Pre-eclampsia affects around 2-8 in every 100 pregnant women. If you ever watched the episode of Downton Abbey where Lady Sybil develops the symptoms of pre-eclampsia which becomes eclampsia when she suffers a seizure and dies, you will understand that this condition is important to be aware of!
Thankfully the care for women has substantially improved since the 1920s, and this article gives a brilliant explanation about how accurate the doctors were in the episode, and an interesting summary of how the management of pre-eclampsia has improved.
Nonetheless, once you have experienced pre-eclampsia you probably want to know how likely you are to suffer again, and what you can do to reduce that risk.
This post will help you answer those questions!
A brief explanation of pre-eclampsia
The usual symptoms are that you experience a headache, flashing lights in your vision, swelling of your hands, feet and face or vomiting and pain at the top of your abdomen.
Your medical team may detect raised blood pressure and protein in your urine. At each antenatal visit you will be checked for these signs.
Pre-eclampsia usually occurs towards the end of pregnancy and is mild. The high blood pressure can be treated with medication. Pre-eclampsia itself is not cured until the baby is delivered (usually at 37-38 weeks).
In rarer cases (around five per 1,000 pregnant women) it leads to more severe disease. This may start earlier and affect the growth of the baby in the womb or the health of the mother. In these cases the baby may need to be delivered (induced) earlier.
Complications of pre-eclampsia
Early diagnosis followed by appropriate management, including delivery, may prevent some of the serious sequelae of the disease, such as eclamptic seizures and multiorgan failure.
Will I get pre-eclampsia in a future pregnancy?
Overall, one in six women who have had pre-eclampsia will get it again in a future pregnancy.
Of women who had severe pre-eclampsia, or eclampsia:
• One in two women will get pre-eclampsia in a future pregnancy if their baby needed to be born before 28 weeks of pregnancy
• One in four women will get pre-eclampsia in a future pregnancy if their baby needed to be born before 34 weeks of pregnancy
While repeat occurrence is often less severe, no one can predict for sure.
If you’ve had preeclampsia in a previous pregnancy, you and your healthcare provider should carefully monitor you and your baby during your current pregnancy for any signs or symptoms.
You should be given information about the chance, in your individual situation, of getting pre-eclampsia in a future pregnancy and about any additional care that you may need.
It is advisable to contact your midwife as early as possible once you know you are pregnant again.
Risk factors
The risk of preeclampsia recurring increases if you have these risk factors;
- If you’ve developed chronic hypertension or diabetes since your previous pregnancy
- IVF pregnancy
- Twin, or other multiples.
Other risk factors for pre-eclampsia:
- Previous history of preeclampsia
- History of chronic high blood pressure, diabetes, kidney disease or organ transplant
- First pregnancy
- Obesity (Body Mass Index (BMI) of 30 or greater)
- Over 35 or under 20 years of age
- Family history of preeclampsia (i.e., a mother, sister, grandmother or aunt had the disorder)
- Polycystic ovarian syndrome
- Lupus or other autoimmune disorders, including rheumatoid arthritis, sarcoidosis and multiple sclerosis
- Sickle cell disease
- African American
Your doctor may also decide to start you on low-dose aspirin before getting pregnant or during the first trimester of your pregnancy. Taking aspirin does not guarantee that you will not develop preeclampsia. It is simply one more thing that women can do with relative safety to reduce their overall risk.
What is the long-term impact of preeclampsia?
Women who have had preeclampsia have three to four times the risk of high blood pressure and double the risk for heart disease and stroke. They also have an increased risk of developing diabetes.
Although this may seem scary, there are many ways to reduce this risk through leading a healthy lifestyl!
For some women pregnancy can serve as an early warning sign for future heart disease. This kind of “heads up” gives you an opportunity to make changes now for a healthier future!
Some studies suggest, babies born from preeclamptic pregnancies have a higher risk of developing hypertension, coronary artery disease, and other chronic illnesses in adult life. These risks are especially true among babies who were delivered at term.
Reducing the risk
The most important way to reduce the risk of recurrence is to reduce or remove any risk factors. Therefore if you are overweight, reducing your BMI, quitting smoking and regular exercise are all beneficial.
What is low dose aspirin?
Aspirin is a blood-thinning medication. It is known as an NSAID (a non-steroidal anti-inflammatory drug).
Aspirin is often used to treat pain, fever or inflammation. It is usually prescribed to be taken from 12 weeks pregnancy (and at least started before 16 weeks) of 150mg per day until the end of pregnancy.
Taking a low dose of aspirin may help to reduce the risk of:
- Developing hypertension or pre-eclampsia (16 fewer per 1000 women treated)
- Your baby being smaller than expected (seven fewer per 1000 treated)
- Preterm birth (16 fewer per 1000 treated)
- Neonatal death (five fewer per 1000 treated)
Stats taken from Cochrane Review 2019.