preeclampsia, sinus exit block, family history

[expert@preeclampsia.org]

With my first child (third pregnancy), it was discovered that I had preeclampsia when I was 36 weeks pregnant at a regular OB check-up (my BP was through the roof, protein in urine, severely swollen, gained 11lbs in a week due to water gain). I was induced immediately, and via a successful c-section, my daughter arrived Jan 11, 2009. I was put on blood pressure medication for about 6 weeks afterwards until my BP returned to normal. Eight months later I was in the emergency room with heart complications. After going to a cardiologist, it was discovered that I had a sinus exit block. According to my cardiologist, it was nothing to be concerned about and that I should go about my life as normal and it was okay for me to have more babies. I am now currently 18 weeks pregnant and I'm using my same OB and they know about my heart condition. My OB (all 4 docs in the practice) have all assured me that my risk for preeclampsia in this pregnancy is very low because it is my second successful pregnancy and it is with the same father. Is this true? Have there been recent studies that show this? Or is my risk the same or higher in this pregnancy? And is there anything I should be watching out for with my heart during/after this pregnancy? I don't know if this helps or hurts my risk, but preeclampsia runs in my family (my maternal grandmother and aunt had it).

[expert@preeclampsia.org]

Her risk for recurrence are low but still more than the risk for a first pregnancy without history of preeclampsia. Best guess would be 10 to 20% compared to 4-6% with a first pregnancy. The good news is that in the next pregnancy if the preeclampsia does recur it is usually a little later and a little less severe.

What does this mean terms of management? She should be followed carefully. This is largely following at usual frequency but with close attention to any borderline findings. She and her physicians could consider aspirin 80mg/day (baby aspirin). Although aspirin was not effective in individual trials it does seem to be minimally effective when all trials are combined such that in someone with a 20% risk it would be necessary to treat 56 women to prevent one case of preeclampsia (about a 10% reduction of risk). This is clearly an individual choice. Aspirin has not been associated in the sum of studies with acute risk for mother or baby but there is no long range follow up.

The most important point is that she has at least an 80% chance of an absolutely normal pregnancy!