If You Have Preeclampsia Will You Have It Again?

By Dr. Kenosha Gleaton, OBGYN

Preeclampsia is a hypertensive (high blood pressure) condition that occurs during or after pregnancy. [1] Preeclampsia has the potential to impact all of the organs in the body and can become very dangerous. It’s estimated that up to 8% of pregnancy-related complications are caused or related to preeclampsia. [2] Fortunately, knowing early warning signs and common risk factors can potentially improve maternal and fetal outcomes. [2] 

Preeclampsia in Your First Pregnancy

Preeclampsia is a challenging condition that can be difficult to manage.  Let’s take a look at the general experiences, challenges, and treatments that are associated with preeclampsia. 

Experiences and Challenges

Often the first identification of preeclampsia is a high blood pressure reading, specifically 140 mm Hg/ 90 mmHg or more on two occasions at least four hours apart. [2] A shorter interval timing of 160 mm Hg/ 110 mm Hg or more can also identify preeclampsia. [2] These readings must be identified after 20 weeks of gestation. Presentation of preeclampsia often arises towards the end of pregnancy, but can also develop in the weeks after childbirth. [1] Read more about postpartum preeclampsia → 

We aren’t exactly sure why some develop preeclampsia while others do not. We have been able to pinpoint some high risk and moderate risk factors that should be considered when discussing preeclampsia risk [1-2]:

Moderate risk factors include:

• Use of in vitro fertilization (IVF)
• First time pregnancy
• A pregnancy occurring more than 10 years after a previous pregnancy
• BMI of 30 or more 
• Family history of preeclampsia
• Age 35 or older
• Factors associated with health inequities, such as race and income

High risk factors include:

• History of preeclampsia
• Multiple pregnancy (twins, triplets, etc)
• Chronic hypertension
• Lupus or another autoimmune disorder
• Diabetes
• Kidney disease
• Presence of multiple moderate risk factors

Medical Interventions and Outcomes

Managing preeclampsia begins with early detection and intervention. [1-2] Focusing on adequate blood pressure control and seizure prevention using beta blockers is often the first step. Depending on the severity of the condition, patients may be treated in a hospital or as an outpatient. [1] Close monitoring of fetal health, fetal movement, blood pressure, and other symptoms are vital for improving outcomes. Specific treatment and management options can differ and should be discussed with your healthcare provider. 

The Risk of Recurrence

Recurring preeclampsia is seen in anywhere from 13% to 65% of pregnancies. [3-4] The potential for preeclampsia to return is impacted by various factors, including ethnicity, region, clinical intervention, and others. [3-4] Research shows that certain supplements or medications may potentially reduce the risk of developing preeclampsia again. 

Factors Influencing the Risk of Recurrence

There are many factors that can impact the probability of developing preeclampsia again. Some studies show that the use of low-dose aspirin or heparin can actually reduce the risk of recurrent preeclampsia by 20% to 30%. [4] Research also shows that vitamin D supplementation can reduce cases of recurrent preeclampsia by 15%, as well as omega-3s, calcium, and folic acid. [4-5] Magnesium has also been found to decrease the risk of pregnancy induced hypertension in some people. [10] One study found that the risk of preeclampsia was inversely related to gestational age at first delivery, showing a higher risk (38.6%) of recurring preeclampsia when the first delivery occurred at or before 28 weeks gestation. [3] The study also found the following [3]:

• 29% risk of recurrent preeclampsia when the first delivery occurred between 29-32 weeks of gestation.
• 22% risk of recurrent preeclampsia when the first delivery occurred between 33-36  weeks of gestation.
• 13% risk of recurrent preeclampsia when the first delivery occurred at 37 weeks or more of gestation.

(The gist is that an early delivery in your previous pregnancy increases your risk of developing preeclampsia during later pregnancy.) 

Preparing for a Subsequent Pregnancy

If you are planning for or you’re currently experiencing a subsequent pregnancy after having preeclampsia, be sure to let your healthcare provider know about your medical history. There are ways to potentially reduce the risk of preeclampsia occurring again or catching and treating it as early as possible. [1-3] 

Consultation and Pre-Pregnancy Planning

Your healthcare provider will likely want to monitor your heart and kidney function early on. They will likely also go over any current medications you’re on, ask about your previous experience with preeclampsia, and any signs or symptoms you have experienced or know to watch out for. [1-2] Planning ahead is a great way to promote positive outcomes and early detection. 

If you are not yet pregnant, your healthcare provider may suggest certain lifestyle changes to reduce your risk of preeclampsia. Examples include diet and exercise, stress management, and medications to help reduce blood pressure. [1-2] 

Monitoring and Management Strategies

Regular monitoring and prevention methods may help to reduce the risk of developing preeclampsia. Some potential symptoms to monitor include [1]:

• Swelling in the hands or face 
• Prolonged headache
• Changes in eyesight
• Pain in the abdomen or shoulder
• Difficulty breathing
• Sudden weight gain
• Nausea and vomiting in the second half of pregnancy

Your healthcare provider may also suggest certain medication use or other strategies to keep blood pressure low, such as drinking plenty of water, reducing salt intake, and resting. [6] 

Role of Low-Dose Aspirin

Depending on your medical history, some healthcare providers may suggest a low-dose aspirin to reduce the risk of preeclampsia. [1] Low-dose aspirin is often a good choice if someone is at a high risk of developing preeclampsia or has multiple risk factors for preeclampsia. Aspirin works to thin out blood, which may help lower blood pressure, reduce the risk of heart disease, stroke, and heart attacks. [7] 

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Long-Term Impact of Preeclampsia

Untreated preeclampsia may lead to serious complications, impacting both maternal and fetal health. 

Health Risks for Mothers

Preeclampsia may lead to a condition that causes stroke and seizures. [1-2] Preeclampsia can also cause a syndrome known as HELLP (hemolysis, elevated liver enzymes, low platelet count). [1] HELLP syndrome can interfere with blood clotting and may lead to damaged or destroyed red blood cells. Other symptoms include chest pain, internal bleeding, and abdominal pain. HELLP syndrome can cause lifelong health problems and may be fatal. [1] 

Potential Impact on Future Offspring

Preeclampsia may require an early delivery. [1-2] Depending on how early a baby is delivered, there may be an increased risk of problems with vision, hearing, eating, breathing, and thermoregulation. In some cases premature babies may require ongoing medical care. [1] 

How Natalist Can Support Your Journey

Preeclampsia is a very serious condition that can result in added stress for many families. While we don’t have any proven methods for preventing preeclampsia yet, we do know that maintaining a healthy lifestyle during and before pregnancy lowers the risk of many complications and supports maternal health as well as fetal development. [8] Recommendations for a healthy lifestyle may look different from person to person, so be sure to check in with a healthcare provider if you’re pregnant or are trying to conceive soon. Many providers recommend prenatal vitamins, adequate hydration, a balanced diet, maintaining a healthy weight, stopping unhealthy substances, and maintaining regular exercise. [9] Additionally, some research supports the use of certain vitamins and minerals, including magnesium, for decreasing pregnancy-related high blood pressure. Support a healthy lifestyle with prenatal vitamins, magnesium drink powder, and more that are evidence-backed and plastic-neutral. [5,10] Shop all Natalist products → 

References:

1. Preeclampsia and High Blood Pressure During Pregnancy. FAQ034. ACOG. April 2023. URL. 
2. Karrar SA, Hong PL. Preeclampsia. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570611/
3. Mostello D, Kallogjeri D, Tungsiripat R, Leet T. Recurrence of preeclampsia: effects of gestational age at delivery of the first pregnancy, body mass index, paternity, and interval between births. Am J Obstet Gynecol. 2008;199(1):55.e1-55.e557. doi:10.1016/j.ajog.2007.11.058
4. Dong X, Han M, Zeb S, Tong M, Li X and Chen Q (2021) Active Management Reduces the Incidence of Recurrent Pre-eclampsia and Improves Maternal and Fetal Outcomes in Women With Recurrent Pre-eclampsia. Front. Med. 8:658022. doi: 10.3389/fmed.2021.658022
5. Mallory, J. Supplements Used in Prevention of Preeclampsia and for Labor Preparation. VA. March 2022. URL. 
6. Preeclampsia. American Pregnancy Association. Accessed July 2023. URL. 
7. Prevalence of Aspirin Use for Primary Prevention of Cardiovascular Disease in the United States: Results From the 2017 National Health Interview Survey. O'Brien CW, Juraschek SP, Wee CC. Ann Intern Med. 2019 July 23. doi: 10.7326/M19-0953. [Epub ahead of print] No abstract available. PMID: 31330542.
8. Koletzko B, Cremer M, Flothkötter M, et al. Diet and Lifestyle Before and During Pregnancy - Practical Recommendations of the Germany-wide Healthy Start - Young Family Network. Geburtshilfe Frauenheilkd. 2018;78(12):1262-1282. doi:10.1055/a-0713-1058
9. Good Health Before Pregnancy: Prepregnancy Care. FAQ056. ACOG. December 2021. URL. 
10. Li S, Tian H. Oral low-dose magnesium gluconate preventing pregnancy induced hypertension. 1997;32(10):613-615.