I am 33 years old and have chronic (essential) hypertension. Outside of times where I am trying to conceive, I am well controlled with Lisinopril with HCTZ. With my first pregnancy (4 years ago), I had blood pressure problems beginning around 28 weeks. I was placed on bed rest and then induced at 35 weeks (although my baby girl weighed 8 pounds, was 20" tall and completely healthy - I believe my due date was wrong.) During my pregnancy I had blood in my urine. My blood pressure problems only worsened after delivery. I was on labatelol for over a week in my effort to breastfeed, but got so out of control I finally landed in CCU with an internist taking over my case. I was on a cocktail of 7 different blood pressure meds for control. Of course I eventually weaned myself to 2. I believe that part of my problem was due to improper care post partum by my ob/gyn doctors. Please note that I was never preeclamptic, and a renal ultrasound post partum showed that everything was functioning normally. One other note, I had chronic hypertension before my 1st pregnancy but was unaware of it (I had high blood pressure before 9 weeks gestation) and was not controlled by medication.
I would now like to have another child but of course am aware of the risk. Since my first pregnancy, I have lost 30 pounds - I am 5' 11" and 170 pounds - a "healthy" weight as determined by BMI calculator. I have switched my blood pressure medicine to aldomet and am controlled on 250 mg 3/day. My ob/gyn and internal medicine doctors have given me the green light to get pregnant. I am trying to evaluate my true risk - sometimes when I look at information I feel very reluctant and overwhelmed, at other times I feel as if I can make it. I have two specific questions I would like your help on as I am trying to decide:
1) I am consulting a perinatologist for prenatal counsel, but I live in a small town in Northwest Arkansas and am 3 hours away from the closest perinatologist (Little Rock). Is it wiser for me to use my ob/gyn here? I am very confident in my ob/gyn here but of course he does not officially have perinatology experience. But we have discussed my pregnancy at length and have a solid post-partum plan and he has taken all of my information from my 1st pregnancy to help us with the 2nd. I am not sure how beneficial a perinatologist 3 hours away might be - how might that work?
2) I get somewhat confused on how my absence of preeclampsia in my first pregnancy might affect my 2nd. Since I was not preeclamptic with first is that a "good" sign - meaning it is unlikely I will develop it with my 2nd? Or does the existence of my chronic hypertension mean I have increased risks for super-imposed preeclampsia in my 2nd as well (regardless of what my 1st pregnancy was like)?
Thank you for any help you might be able to provide. I would love another child but am wanting to make sure I am as responsible as possible before taking the risk. Thank you again!