At risk for Preclampsia, but am I freaking over nothing?

[sthuss]

My Dr. has been worried about me developing preclampsia since I got pregnant. I have had troubles with blood pressure before and have a history in my family. A while ago she helped me get it under control with meds. and weight loss. Now I have normal blood pressure and it dropped to where it was supposed to in my first trimester 110/65. In my third trimester, that I am just starting it has gone back up. Went to 135/78 in her office. She has since made me get a blood work up and check my bp everyday at different times and send that to her. She has been testing my urine too. And I am currently experiencing a migraine and panicking. My daily BP has been at 120/80 on avg., and last night I got a migraine and still have it. WHICH, I am used to as I also suffered with migraines about once a year around this time anyway and they make me feel sick. All the sites say severe headaches are a major sign of preclampsia. My husband is away for work and I am really freaking out wondering if I should go in. Can you still have preclampsia with normal bp/normal urine/normal liver enzymes, but a headache? I know everything says "talk to your doctor" and I am, but just wondering if anyone had these experiences before? I am 28 weeks.
Thanks,
Paranoid!

[libby123]

First of all,

NO, you cannot have preeclampsia if you don't have protein levels over 300 and blood pressure over 140/90 over several readings. That is the diagnostic criteria.

However things with preeclampsia can sometimes change within hours and so I would recommend monitoring your blood pressure at home to note any sudden changes.

Because you have migraines previously, I wouldn't rely on a bad headache as a preeclampsia symptom because you have them even when you aren't pregnant. So you certainly can't rely on that. Instead, i would monitor your blood pressure and be aware of the other symptoms, such as swelling (though this is also a common pregnancy symptom) and vision changes (which can also accompany a migraine!).

Do yourself a favor and stay off the internet websites that list a bunch of symptoms. They will just stress you out, as a headache can be a symptom of a thousand different things or it can also be benign, so it really is opening a pandora's box and I would spare you that.

Just monitor your blood pressure at home, see your doctor, and try to enjoy your pregnancy as best as you can.

*I should also add that this is just my opinion, and that I am not a doctor and that you should always follow the advice of your doctor!

[sam10]

Welcome to the PE boards! I am always happy to hear about doctors who are proactive! Unfortunately, this is not always the case!
Taking your BP daily seems to me a good idea, especially with your history of higher pressures, even though you have not been diagnosed with PE. Headaches can be tricky, as they can be PE related or not at all. Have you tried tylenol? If it does not do anything to your headache, and you feel uncomfortable, I'd call in the on-call doc and ask about it. At least try to get to see your doc first thing tomorrow morning. PE does not always present with all symptoms and can come on quickly.

[sthuss]

Thank you for the support and the welcomes! Good advice to stay off the internet sites. They don't do anything to calm my nerves. I am lucky to have a pro-active doctor. I will monitor my blood pressure everyday.
Thanks!
-Sarah

[lemons]

Congratulations on your pregnancy and welcome. I'm glad to hear that you were working with your doctor to get as healthy as possible before becoming pregnant

As for blood pressure, during pregnancy there is usually a drop in mom's BP during the first half with a gradual rise starting somewhere around the third trimester. This normal rise *could* be what you are seeing (disclaimer: I am not a physician). Keep in mind that doctors don't always "trust" one higher BP value taken in their office, since it could be due to "white coat hypertension" (if you are stressed when you go see them, your BP could be temporarily higher). That doesn't mean they should ignore it- and your doctor seems very cautious, since she is testing your urine/blood and keeping on top of your BPs. Daily BP readings from home can help sort out whether or not your BP is reaching levels where your medication, if you are still taking it, might need to be tweaked. In addition, daily BP readings will help to identify if you start to have what are called "labile" BP readings (BPs that vary widely over the course of the day). Labile BPs are common in women who go on to develop preeclampsia. Your doctor should be able to tell you what would be considered a normal vs abnormal "swing" in your BPs, given your unique situation.

I also suffer from migraines a few times a year. I have always been able to control them with over-the-counter medication, but since the medicine contains significant aspirin and caffeine, I could not take it during my pregnancy. During the first half of my pregnancy, I did not get any migraines. And then at about 26 weeks, I developed one, complete with visual aura, numbness, tingling, sensitivity to sound and light, and immense pain. And as usual, tylenol did not even touch the pain. But this is normal for me! So, given that my BP was not elevated and there was no protein in my urine, it was *just* a migraine! Migraines are common in pregnancy given that your hormones undergo such drastic changes from normal (and sometimes, pregnancy actually gives migraine sufferers temporary relief).

In the weeks after my first migraine, I did develop a couple more that followed the same path. Eventually, I was diagnosed with PE at 29 weeks and delivered my daughter at 30 weeks. So, the migraines may have been the first indication that something was not right. Please keep a close eye on your headaches, report them to your doctor, and make sure that she continues to follow you closely. If you continue to get headaches and they are somehow abnormal for you, or you just think something is not quite right, call your doctor. As we all know, PE can be very quick to develop! Good Luck and we will be looking for an update!

[blythe]

Many of our posters have reported symptoms weeks before their blood pressure and / or protein became diagnostic, and the research supports that the factors that appear to cause preeclampsia are elevated at least 6 weeks before diagnosis.

An old criteria for diagnosis was an increase in blood pressure from your baseline of 30/15 - your numbers seem to be close to that. Our Experts have said that while an increase of 30/15 is no longer considered "diagnostic" that they would still want a woman with that increase to be monitored closely. I am glad your doctor is taking your increase seriously.

For those reasons and many others, we would *never* recommend that you ignore or otherwise not take your symptoms seriously. Women have had seizures and other complications without reaching the diagnostic bp and protein criteria. Their cases are very very rare, but that is why we always recommend that you watch your signs and symptoms http://www.preeclampsia.org/health-info ... d-symptoms and report your concerns to your doctor.

There is some research that correlates migraine headaches with increased risk of preeclampsia, so in your shoes I would still take your migraines seriously.

In my completely not-a-doc opinion I would guess that you are right - it is likely that you just have a migraine and that you are fine. But again, we are *not* doctors, and more importantly we are not *your* doctor so we cannot judge your health. PLEASE report all concerns to your doctor and let them decide.

[laura]

Heyya Paranoid, we are two peas in a preeclamptic pod- not just because we both found the Preeclampsia Foundation while flipping out, but because I also get vascular headaches and have chronic hypertension.

The good thing to remember is that although (in your case underlying) chronic hypertension has its own set of scaryness, it doesn't necessarily follow the same trajectory as "regular" preeclampsia. Just like age and excess weight, the stress of pregnancy can make your underlying chronic hypertension peep out the same way aging 10 years or gaining 20 lbs would. So, the good news is that those creeping BPs may be you creeping towards you new baseline rather than emerging preeclampsia. It is great that your doc is keeping a close watch on that- that's really half the battle.

"The" preeclamptic headache isn't necessarily part of the same process as migraines. (or I prefer to call the vascular headaches, because migraines really are just your blood vessels in your head acting up) "The" preeclampsia headache is caused by your brain being squeezed by intercranial pressure and can be the only sign that you are at risk for a stroke. It usually happens in the context of really severe disease. The problem comes in because pain is pain, and there's no way for you to tell from home that it is one or the other, which is why *everyone* (especially the Preeclampsia Foundation) says to get severe headaches not relieved by tylenol checked out.

In my experience, the context was important. Migraines could be triggered by hormones (I got more when I was pregnant), by my BP rising (I've read research that it doesn't happen, but it does to me), and low blood sugar. They started and finished like migraines did when I wasn't pregnant.

When I had "the" preeeclampsia headache in my postpartum period, I was physically unwell- I felt sick and puffy and it started out nagging and then turned into one of those 'I'd jump off a bridge to get rid of this headache' pains.

Like the others, I'd err on the side of caution. When I was pregnant, I called over every migraine. I'd also suggest, just for your peace of mind, to factor in your own intuition as well. Be well.

[lemons]

Hi Sarah,

I hope by now that you have been able to talk with your doctor and that you are feeling better from the migraine- mine can last days if I don't take my medicine. I want to clarify a couple of issues from my previous post-

1. I was trying to give you a number of different reasons for why your BP might be sneaking up (third trimester rise, white-coat hypertension, labile BP) but was not suggesting that you shouldn't take it seriously. As I said, I am glad that your doctor is being proactive and hopefully the daily BP readings will shed light on what is going on. Don't be hesitant to tell your doctor that the increased watch over your BP is making you nervous. Ask her to keep you updated as to what she is thinking in regards to the numbers- are they good, is she starting to get more concerned, is something abnormal? Please advocate for yourself and your baby and insist that she stays proactive.

2. You had asked for someone else who suffers from migraines to share some insight. This is what I tried to do- to share my story, to reassure you that not every migraine headache is an immediate precursor to preeclampsia and stroke, to urge you to call your doctor, and to urge you to continue watching your headaches and reporting them to your doctor. I hope that this is what I conveyed.

3. I should have stated my migraine at 26 weeks might have been the first symptom- that I could actually feel- to suggest that preeclampsia was developing. In fact, I had a very low PAPP-A level detected on my first trimester combined screening, which suggested that the placenta was impaired. And my daughter was measuring small throughout my pregnancy. So, I was being watched closely for PE as well as other complications. Hopefully, neither of these issues is affecting your pregnancy!

Please, talk to your doctor about your concerns, because while stress can't cause PE, it sure as heck can trigger migraines! Hopefully, you will feel more informed and therefore, less stressed.

Take care,
Diana