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Newbie: 21+4 weeks pg; high risk for PE (ex. low PAPP-A etc.

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Re: Newbie: 21+4 weeks pg; high risk for PE (ex. low PAPP-A

Postby GeorgiaGirl » Fri Jan 06, 2012 01:03 pm

by GeorgiaGirl (38 Posts), Fri Jan 06, 2012 01:03 pm

caryn wrote:Just checking on you...

Thank you... and sorry for the delay... there's a lot to update. On Monday, I had a routine midwife appointment and my BP measured around 160/100, after several readings using both arms. I was told by the midwife in no uncertain terms that I have dangerously high BP and that I must immediately go on medication. (I'm not sure whether it's considered chronic or PIH, since I'd had 140ish/90ish readings prior to 20 weeks? Previously, I'd had fairly normal, sometimes low BP.) The midwife consulted with the OB and I was prescribed 250mg methyldopa twice daily, which she said was the lowest possible dosage.

I tested negative for proteinuria at the office visit but received instructions for the 24-hour urine test, which I'm doing on Sunday/Monday. So, hopefully that will be negative also.

I asked about the risk of meds masking preeclampsia later on, and she said that's definitely a concern and for that reason, they'll be monitoring me more carefully for the other signs of pre-e.

As for the BP thing, I had gotten a home BP monitor, and I was getting some very alarming readings from it over the holidays. The scariest was 211/114! But, the readings were generally all over the map even within a short amount of time, so I question the accuracy (and it's a wrist monitor, so I'm sure user error came into play). I had no alarming symptoms when I was getting the super-high readings, so I assumed the monitor was wrong and didn't bother calling in to the office. I'm going to buy an arm cuff monitor instead in hopes that will be more accurate.

Many OBs and MFMs will not treat HTN until you get above 160/100, with a target of 140/90, because the meds also carry a risk of IUGR.

That is one of my BIG concerns. The midwife claimed that methyldopa does not cause IUGR, but uncontrolled chronic hypertension can. Does that ring true to you? I haven't been able to find any studies online linking methyldopa to IUGR; do you know of any or is it possible that it's the other hypertension meds that cause it?

I've continued to scour the Internet for any possible preventative measures, and I found a study that indicated l-arginine may reduce the risk of pre-e (I did a search on it on this forum, and it's been posted about here as well, earlier this year). So, in my desperation, I've dutifully added l-arginine to my regimen of daily supplements.

Anyway, pending the 24-hour test results, I'm assuming I don't have pre-e at this point, but the hypertension diagnosis also puts me at much higher risk of pre-e that I already was (based on my extremely low PAPP-A result in the first trimester, which already put me at high risk). It's very dismaying that after all our miscarriages, I can't have one moment to relax and enjoy this pregnancy, that I must be constantly looking out for little signs and symptoms that could kill my baby and/or me. Even as I'm sitting here, I have a very mild headache (I also had one yesterday, but the lowest dose of Tylenol took care of it), and I felt the baby kick upward, but my mind is obsessing that these two things could be signs that I have pre-e. I'm feeling somewhat hopeless that this baby will survive and almost wish I could check myself into the hospital for the next 3-4 months so my baby won't die without me even realizing I've developed pre-e.
Julia, age 40
six first-trimester miscarriages
expecting a miracle baby May 3, 2012
diagnosed with chronic hypertension at 22 weeks; high risk of PE (extremely low PAPP-A, bilateral uterine artery notching and other risk factors)
diagnosed with pre-eclampsia at 27w5d
delivered my miracle baby, John Jr. ("Jack") at 29w1d, 2 pounds 8 ounces of absolute perfection
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Re: Newbie: 21+4 weeks pg; high risk for PE (ex. low PAPP-A

Postby kerisue » Fri Jan 06, 2012 02:23 pm

by kerisue (623 Posts), Fri Jan 06, 2012 02:23 pm

I'm sorry that this pregnancy has been so filled with worry and you haven't been able to enjoy it, but don't give up hope for that baby yet! Are you only seeing the midwife? Nothing against midwives, but sometimes you just need to see a specialist and now might be one of those times. If there's any concern about IUGR they'll likely want to do more ultrasounds to monitor growth. As for the l-arginine, I've read some positive research too, but I hope you checked in with your provider before starting to take it. Good luck, I hope things smooth out for you.
Mama to Millie
born June 2010 @ 24 wks. gestation due to my severe PE and CHF
lived 25 days, loved and missed
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Re: Newbie: 21+4 weeks pg; high risk for PE (ex. low PAPP-A

Postby GeorgiaGirl » Fri Jan 06, 2012 02:34 pm

by GeorgiaGirl (38 Posts), Fri Jan 06, 2012 02:34 pm

kerisue wrote:I'm sorry that this pregnancy has been so filled with worry and you haven't been able to enjoy it, but don't give up hope for that baby yet! Are you only seeing the midwife? Nothing against midwives, but sometimes you just need to see a specialist and now might be one of those times. If there's any concern about IUGR they'll likely want to do more ultrasounds to monitor growth. As for the l-arginine, I've read some positive research too, but I hope you checked in with your provider before starting to take it. Good luck, I hope things smooth out for you.

Thank you... I've only seen a midwife twice; other than that, I was initially seeing an RE, then my OB, then a perinatologist (MFM) at 12, 16, and 21 weeks. My appointment on Monday is with my OB (who had preeclampsia herself with both her pregnancies). The reason I had switched to a midwife (before this BP disaster came up) was that I was naively hoping that since everything was fine with the baby at that point, I might have smooth sailing for a few months and a natural childbirth. (Yeah... stupid, in retrospect.)

As of 21 weeks (two weeks ago), baby was measuring slightly ahead on all counts, including his abdomen (and a week ahead for femur length), so no signs of IUGR as of yet (HUGE relief). Will see MFM again at 25 weeks, two weeks from now, for another ultrasound and fetal echocardiogram.

I'm definitely not giving up hope for this baby... we love him so much already, and I'd rather risk dying than risk any harm to him. I will be 41 in two months and he will very likely be my only chance at a healthy baby! Wish he didn't have to hear his Mommy crying so much these days out of worry for him....

edited to add: I really apologize for sounding so pathetic. I learned yesterday that two of my aunts had hypertension and then PE with at least one pregnancy each. They made it to 35-38 weeks before they had to be induced, which sounds like a best-case scenario to me, from where I sit at 23w1d... with me getting hypertension so early, it seems inevitable that I'll have early-onset PE and therefore will have to be induced far earlier 30 or 35 weeks and have an extremely premature baby. It's terribly dismaying knowing there's absolutely nothing that can be done to prevent it.
Julia, age 40
six first-trimester miscarriages
expecting a miracle baby May 3, 2012
diagnosed with chronic hypertension at 22 weeks; high risk of PE (extremely low PAPP-A, bilateral uterine artery notching and other risk factors)
diagnosed with pre-eclampsia at 27w5d
delivered my miracle baby, John Jr. ("Jack") at 29w1d, 2 pounds 8 ounces of absolute perfection
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Re: Newbie: 21+4 weeks pg; high risk for PE (ex. low PAPP-A

Postby sam10 » Fri Jan 06, 2012 08:51 pm

by sam10 (1448 Posts), Fri Jan 06, 2012 08:51 pm

It's so unpredictable, and you could just get to your due date, or close to it, even with a bumpy ride ahead of you! We'll keep all our fingers crossed.
~Julija (42)
MC 3/2009 and 3/2011
H (1/1/2010-1/7/2010) - forever loved and missed; severe PE with Hellp; partial placental abruption, classical c-section at 25.6 weeks
M (Nov. 2012, born at 35.4 weeks) - severe PE


Our pain has been put into words, placed into empty cradles, to remember that all our babies lived, that they mattered and always will. - Field of Cradles http://www.fieldofcradles.org/
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Re: Newbie: 21+4 weeks pg; high risk for PE (ex. low PAPP-A

Postby caryn » Sat Jan 07, 2012 11:06 am

by caryn (10177 Posts), Sat Jan 07, 2012 11:06 am

You don't sound pathetic and it is not your job to pretend everything is going swimmingly. Everyone here has been in variations of the boat, and the boat sucks.

Methyldopa has been used forever and is known to be safe with close monitoring, which I'm sure you'll be getting. There are a couple of other meds that are similar. They are all so old that they have miserable (but inconsequential medically) side effects for you (fun stuff like exhaustion and a tingly scalp.)

For what it's worth, here's what we've got on l-arginine:
viewtopic.php?f=28&t=43413
viewtopic.php?f=28&t=42748
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies? Lectures from researchers?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy
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Re: Newbie: 21+4 weeks pg; high risk for PE (ex. low PAPP-A

Postby alexis » Sat Jan 07, 2012 12:46 am

by alexis (305 Posts), Sat Jan 07, 2012 12:46 am

Yes - chronic HTN can cause IUGR and IIRC this risk is independent of superimposed PE (i.e. chronics have a higher rate of IUGR even if they don't develop PE).

Methyldopa and labetalol are the best tested drugs in pregnancy. I was on metoprolol, which is not as well studied. I was told that there is a small possibility of IUGR with beta blockers, but that only antenolol really has evidence (which is why atenolol is category D, and metoprolol category C). Of course, this has to be weighed against the possibility of IUGR from hypertension... so the judgment seemed to be to control it, check carefully, and adjust my meds if the baby had any problems.

My BP was stable on meds but I was carefully monitored and did have growth ultrasounds. Because I was on a fairly heavy duty dose of meds, giving me normal (<120/80) pressures, I got regular 24 hour collections and labs--and the time I spiked a high BP, I got a hospital visit.

I would definitely get an arm monitor (I have an Omron 7 series, and I had it checked in-office, so I know it gives me pressures within 5 mmHg of a manual).
Chronic hypertension
Aliza - 01/05/2007 - Severe preeclampsia, emergency CS 37 weeks
Isaac - 09/26/2011 - controlled on 150mg Toprol, NO PE, 39 weeks!
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Re: Newbie: 21+4 weeks pg; high risk for PE (ex. low PAPP-A

Postby GeorgiaGirl » Sat Jan 07, 2012 03:18 pm

by GeorgiaGirl (38 Posts), Sat Jan 07, 2012 03:18 pm

Thanks so much, Caryn, Alexis, and Sam10... I really appreciate your encouragement and input.

Alexis, that is good to know about beta blockers being the kind with the risk of IUGR, but I'm sorry you had to take it and am so glad things worked out for you.

Caryn, yours were the articles/posts I had found about l-arginine the other day... thank you SO MUCH for all the work, research, and thought you put into your writings here. It's so very much appreciated. I just re-read the posts and original articles, and although it says l-arginine won't be recommended because there is more research that must be done, what I took away is that there's no harm in taking it and based on that study, it might help. Is that a fair assessment? Since I'm feeling completely helpless sitting here waiting for PE to strike, I just thought it would be one more small, harmless thing to throw at it in hopes that something I'm doing might be the thing to help prevent or slow PE in my case. I wasn't able to find info on possible negative consequences of l-arginine in pregnancy.

This low dose of methyldopa has been fine so far; the only side effect I've noticed has been tiredness (although maybe it's helped bring on some depression as well; hard to say). Every day that I get closer to "viability day," 24 weeks, I'm feeling just a little better... five more days now. Praying I can make it to the 30's.
Julia, age 40
six first-trimester miscarriages
expecting a miracle baby May 3, 2012
diagnosed with chronic hypertension at 22 weeks; high risk of PE (extremely low PAPP-A, bilateral uterine artery notching and other risk factors)
diagnosed with pre-eclampsia at 27w5d
delivered my miracle baby, John Jr. ("Jack") at 29w1d, 2 pounds 8 ounces of absolute perfection
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Re: Newbie: 21+4 weeks pg; high risk for PE (ex. low PAPP-A

Postby blythe » Sun Jan 08, 2012 11:27 am

by blythe (3059 Posts), Sun Jan 08, 2012 11:27 am

Okay, I just wrote a huge post below and I know all this information could be overwhelming. I'm also very aware, just from your handful of posts, of how hard this pregnancy has been for you and I don't want to add to your distress! I also don't expect you to change anything you're doing based on my say so, I'm not your doctor and I'm not you, only you and your doc can evaluate the information for *you* and your values and your comfort level with the benefit - risk analysis. What I do want to give you, though, is more information, since I believe (and remember I'm no doc) that you are making decisions based on minimal information, and more information might give you better informed consent.

The "can't hurt, might help" perspective is one we usually do better refuting, sorry! To be fair, my bias comes down much more on the side of don't do *anything* until the research is really clear, because time and time again I see the research change and I see women's stories here. It's true that negative effects are often rare, but anything you take in pregnancy is a risk / benefit analysis that we always want your doc to weigh in on and have you evaluate with as much information as possible. And when the research isn't quite there, you can't have full informed consent, so you're essentially experimenting on yourself and your baby.

I absolutely understand the desire to do something, anything, and I supplemented and changed my diet and did just about anything available to me in my own second pregnancy. My blood pressure was wonkier in my third pregnancy when I did nothing so I ended up with a lot more monitoring, but I delivered at exactly the same time - 37 weeks - as the pregnancy when I did "everything", but both immediately post-partum and longer term, my "nothing" baby is healthier by far than my "everything" baby. But correlation doesn't equal causation - doing "nothing" probably had nothing to do with my wonkier bp, just like doing "everything" probably had nothing to do with my other baby's health issues, but... I will always wonder.
Still, my experience is also just anecdotal, what is most important is what the research says.

Aspirin is now pretty standard, especially in Europe, but our docs are less than impressed with the research and some interpretations of the data show risks of placental abruption as about equal to the PE reduction benefits.

A high protein diet can be really hard on already stressed kidneys - and high blood pressure alone can stress kidneys. A high protein diet can also be hard on your body in general. I had blood in my stool (TMI, I know) for almost a year after my protein-diet pregnancy any time I had a carbohydrate-heavy meal (lots of rice, pasta, etc) that my doctor attributed to my body not knowing how to process carbohydrates any more.

And... high-protein low-carb diets have been shown to affect offspring:
http://www.preeclampsia.org/forum/viewtopic.php?t=23462
http://www.preeclampsia.org/forum/viewtopic.php?t=24698

For the less-researched supplements like fish oil and l-arganine, I have two main concerns, that may or may not ring accurate to you. You wrote "If low-dose aspirin and fish oil can help prevent micro-clots, logic tells me that will give the placenta a better chance at continuing to provide maximum nutrients to my baby, for a longer length of time." - the problem I see there, and remember I'm not a doc, just a woman who has been there, is that I haven't seen any studies that say lda or fish oil prevent micro-clots. I think the latest understanding is actually that lda's effects - if any - may be due to anti-inflammatory effects. A quick google search tells me fish oil can also have anti-inflammatory effects - but fish oil has even less encouraging research than lda.

Here's an older thread where we discuss fish oil
http://www.preeclampsia.org/forum/viewt ... 17&t=33025

*I know you didn't include Vitamin C and E in your list of supplements, I'm including this information because it's the best example I have to explain my position against "can't hurt, might help".*
The biggest reason I personally am against supplementation without strong research is because of Vitamin C and E. For years the docs and researchers had good evidence that antioxidants like Vit C and E might help prevent preeclampsia from developing. Early studies, even moderately large ones, were promising. A few studies even seemed to confirm the "can't hurt, might help" possibility. Then they did more research and found that for most people vit c and e didn't hurt, but they didn't decrease the risk of PE at all and made some women sicker and their babies smaller.
http://www.ncbi.nlm.nih.gov/pubmed/19843004
http://www.ncbi.nlm.nih.gov/pubmed/16616557
http://www.ncbi.nlm.nih.gov/pubmed/18937704
http://journals.lww.com/greenjournal/Ab ... _A.17.aspx
http://www.medpagetoday.com/OBGYN/Pregnancy/2957
http://www.preeclampsia.org/forum/viewt ... ker#p35318

I am generalizing the Vitamin C and E to other supplements and interventions because any intervention that has the possibility of doing something good also has the possibility to do something we don't want. So again, risk-benefit according to your values and comfort level.

I'll also add yet another reason why working with your doctor is so important - even something that is benign or even helpful in the vast majority of people can be damaging for a rare individual. Our founder, Anne Garrett, has Sarcoidosis, so even though calcium supplementation is generally accepted as helpful in low-calcium intake populations, giving *her* calcium can be very damaging, and possibly contributed to her dangerous PE in her fourth pregnancy.
http://www.preeclampsia.org/forum/viewt ... ium#p41012

Just like the rare possiblity of IUGR from bp drugs concerns you, I would like you to consider than any intervention or supplement you try could have risks, known or unknown, and have a much less chance of being helpful than the research supporting bp meds to reduce the risk of stroke and organ damage for you (though bp meds have not been shown to have success in decreasing progression to PE).

(And adding to what Alexis said, hypertensive pregnancies in general are known to produce either small or large babies - I think it's called "bimodal" - but very few "average" size babes. So yes, it's my understanding that the risk of IUGR from uncontrolled hypertension is much higher than the risk of IUGR from the mild bp meds like methyldopa.)

Whew, if you've read this far, I hope it's helpful and not too overwhelming and scary. Again, you and your doc need to work together to find the best risk-benefit combination for *you*. For *me*, supplementing in my second pregnancy, even knowing a lot of these risks, was something I did anyway because I felt like I had to try *something*. As long as you're aware that the things you're trying to prevent PE have risks that include "*could make PE worse or affect my child*".

Caryn says it better in this post.
http://www.preeclampsia.org/forum/viewt ... er#p332945
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH
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Re: Newbie: 21+4 weeks pg; high risk for PE (ex. low PAPP-A

Postby GeorgiaGirl » Sun Jan 08, 2012 01:42 pm

by GeorgiaGirl (38 Posts), Sun Jan 08, 2012 01:42 pm

Hi, Blythe – first of all, I can’t thank you enough for taking so much time and thought into your post… I would rather be overwhelmed by great info than underwhelmed! THANK YOU!!!

Just to clarify, I am not, never have, and never will follow any Atkins-type fad diet (or any other fad diet—well, except for those few years I fell for the awful no-fat trend of the 90’s! ;) ). True, I steer clear of refined carbs (e.g. sugar) as much as possible, but I eat plenty of carbs daily (from whole grains, sprouted grains, vegetables, the occasional fruit and nuts).

The advice was to eat 1 pound of red meat daily during pregnancy and to abstain from carbohydrate-rich foods such as bread and potatoes.

The Times Online link in the first post did not work for me (it kept taking me to the front page of the Times Online site), but I’ve read the study it mentions. And I must say, how horrible!! Even the much-hated Brewer never recommended getting all protein from red meat (he recommended a variety of whole food sources), nor did he suggest a low-carb diet. How dreadful that those poor women were subjected to such an unnatural, unhealthy diet and that their children suffered for it as well (and probably THEIR children, too!).

Since there is no diet proven to prevent PE, I’m simply eating a balanced diet of a variety of organic whole foods. Yes, as it happens, I’m consuming more protein than I did pre-pregnancy, but it’s nothing extreme/crazy like nasty protein powders or a pound of red meat in a day. I just drink several glasses of milk (from grass-fed cows, not “industrial” dairy) and eat a couple of eggs most days… other than that, I don’t eat much meat at all (usually a small serving of chicken, seafood, or grass-fed organic beef at dinner). If you know of evidence that this kind of well-balanced diet is harmful, I’d like to hear about it. Is this considered so high-protein that it will stress the kidneys (assuming I had healthy kidneys to begin with, which as far as I know I did)?

As for LDA, I began taking that (as well as extra folic acid) at the instruction of my Reproductive Endocrinologist. If I were a normal woman with no clotting issues, I doubt I would be taking it. This explains why my RE had me on it (this doesn’t link to the studies that show that LDA therapy decreases clots in the placenta but I can look them up later):

Low-dose aspirin (80mg or 1 baby aspirin) alone has used for treatment of both repeat implantation failures and post-implantation pregnancy losses. Aspirin therapy has been reported to enhance implantation rates in women undergoing IVF/ET. In these studies the number of eggs retrieved and number of embryos generated were higher in the aspirin treated group than in the non-treated group making it unclear whether the enhancement in implantation rate was the result of better embryo selection or a direct effect on the lining of the uterus. Among women with increased resistance of blood flow through their uterine arteries who were treated with aspirin for a minimum of two weeks, the pregnancy rate was increased from 17% to 47% and the miscarriage rate decreased from 60% to 15%. As a prostaglandin inhibitor, aspirin would be expected to increase blood flow to the ovary prior to implantation, to the endometrium during implantation and to prevent clotting of the placental vessels following implantation.

A rationale for the use of low-dose aspirin therapy during pregnancy for women with antiphospholipid antibodies is to decrease blood clots from forming in the placental vessels. The mechanisms by which aspirin prevents blood clots are through its antiprostaglandin and antiprostacyclin effects and inhibition of platelet adhesiveness and aggregation.


To clarify what you mean here, are you saying that taking aspirin increases the risk of placental abruption or simply doesn’t decrease it?
Aspirin is now pretty standard, especially in Europe, but our docs are less than impressed with the research and some interpretations of the data show risks of placental abruption as about equal to the PE reduction benefits.


Thank you for links on Vitamin C and E supplementation. You’re right; I do not take supplements for those or anything other than l-arginine (which I only began in the last week) and fish oil (at least until I study the research you linked further!), aside from what’s in my pre-natal vitamin. I’m going on the assumption that the amount of either of those vitamins in my pre-natal vitamin isn’t enough to cause the fetal growth restriction you mentioned, but please let me know if I’m wrong and there is a hidden danger in taking a pre-natal vitamin! (The one I take is derived from organic whole foods… on the theory that whole-food-based nutrients work better in a person’s body than artificially isolated derivatives.)

As for the refutation of the “can’t hurt and might help” theory, I definitely see where you’re coming from and appreciate your explaining it so well and linking to older posts that did as well, but where does that leave us as far as lifestyle factors such as exercise vs. no exercise, or bed rest vs. no bed rest? Which is the one that would be considered the “can’t hurt—but in fact it really can” option?? I’m feeling (not from your helpful post, but all the conflicting information) a sense of “damned if you do, damned if you don’t,” hence my inclination to just go check myself into the hospital for the next four months.
Julia, age 40
six first-trimester miscarriages
expecting a miracle baby May 3, 2012
diagnosed with chronic hypertension at 22 weeks; high risk of PE (extremely low PAPP-A, bilateral uterine artery notching and other risk factors)
diagnosed with pre-eclampsia at 27w5d
delivered my miracle baby, John Jr. ("Jack") at 29w1d, 2 pounds 8 ounces of absolute perfection
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Re: Newbie: 21+4 weeks pg; high risk for PE (ex. low PAPP-A

Postby caryn » Mon Jan 09, 2012 01:50 pm

by caryn (10177 Posts), Mon Jan 09, 2012 01:50 pm

Well, the tricky thing here is that the science keeps shifting under our feet. For example, there are new studies saying aspirin doesn't actually seem to help IVF patients!

With aspirin, they've settled on the idea that it doesn't really seem to harm, and if there's a small sub-population of women (whom we cannot identify in advance yet) who are benefiting from it (which is one possible interpretation of why it seems to help in meta-analyses but doesn't help in RCTs) then giving aspirin to women at risk of pregnancy complications is a true "can't harm might help" scenario. Except some providers argue that the data from one of the RCTs show an increased risk of abruption in about the same ballpark of statistical significance as the benefit - and it's hard to say we should take the potential benefit more seriously than the potential harm if they're both about the same order of magnitude with the same justification (namely that the maths look like they are showing statistical significance but there is also an obvious way in which the way we use math to analyse the data could also be generating the result.)

Whew. Statistics dump. Shorter: if your doc believes you're in a subpopulation that might benefit from LDA, then take LDA. :D

With lifestyle factors, they usually say to continue what you've been doing. The idea is that the placenta implants during early pregnancy and configures itself to maximise the environment that it finds when it gets there. If you're in the habit of hard workouts, it will "expect" hard workouts and implant accordingly. If you're in the habit of 8 hour shifts on your feet, it will expect those. If you're in the habit of being mostly sedentary sitting on the couch nursing a new baby and unexpectedly fall pregnant again, it will "expect" that lifestyle. So the "can't hurt might help" option is really the one in the middle of your normal behavior, and changing your behavior - in either direction - off of normal will throw the placenta off its game. Think of it as a targeting problem - it's trying to hit the middle of the bell curve. If you suddenly move it to the far left of the bell curve by going on bedrest, that *might* help - if the problem it was having with implantation can be solved with bedrest - but it might need to move right instead of left, and we have very little way to figure that sort of thing out.

What we usually tell people who've been recommended to lifestyle modifications is that we suggest logging your pressures once you adopt those changes and tracking your outcome. For example, bedresters might track their pressures three times a day on a schedule, and then also after they've gotten up to use the restroom. If the bedrest is helping, you might expect to see a generally lower pressure and a smaller spike after activity. If it isn't, laying down won't do a darn thing. (Acute cases don't often see benefit but women with underlying chronic disorders might. Bedrest in the hospital after you've gotten really crazy pressure readings often does roughly nothing to lower pressures, but some chronics seem to benefit from extra resting from about 20 weeks on.)

Does that make some sense? It's a really weird disease.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies? Lectures from researchers?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy
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