If you had preeclampsia in a previous pregnancy, you are at an increased risk of developing it in future pregnancies. Your degree of risk depends on both the severity and the time when the disorder developed in your first pregnancy. In general, the earlier in the pregnancy you developed preeclampsia and the more severe the disorder, the more likely you are to have it again (see Figure 1).
If you had HELLP syndrome in a previous pregnancy, regardless of the time of onset, your risk for developing HELLP syndrome in future pregnancies is approximately 5%, while your risk for developing preeclampsia is 20%. If you had eclampsia in a previous pregnancy, your risk of developing it again is about 2% and your risk for developing preeclampsia in future pregnancies is 25%. If you had hypertension and abruptio placentae (premature separation of the placenta) in a previous pregnancy, your risk for having this condition again is approximately 10%.
To decrease your chances of developing preeclampsia in a second pregnancy, consider the following.
- Before becoming pregnant, ask your doctor to perform a thorough evaluation of your blood pressure and kidney function.
- If you or a close relative had vein or lung blood clots before, ask your doctor about testing you for clotting abnormalities ( thrombophilias ). These genetic defects increase your risk for preeclampsia and placental blood clots.
- If you are obese, consider weight loss.. Weight reduction may decrease your risk of developing preeclampsia again.
- If you have insulin-dependent diabetes mellitus, good control of your blood sugars before becoming pregnant and early in pregnancy reduces your risk for having preeclampsia again.
The prevention of preeclampsia has been the focus of multiple clinical trials. The following medications and supplements have been extensively studied for their potential to prevent preeclampsia:
- calcium (for example, Os-Cal);
- fish oil supplements (for example, Promega);
- supplements with vitamins C and E; and
- baby aspirin (for example, Ecotrin Adult Low Strength).
However, large studies have not shown calcium supplementation, baby aspirin, or fish oil supplementation to be beneficial in preventing preeclampsia. Early studies with vitamins C and E show a possible beneficial effect, but larger studies should be conducted before these agents can be broadly recommended. .
The best way to improve the outcome of your pregnancy is to see your doctor regularly. Begin prenatal care at the onset of your pregnancy and keep all your scheduled prenatal visits. Likely, your doctor will obtain baseline blood and urine tests during one of your initial visits. Throughout your pregnancy, these tests may be repeated to aid in early detection of preeclampsia should you develop the condition again. The frequency of prenatal visits may need to be increased.
If you do develop preeclampsia, you and your baby will be monitored regularly. Treatment, which centers on delaying the onset of severe disease and prolonging delivery until fetal maturity, may include daily self-measurement of blood pressure and restricted activity. If there is any change in your condition, you may be hospitalized promptly.