weight loss btwn preg. lowers risk of PE

[caryn]

Interpregnancy weight reduction decreases the risk of recurrent preeclampsia and should be encouraged in women who experience preeclampsia.

http://www.ncbi.nlm.nih.gov/pubmed/20733450

More on this later, but the data do show a slight reduction in risk, from 14.8% recurrence to 12.8% recurrence in women who lose weight between pregnancies.

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[kerisue]

I asked my MFM about weight loss before TTC again and he basically said, "can't hurt, might help" so I'll be trying to lose a few pounds! Good to hear my effort might be worth something.

[sarah0381]

I was about 30lbs lighter from my first to my second pregnancy...and my second pregnancy was rough and I still had pe.

[caryn]

Yes, you could definitely lose weight and still get it. It just improves your odds.

So when docs tell us "Your risk of getting preeclampsia again is X%", the easiest way to think about what that means is probably to imagine that you're playing cards. (Here's another discussion where cards are the example. I like cards. Sorry about that.)

You've got a deck, with some jokers, and if you draw a joker, you'll get preeclampsia. You won't know if you've drawn a joker until 6-8 weeks postpartum. But you can know roughly how many jokers are in the deck.

In a first pregnancy with no known risk factors for preeclampsia, you've got a deck of 100 cards with 5 jokers in it. That's a 5% chance of preeclampsia.

In a second pregnancy where a doc's given you 20% recurrence odds, your deck of 100 cards has 20 jokers in it.

Losing weight removes some jokers from the deck, depending on your risk. The abstract reports an odds ratio of .7 -- or seven out of ten -- in women who lost weight between pregnancies. So if you've got a 20% chance of getting it again, but then you lose 20 pounds, your risk drops by 6 cards -- .7*20=.14 -- and now you only have 14 cards in 100. (Someone check me!)

I'm trying to make sense of the difference between that -- which seems right to me, but maybe I've got 'thing blindness' and am missing some really obvious statistics -- and their report that in the whole population of women with a history who lost weight intrapartum, this lowered your chances of getting it again from 14.8% to 12.8%. Shouldn't that number be larger with an odds ratio of .7? It might be that the effect is stronger in women who lose more weight, or lose from a higher BMI, but I haven't read the whole full paper yet...

This is a *significantly stronger effect* than the effect of aspirin. LDA has only a .9 odds ratio in the meta-analyses, and 1.0 in the big multicenter trials, which means it would take away 2 cards and leave 18 (at best.)

So losing weight works better than aspirin according to this study. This is not anywhere near as thoroughly evaluated as LDA, yet -- this is a cohort study, not a randomized controlled trial -- but then again, how *would* you randomly assign women to lose weight or gain it or keep it steady between pregnancies?

[l412angel]

Fantastic explanation Caryn!

[kerisue]

I love the cards/jokers explanation- the only change I might make is that in the first pregnancy you don't know how many jokers you have so you guess you have about 5 because that's the average number of jokers others have had on their first draw. ?

[caryn]

Exactly. In a first pregnancy, you generally don't know your risk factors, so they go with the figure for the whole population.

If you had a mother or a sister with PE, or are a known chronic, that number can quintuple. But a) most young women don't know they're carrying the genes for 'chronic hypertensive' and b) someone in the extended family always has to go first. So this is somewhat less useful than it seems...