Preeclampsia is a serious pregnancy-specific complication defined by the new onset of high blood pressure, often accompanied by signs of damage to other organ systems, such as the liver or kidneys. This condition typically appears after 20 weeks of gestation, most frequently occurring during the third trimester. It is a multisystem disorder that affects both the mother and the developing fetus, requiring close medical surveillance once identified. While it is a form of hypertension in pregnancy, preeclampsia is distinct because it involves signs of end-organ damage.
Recurrence Risk in Subsequent Pregnancies
The question of developing preeclampsia in a third pregnancy is a common concern. A prior history of preeclampsia significantly increases the chance of recurrence in any subsequent pregnancy. The risk is substantially higher than for someone who has never had the condition.
The recurrence rate is highly dependent on when the condition developed in the previous pregnancy and its severity. For women who experienced preeclampsia that resulted in a full-term delivery, the risk of recurrence in a later pregnancy is generally estimated to be in the range of 10% to 20%.
However, the risk increases dramatically if the prior preeclampsia was severe, or if it occurred early in the pregnancy, leading to a preterm delivery before 34 weeks. In these specific cases, the recurrence rate can be as high as 40%.
For a person who has had preeclampsia, the risk of developing it again in a third pregnancy is around 15% if only one prior pregnancy was affected. This is much higher than the 1% to 3% risk for someone who did not have preeclampsia in their first pregnancy. Furthermore, having had preeclampsia in two consecutive previous pregnancies raises the risk to approximately 30% to 32% for the third pregnancy.
Key Warning Signs to Monitor
Monitoring for specific symptoms is a proactive measure, though many signs of preeclampsia can mimic normal pregnancy discomforts. One of the most common signs is a new onset of high blood pressure, typically defined as readings of 140/90 mmHg or higher on two separate occasions at least four hours apart. Regular prenatal visits are designed to catch this symptom early, even before others appear.
The following symptoms must be immediately reported to a healthcare provider:
- Persistent or severe headaches that do not improve with typical pain relievers.
- Vision changes, such as seeing spots, flashing lights, blurred vision, or temporary loss of sight.
- Pain in the upper right side of the abdomen, located under the ribs, which can indicate liver involvement.
- Sudden, excessive swelling, particularly in the hands and face, or rapid weight gain of more than two pounds in a week.
- A reduction in the frequency or volume of urination, signaling impaired kidney function.
While not all symptoms will be present at once, any combination of these signs must be immediately reported to a healthcare provider. Early identification and prompt reporting of these changes are important for both maternal and fetal safety.
Proactive Prevention and Management
For patients with a history of preeclampsia, particularly those who had an early or severe case, medical intervention is often recommended to reduce the recurrence risk. The most effective preventative strategy is the use of low-dose aspirin, typically 81 milligrams daily, starting late in the first trimester. This medication helps prevent the condition by improving blood flow to the placenta.
This aspirin prophylaxis is generally advised to begin between 12 and 16 weeks of gestation and continue until delivery. The use of low-dose aspirin is considered safe during pregnancy and has been shown to significantly reduce the risk of preeclampsia in high-risk individuals. Other high-risk factors that warrant this prevention method include chronic hypertension, kidney disease, or an autoimmune disorder.
Once preeclampsia is diagnosed, the only definitive treatment is the delivery of the baby and placenta. Management involves close monitoring, including frequent blood pressure checks, laboratory tests to assess kidney and liver function, and fetal surveillance. The medical team will weigh the risks of continuing the pregnancy against the risks of preterm delivery.
For severe cases, or when the pregnancy reaches 37 weeks, delivery is typically recommended to prevent serious complications such as eclampsia, which is the onset of seizures. Medication to control blood pressure and magnesium sulfate to prevent seizures may be administered during the management phase.