other month. My protein level was about 2700. I didn’t start monitoring my BP w/ my 2nd until the last 3mo. of pregnancy, it was always @ 120/80. I am now pregnant with my 3rd child. At my 12 week visit my protein count was 2+ and my BP is @100/64. My Dr. does not seem concerned and has not recommended the nephrologist again. My question is that with my protein already elevated and climbing, if my BP reaches 120/80, shouldn’t I be alarmed? At what rate should my BP become a red flag to me? THANKS!

[expert on call]

Given that you have proteinuria at the beginning of pregnancy, we can assume that you have proteinuria when you are not pregnant. You have some sort of renal disease that needs careful attention when you are pregnant and when you are not pregnant. Do you know your creatine level or creatinine clearance, (a measure of your renal function)? There are a multitude of diseases that could cause proteinuria such as diabetes, lupus or IgA nephropathy. A few of them respond to treatment with steroids. Some nephrologists will recommend a kidney biopsy to determine the cause. This information occasionally can direct therapy. It can also help know what clinical course the disease will run. Some diseases are worse than others.

Outside pregnancy, blood pressure is treated very aggressively in the case of renal disease, (<130/80). In pregnancy, treatment is much more controversial. At 100/64, you do not need treatment. At 120/80, I would certainly begin to be concerned.

Renal disease is certainly a risk factor for preeclampsia. You have had preeclampsia before - that is also a risk.. You will very probably have preeclampsia again. It only really matters when you get it - hopefully near term, and that you are followed carefully. Your blood pressure and the baby's growth are the most critical things to be concerned about.


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