risks for 2nd pregnancy -- overweight, HELLP w/1st

[expert@preeclampsia.org]

I am hoping someone will be able to offer some advice. I developed pregnancy induced hypertension at 27 weeks with my first child. My highest BP was 170/100 and my left leg swelled significantly more than my right. Was put on bed rest and managed to keep him in (baking) until he was 35w3d. He was born at 4lbs5oz and never spent a minute in NICU. He was released from hospital at 3lbs 5oz. We had an emergency c-section as I had developed HELLP. I never showed protein in my urine during any of the 24hr urine tests. When I got pg with him I was 255lbs, 5ft8inches and did not exercise.

I am now 10weeks pg with #2 - unplanned.. big surprise. I am 40lbs lighter than I was with my first but my BMI is still > 35. I exercise at gym 3-4 times a week and have been doing this for about a year doing elliptical and weights. There will be 3 years and 3 months age difference between the children and I have had no pregnancies in between. I am seeing a high risk perinatal team at UTMB. I have also been taking anti depressants for 6 months and am being treated for hypothyroidism.

So my questions are:
1) Is my risk for pre-eclampsia and HELLP less now that I am fitter and lighter or does it not make a difference?
2) Can I continue to exercise now and when would I need to stop exercising? (I am a wimp and do not over do it at the gym...)
3) I drink 1cup of coffee (made at home) a day. Do I need to eliminate this as well or is it ok to drink it?

Thank you in advance for all your help. I am pretty scared of what the next nine months hold for us.

[expert@preeclampsia.org]

Thank you for your question.

In direct answer to your question, we cannot say definitively that being lighter and fitter will definitely reduce your risk for preeclampsia & HELLP syndrome. The overall rate for recurrence of HELLP syndrome has been described to be between 8-20%. The risk of recurrent preeclampsia of any severity varies depending on issues such as chronic hypertension, history of preeclampsia, presence of underlying chronic diseases (ie diabetes, obesity, autoimmune issues), etc. However, theoretically, controlled weight loss would lessen the likelihood of having those comorbid factors (obesity, diabetes) that are normally associated with increased risk for preeclampsia.

In terms of exercise, recent data published by Sorenson et al, 2003 & Yeo et al, 2001 do seem to indicate that regular exercise, especially done prior to pregnancy up to the 1st 20wks of gestation, does result in a lower risk for devleopment of preeclampsia (in Sorenson's study, up to a 35% reduction in risk).

I applaud you for your current exercise regimen, which sounds very suitable. ACOG does recommend that healthy women without severe contraindications to exertion (ie cardiac or pulmonary disease that restricts exercise tolerance) participate in regular physical activity as often as possible in pregnancy. I myself usually have patients give an honest fitness assessment of themselves when they start in our practice. I usually urge a minimum of 3 sessions/wk at 30min per session of some aerobic, low impact, low trauma activity.
With regular exercise, you'll not only have greater stamina and physical strength, but it may help control your blood pressure and wt gain in pregnancy.

Lastly, in regards to caffeine, there are varying opinions, however, most experts tend to agree that limiting caffeine consumption as much as you can is best. However, moderate levels of caffeine consumption (150mg-300mg/day max) does not appear to have a negative effect on pregnancy.