Preeclampsia can occur during a third pregnancy, as previous successful pregnancies do not provide complete protection from the condition. It is a serious complication of pregnancy that typically begins after 20 weeks of gestation, characterized by high blood pressure. This disorder can also damage other organ systems, most commonly the kidneys and liver. Preeclampsia is unique to pregnancy and requires close medical monitoring.
Understanding the Condition and Its Symptoms
Preeclampsia is defined by new-onset hypertension—a blood pressure reading of 140/90 mmHg or higher, measured on two occasions at least four hours apart, after 20 weeks of pregnancy. Diagnosis is confirmed when this high blood pressure is accompanied by signs of organ involvement. Organ damage is often indicated by proteinuria, which is an excessive amount of protein detected in the urine.
Even without proteinuria, preeclampsia can be diagnosed if high blood pressure is accompanied by other signs of organ dysfunction. These signs include a decreased number of platelets, impaired liver function shown by elevated liver enzymes, or new-onset kidney problems. Symptoms a person might notice include severe headaches that do not respond to standard medication, or changes in vision such as blurriness, light sensitivity, or flashing spots.
Upper abdominal pain, particularly under the ribs on the right side, is a serious symptom that can indicate liver involvement. While some swelling is normal during pregnancy, a sudden, excessive increase in swelling, especially in the face and hands, may signal preeclampsia. Since many people with preeclampsia experience no noticeable symptoms, regular blood pressure checks and urine tests at prenatal appointments are the primary detection method.
Analyzing Risk in Subsequent Pregnancies
While a first pregnancy is considered a high-risk factor, subsequent pregnancies are still susceptible to preeclampsia. The overall risk in any later pregnancy is lower than in the first, but it is heavily influenced by specific factors. For women without any history of the condition, the risk in a third pregnancy is around 1%, similar to the risk in a second pregnancy.
The most significant factor influencing the risk in a third pregnancy is a history of preeclampsia. For those who developed it in their first pregnancy, the risk of recurrence in the second is approximately 14.7%. If a person has had preeclampsia in two prior pregnancies, the risk in the third rises substantially, potentially reaching 31.9%. The severity and timing of the previous episode also matter; an earlier or more severe case is associated with a higher likelihood of recurrence.
Beyond a prior history, several other non-parity-related risk factors contribute to preeclampsia development. These include pre-existing medical conditions like chronic hypertension, diabetes, or kidney disease. New or persistent factors, such as maternal age over 35, multiple gestation (like twins), or obesity, also increase the baseline risk. Changes in underlying health status between pregnancies, such as developing chronic high blood pressure, can elevate the risk profile for any future pregnancy.
Prevention Strategies and Ongoing Management
For individuals at increased risk of preeclampsia, such as those with a history of the condition, specific preventive measures are recommended. The most common and effective primary prevention method is the daily use of low-dose aspirin, typically 81 milligrams. This therapy should begin early in pregnancy, ideally before 16 weeks gestation, to help reduce the risk of severe preeclampsia.
Regular prenatal monitoring is paramount for all pregnant individuals, particularly those with existing risk factors. This monitoring includes routine checks of blood pressure and urine at every appointment to screen for early signs, such as elevated readings or the presence of protein. Once preeclampsia is diagnosed, management focuses on preventing complications and safely prolonging the pregnancy.
In milder cases, management may involve increased rest and frequent checks of the mother’s and baby’s health through blood tests, ultrasounds, and nonstress tests. If the condition progresses to a severe stage, blood pressure-lowering medications may be administered, and the mother may be hospitalized for continuous monitoring. The only cure for preeclampsia is delivery, and healthcare providers determine the optimal timing based on the condition’s severity and the fetus’s gestational age.