Can PP hypertension indicate a risk factor for PreE?

[Nevlonniel]

I'm new to the forums, and I wasn't sure where to post this question, so I figured the Misc forum would be the safest bet.

I have been pregnant twice. My first pregnancy was very easy. There was only one visit to my OB/GYN where they said my BP was a little elevated, but nothing to raise any flags. All the visits after that showed normal BP. My second pregnancy was also very easy, and no mention of elevated BP was mentioned at any of my doctor visits.

However, exactly one week after delivering my second baby, I was afflicted (for lack of a better term) with extremely high BP. I had a severe headache, rapid breathing, chest pains and difficulty thinking. At first I thought I was having an anxiety attack, but it wasn't getting any better, so I had to go to the ER (it was a weekend). They gave me medication to lower the BP and ran all sorts of tests. They sent me home with some BP meds (I had to make sure they were safe for breast feeding), stating it was simply post-partum hypertension. Well, apparently the dosage of BP meds they gave me wasn't strong enough, cause all the symptoms came back the next day, but worse. I couldn't even talk on the phone to tell the doctor how I was feeling, so I had to give the phone to my husband to describe my symptoms. Off to the ER again (it was still the weekend), and they gave me a higher dosage of BP meds and ran more tests. They also kept me overnight for observation.

In the course of that weekend, I had blood tests done, MRI, CAT Scan, and Ecocardiogram. I never thought I'd ever see some of those machines in person. Everything came back negative. So, again, they just confirmed it as post-partum hypertension, raised my BP meds, and sent me home. Thankfully, the dosage of BP meds was good this time, and I didn't have anymore surprise episodes.

The post-partum hypertension stuck with me for about 3-4 months. Nearing the end of the 4th month, my general practioner wanted to get me off the BP meds, so I was instructed to slowly taper off the meds. After a week, I was off of them, and my BP was back to normal.

Now that baby #2 is nearing his 1-year birthday, my husband and I have been talking casually, on and off, about maybe having a third (I'm still trying to determine if my sanity can take a third. )

One of my main concerns is the risk of contracting high BP during the pregnancy, and that in itself turning into preeclampsia, due to having gotten post-partum hypertension. I've asked my OB/GYN about this, and she simple said that they would just keep an eye on my BP, and if they saw it getting high they would put me on bed rest.

I guess I'm just trying to find out if anyone here has ever heard of post-partum hypertension that was not associated with preeclampsia, being an indicator for at risk of contracting preeclampsia.

I hope that makes some sense.

[alviarin]

Hi & welcome to the forums.

I'm wondering if perhaps you had post-partum pre-eclampsia? Did they check your urine for protein? My sister-in-law actually developed pre-e after her baby was born, her main symptoms were high BP and edema. Here is a link to another post about high blood pressure postpartum: http://www.preeclampsia.org/forum/viewt ... 49&p=58192

Pre-eclampsia at term has a low re-occurence risk, around 15-20%: http://www.preeclampsia.org/forum/viewt ... f=19&t=331.

On the other hand, there is some thought that lingering hypertension postpartum is pregnancy unmasking a genetic tendency towards chronic hypertension. Chronic hypertensives have roughly a 25% chance of developing super-imposed pre-eclamspia during any given pregnancy. http://www.preeclampsia.org/forum/viewt ... &t=98&p=15

I was diagnosed chronic hypertensive after my second pregnancy. A week after delivery my BP spiked and I was put on meds before it gradually started to come back down over next several weeks. However my BP never quite returned to normal so I'm still on a low dose of BP meds. My maternal grandfather was also a chronic hypertensive though for most of his life. Do you have any hypertension in your family tree?

If you want a second opinion you could always schedule a pre-conception visit with a MFM specializing in high risk pregnancies. https://www.smfm.org/ If you do decide to try again it is always good to have an expert in your corner just in case.

I hope this helped, let us know if you have any more questions!

[Nevlonniel]

Thank you for all the info and links you provided! I'm so glad I found this site!

The doctors at the hospital and my OB/GYN never mentioned it was post-partum pre-eclampsia. I have some recollection of them taking a urine sample and mentioning nothing about protien in the urine, but I'll call my OB/GYN (she should have all the records) and ask her specifically if they did or didn't. Honestly, my memory is fuzzy in regards to that whole ordeal. (Having a baby, coming home to a 2 year old, etc etc, yeah, I was stressed. I think my memory basically stopped retaining info. )

There is some hypertension in my family, yes. My sister has high BP, but we're not sure if that's genetic or due to her kidney problem (one kidney only functions about 25-50%). My mom has hypertension now, but she didn't have it when she was younger. I noticed she got it when she started gaining weight and getting older. Both have to take meds to keep their BP down. They're the only two in my immediate to nest-to-immediate family that I know of that have to take BP meds for hypertension.

The other issue I have, and it's just part of my personality I think, is that I stress easily. And I know stress can be a cause for high BP.

I'm open to having a third baby (for instance, if it happens, it happens), but I want to be sure I'm informed and educated. I'll be honest, the idea of contracting pre-eclampsia while pregnant scares the bejeebus out of me, and that in itself stresses me out. I try not to think about it, but it's always there, lingering in the back of my mind, it's little beady eyes peering at me from the shadows.

[blythe]

Search our archives for "white coat" hypertension, and "stress" as it relates to PE and hypertension. In general our experts have said that bp that goes too high with "stress" isn't a reflection of personality trait, it's a sign that the mechanism that controls your bp is broken to some extent - which may be a risk factor for PE, and at least a reason to watch you closer in subsequent pregnancies.

Alviarin gave you lots of great info, and I'll second the MFM consult recommendation!

Please feel free to ask more questions! I know I felt tons better in my subsequent pregnancies just because I felt like I knew what was happening and what to expect.

[alexa5]

Definitely agree with the above. I don't have a stress reaction to bp, but I do get white coat hypertension easily, and have for years. I did develop pre-e in my pregnancy, and had elevated bp postpartum for several months. I was fortunate enough to get off meds and that my bp normalized below my prior typical bp, but I know that all of these things along with my dad's cardiac history definitely indicate I am at risk.

I chose not to try for another child because I am good with one, but also partly because I have a strong feeling a second pregnancy would cause hypertension/require meds for the long term. I could deal with a bit of preeclampsia, as that feels temporary and can be monitored, but I just felt lucky to get out of the first pregnancy okay, and I am not sure that my body would like the second one very much. I don't know that, just my gut feeling based on my risk factors.

But that said, that is not the case for everyone, and you could very easily have a great pregnancy! I just understand how you feel.... But your doctors can definitely keep a close eye on you, so that is piece of mind.

[Nevlonniel]

Thank you all for the encouragement! It really does help to be able to talk about this kind of thing with others that know what I'm talking about!

At my last annual with my OB/Gyn, I asked her what were to happen if I were to get hypertension with a third pregnancy. Her answer was simply to put me on bed rest and monitor me. While that's all well and good, I've read in too many cases where that is a blanket answer Ob/Gyn's give. I don't want just a blanket answer, I want answers that might explain what's happening and answers to help prevent such an episode of hypertension. She just smiled and nodded her head at my response, but I think she just did that to appease me.

I'm actually going to go see a new OB/Gyn. I feel it's time to get a second opinion. (Also, in unrelated news, my cycle has returned, but it's all sorts of weird. It came back when my now 1-year-old basically stopped nursing (at the end of April), and I've had about three cycles, but no ovulation. And the cycles have been regular (29-32 days). (I don't take birth control, opting to chart naturally. I like to avoid taking medication unless I really really need it.) The reason for a new OB/Gyn is because my current one doesn't really "believe" in charting, and I can't work without that kind of support. The new OB/Gyn (who happens to be a part of my family) does support and encourage charting. So, through him I'll be figuring out what's wrong with my cycle, if anything.)

I'll have to get copies of all my charts from my current OB/Gyn to give to my new one so we can start looking into the hypertension and possible PreE. I'm also going to ask him for referrals to any MFM that I can consult with.

I want to be sure all my bases are covered and I have a good support system. If I decide for a third pregnancy, assuming I'm not too high at risk, I want to be sure I am educated enough to know what I'm getting myself into.

[alexa5]

I know that docs differ in their approaches, but if my doctor told me that the moment I developed hypertension in a pregnancy that he would put me on bedrest, I would be skeptical too. Generally some docs might do that further along in the pregnancy if the patient is having other issues too, but many pregnant women do fine with the actual hypertension for a while, and bedrest isn't proven to help with that.

In my pregnancy I developed high bp at 28 weeks, but my doc didn't panic, he just kept monitoring me for other preeclampsia indicators (that I didn't have yet), and honestly my bp was about the same laying down as it was standing up, so it wouldn't have done a thing. At 33 weeks I finally had protein in my urine and based on my high bp they did decide to induce, but I appreciate that he handled it well, didn't panic, and didn't put me on bedrest needlessly.

[alviarin]

My periods were wonky before I was diagnosed with (& medicated for) hypothyroidism. I was pretty sure I wasn't ovulating as well. Hopefully though your body is just taking some time to return to normal after weaning.

Good luck finding a doc you are more comfortable with.

[Nevlonniel]

Well, I went to go see the new OB/Gyn, from here on referred to as Dr. #2. In short:

I explained to him about my post-partum hypertension. While it's something he would look out for if he were to treat me while I was pregnant, he wasn't terribly concerned about it (there were no protiens in any urine tests during and after pregnancy, with either pregnancy). I have no immediate family, or any family that I'm aware of, that has hypertension. My sister has high BP, due to a kidney problem. My kindey's are fine. My mom has high BP due to age/weight. I'm at a healthy weight and not terribly old (34).

He believes the PP hypertension I experienced was due to the extreme edema I had after my second pregnancy (I also had extreme edema after my first pregnancy, but the only thing it affected were my arms. I have carpal tunnel issues, and the over-abundance of fluids had closed up all my nerve tubes, making my arms go numb up to my elbow. This was during the third week PP.) Bottom line, my body will not get rid of the excess fluids naturally --I'm not much of a sweater--, so it is determined at this point that I need assistance in the form of latex and/or steroids.

He was actually a little perplexed as to why my current OB/Gyn, referred from here as Dr. #1, didn't prescribe latex after my second pregnancy since I experienced extreme edema that just wasn't going away after my first pregnancy. He said he would have.

(Note: I had no visibly noticeable edema during pregnancy. Maybe a bit poofy here or there on the ankles, but nothing serious. And certainly nothing with discomfort. After both pregnancies, oy! That was some very uncomfortable swelling all the way up to my thighs! And affecting my arms, no less!)

So, basically, Dr. #2 said he would watch but not worry about hypertension during pregnancy. Dr. #1 also said the same thing.

As for the cycles being normal lengths, and menstrual cycles being normal length and flow, but no ovulation, Dr. #2 did an ultrasound on day 12 of my cycle (follicles looked healthy, no PCOS suspected, right side had a follicle of 12mm and left side had a follicle of 14.5mm). He ordered a blood test for progesterone levels for day 21. Dr. #1 also ordered a blood test for progesterone levels on day 21, along with FSH levels and thyroid check.

On day 19, I got VERY distinct Mittelschmerz coming from my left side. Seriously unmistakable. The ovulation test sticks also said I was ovulating, or at least had a high enough LH surge that was detectable. The sticks also gave a positive LH surge on day 20. On day 21 it went back to negative.

Day 21 came and I went into the lab.

Dr. #2 called me today to give me the results from the lab. My progesterone level was a 2.4 (normal is 10-12). So, yeah, horribly low. He also said that even though I felt the Mittelschmerz (follicle bursting) and the ovulation tests gave a positive result (LH surge), that doesn't necessarily mean I ovulated. He pretty much said it was probably due to age (I wasn't aware 34 was considered "old", but he explained any pregnancy that results in childbirth at the age of 35 is considered mature maternal age... in other words, old. ). It could be "fixed" with Clomid, but I told him I wasn't trying to get pregnant... I just wanted to figure out where my cycle was at (I'm also wary of Clomid raising the chances of having twins up to 5%... not to mention being a bit freaked out about possible birth defects due to ageing "womanly parts".) He doesn't suspect anything else, so he won't be running anymore tests from what I discerned while talking with him.

Still waiting to hear back from Dr. #1 about progesterone, FSH, and thyroid. Hopefully I'll get those results tomorrow.

I'm thinking of maybe getting some natural progesterone creams. I used to use some when I was younger (got them at a vitamin shop). But I just don't know if it'll help with the issue I'm having or not.

I guess I just don't know where to go from here. I honestly didn't think I'd have to think myself as old and rundown at 34. And 'd been considering having a third baby, but now it looks like my body is making the decision for me rather than letting me choose.


(Sorry. I totally rambled. I guess this whole thing has really shaken me up. )

[alviarin]

Sorry you are dealing with this. Aside from thyroid problems, I don't know much about female hormones.

One of my sisters did benefit from progesterone but she had endometriosis. Another friend saw a reproductive endocrinologist trying to figure out her weird cycles/possible PCOS.

I read an interesting book once written by a doc, called _It's My Ovaries Stupid_. It went into a lot of detail about hormonal problems. Dunno if it would help but thought I'd mention just in case.

Good luck, let us know what you find out from the other doc.