pregnancy at 45 and afraid

[expert@preeclampsia.org]

I am nearly 45 years old and facing an unexpected second pregnancy. I experienced toxemia in my first pregnancy at age 41 and delivered a 5lb 12 oz. baby 36 1/2 weeks early. I have a strong family history of heart disease (my father died at age 43;grandfather age 55) and I have started to see a cardiologist for preventive measures. My concern is the risk of getting pre-eclampsia again, particularly at an earlier phase in the pregnancy and possibly delivering a severely premature baby. My OB is nonchalent about the chances of getting toxemia/pre-eclampsia again and says I got it late in pregnancy last time and we handled it and not to worry. My cardiologist is equally nonchalant but does say pre-eclampsia does increase my probability for high blood pressure earlier in my lifetime. But everything I've read says I should be concerned especially given my family history of heart disease. What should I do or what can I do at this early stage? Am I being too concerned as my OB and others suggest? Is it a huge risk to be pregnant at age 45? Can I get pre-eclampsia earlier in pregnancy even though the first time was later in the pregnancy? What are my risks compared to women who do not have a family history of heart disease?

[expert@preeclampsia.org]

To answer this patients questions more adequately a consultant would require much more data than given below, including the patient’s actual blood pressure levels before conception, and other aspects of her health. In general one can note that women who have had previous preeclampsia have about a 20% chance of recurrence, and while long term outcomes in women who had late versus early preeclampsia are better, remember the disease was diagnosed last time during the 36th week it does not preclude its being there earlier. There are of course other questions to ask, but of importance, the lower the initial blood is to the 100/70 mm Hg range the better, and on the other hand women with pressures that exceeded 120 systolic were at greater risk in one of the NICHD preeclampsia studies. In the last analysis, the important thing is frecquent evaluation by a high risk Ob specialist, who also educates the patient to call in regards to warning signs and symptons. If the blood pressure and markers of renal function were all normal at conception and the subject is not overweight the outlook is quite good.