Should we TTC again or just be happy?

[libby123]

A little background: I just had my daughter at 36 weeks gestation by c-section due to preeclampsia on February 17th. Fortunately she was fine and didn't need any NICU time. My blood pressure remained high until about a week postpartum when I was able to get off of my BP meds.

My pre-e started out as mild PIH at 26 weeks gestation. It stayed mild until about 30 weeks, when I got on BP medication. At 32 weeks my BP shot up to 170/100 and I was put on labetatol and given steriod shots. From 32 weeks until I delivered at 36 weeks, I was in and out of the hospital, on strict bed rest, and having appointments every couple of days. I was officially diagnosed with PE at 35 weeks, because my protein had gone up over 400.

I have a few questions. First: I am obese. If I get to a normal weight, will this improve my chances for a healthier pregnancy next time? Second: Because my PIH/PE was slow moving and mild, even when I delivered, is there a chance I will have more severe PE next time or will it likely be the same or nonexistent? Third: I never had any platelet problems or blood issues. Does this decrease my chances for PE in my next pregnancy?

I am just trying to understand the types of PE. Some seem to be mild and slow moving like mine, while some seem to involve platelets and need delivery at 25 weeks.

[riehlism]

Congratulations on your baby girl. Deciding to have another baby is a tough question. For someone like myself who lost my son, there's really no question. Even though I almost died, I was certain I wanted another baby. But for someone who already has children, I can see how challenging that might be. Obviously, an informed decision is best.

Being at a normal weight is healthy for you and the baby. It will help with TTC, but whether it will decrease your risk or not is something that isn't exactly agreed upon. Some providers say yes, absolutely. Obesity increases the likelihood of having blood pressure problems in the first place. So if that can be eliminated, great. Others say, preeclampsia does what it wants to do. I am sure some of our skinny posters here would have to agree that it does not discriminate based on BMI.

Slow moving and mild PE is good. The stats do show that preeclampsia is usually less severe, or comes on at a later stage in pregnancy. Of course, getting it earlier and more severe can also happen (sorry). The prevalence stats seem to be based on women who just have a second pregnancy without doing anything different. As you can see by all the posts, a lot of our providers are medicating us during pregnancy. The research shows more favorable outcomes.

Most of us here do not have an underlying blood disorder, so your particular risk based on not having an identified disorder is probably not decreased. But it should be less than someone who does have a blood problem. My OB and hematologist put it this way: Yes, I tested negative for all known blood disorders. But they are finding new disorders and tests every day. So while I test for nothing now, who is to say that something new will come up and I will test positive for that?

I had preeclampsia and HELLP and had to deliver at 24+6. I am fluffy. I don't have hypertension. And I do not have and underlying blood disorder. My MFM gave me a 20% chance of developing it with this pregnancy. Where they pull those numbers from...I have no idea. But hopefully it gives you a rough idea of where you might stand. I am on Baby Aspirin, Lovenox, and extra folic acid for this pregnancy.

[flori]

I am also considered "obese" but my MFM said that my bout with preeclampsia is tied more closely to me having chronic hypertension rather than to my weight. However, like Jasmin said, being overweight does put you at risk for having hypertension. I've seen other posters who's doctors have said the same thing about weight. Right now, my quest to lose weight is to help lower my blood pressure naturally and reduce the amount of medication I am on. Will it help, I don't know, but if I'm sure going to try.

[aajatwins]

Jasmin, you state it all really well!! (she's a great resource on this board & she's good at researching and finding answers)

Since she said it all, in my opinion, I just wanted to offer some hope. I believe I had PIH starting pretty early on with my twins - but I was never diagnosed, so this is my version of the story - like maybe 20 weeks. But I had a second trimester dip where it went down a little and then when I went into preterm labor at 28 weeks, it went up and stayed up. I never spilled protein, so I would never have been diagnosed with PE. (and high for me is 130/80, so that would also knock me out of the official PE diagnosis.) Anyway, at induction at 36w, it was 138/85. And then halfway through labor, I had seizures (eclampsia). it's taken me a while to figure out all the technical terms and how they separate PE from E, etc.

All that to say... I'm now 19+3 with one baby and my bp hasn't gone over 90/50. (which is freakishly low, but that's a whole different story!!) And my OB realizes that my threshold for bp is much lower than most people's. (I thank God that she came to this because I really didn't want to switch docs on account of her repeating the same mistakes as last pregnancy.) So my bp may go up later, but later is definitely good and I just have to hope and pray that it progresses slowly and we don't miss the symptoms we did last time. but at least this time I know what to look for and so does my OB - who is watching me a like a hawk!

It is a very personal decision whether or not to TTC. I think it just comes down to risk vs. benefit. But you know as a mama that children are priceless and precious.
I wish you all the best in your decision and journey! (and there will always be fabulous women here to support you and walk the road with you.)

[libby123]

First, thank you all so much for your responses. It seems so hard to find anyone who can relate to preeclampsia, and you all can!

Reihlism - I am so sorry for your loss. I am also very happy for you to be pregnant again and due in November. Congratulations! You remind me a little bit of my friend. She had a perfect pregnancy but then lost her baby at 40 weeks due to a placenta issue. The baby was perfect, but she died before she was born. You remind me of her in that she also wanted to try again, in fact very soon after she lost her baby, she conceived again and gave birth to a healthy baby boy. They did take her baby early though, at 37 weeks. Thank you for all of the information, I really appreciate it. It would be nice if there were more research done on preeclampsia! Can I ask you what medications you are taking that seems to be helping this time around?

Flori - I am actually nursing my daughter right now, so my doctor said I should hold off on drastic weight loss until I wean her. She is 4 months next week and will be starting solids soon. I have lost all of my pregnancy weight gain though. I have had a lot of success before following a liquid diet called New Lifestyle Diet which I will use this time to lose the weight. I gained weight in college the first time on anxiety medication. Then I lost 85 pounds on NLD. I kept it off for years, and then when I went on the Depo Provera shot I gained it all back very quickly. When we conceived it was a shock to us, we didn't set out to conceive while I am 100 pounds overweight! I won't have another baby until I have lost the weight again. My body is just very sensitve to medications and I am very prone to weight gain. My blood pressure is normal right now though, it ranges from 110/70 to 140/90 throughout the day. But overall pretty normal.

aajatwins - It is funny how blood pressure affects different people differently. I was in the 150s/90s beginning at 26 weeks and continuing for the rest of the pregnancy. I maintained this BP through medication, bedrest on my left side, and hospitalization. But that was okay for me, it wasn't too drastically high. I started spilling protein gradually and my protein kept going up during each 24 hour urine test and I also produced less urine and it was very dark. But I never had a seizure, that is very odd to have a seizure with BP in the 130s/80s, mine is that a lot of the time even now!!! If you didn't spill protein, then it doesn't sound like pre-e as this is one of the requirements of it. I wonder if your seizure could have been related to something else?

[caryn]

There is probably more benefit from weight loss to a normal weight than there is from LDA or anticoagulants. That said, the benefit is very small. Here's a discussion: http://www.preeclampsia.org/forum/viewt ... 28&t=40644 and another: http://www.preeclampsia.org/forum/viewt ... 28&t=39318

The data on anticoagulants comes from several small trials and is getting weaker with time, as I understand it.

[angieb]

FWIW, I was pretty close to my ideal weight in my first pregnancy (hellp @ 23 wks), and was overweight/about 20ish pds heavier in my second pregnancy (my mfm told me it was ok if i didn't lose wt before getting pregnant again, weight wasn't going to make a difference), and made it to full term for me (36 wks was as far as they wanted me to go due to my classical c-section the first time), 6 weeks postpartum and no pre-e or hellp at all.

[aajatwins]

Funny you should say that, my OB and the neurologist who saw me were unconvinced that my seizures were BP related, too. but no one tested me for underlying disorders. I should say that my BP at induction was 130s/80s and climbing while during labor. Then when I was at 5cm, it spiked out at 150/105. So really, that's 40 over my normal. And looking back, I had the URQ pain for weeks, a headache that wouldn't go away with tylenol for 2 days before induction, and saw stars the night before induction. So to me, it all fits, if irregularly. But I think I will push for underlying disorder testing after this baby comes.