Preeclampsia is a serious condition that can develop during pregnancy, typically after 20 weeks of gestation. It involves high blood pressure and can impact organ systems throughout the body, such as the kidneys and liver. This condition poses health considerations for both the pregnant individual and the developing fetus. Recognizing the factors that influence its occurrence is important for managing current and future pregnancies.
Understanding Recurrence Rates
A history of preeclampsia increases the likelihood of experiencing it again in subsequent pregnancies. The risk of recurrence is not uniform, varying significantly among individuals. Research indicates the chance of preeclampsia recurring ranges from approximately 5% to 80%, with an average often cited around 20%.
An individual’s specific risk is influenced by numerous factors. For instance, a study in Sweden found a recurrence rate of 14.7% in a second pregnancy for women who had preeclampsia in their first, increasing to 31.9% if it affected two consecutive previous pregnancies.
Factors Influencing Recurrence Risk
The severity of preeclampsia in a previous pregnancy and the gestational age at which it occurred influence the risk of recurrence. If preeclampsia developed early in a prior pregnancy, especially before 34 weeks, the chance of it recurring is higher. For example, a previous delivery at or before 28 weeks due to preeclampsia is associated with a 38.6% recurrence risk, decreasing to 13% if the first delivery was at 37 weeks or more. More severe forms, such as those involving HELLP syndrome or eclampsia, can lead to recurrence rates approaching 50%.
Underlying health conditions also contribute to the risk of repeat preeclampsia. Individuals with chronic hypertension, kidney disease, or diabetes (Type 1 or 2) face an elevated risk. Autoimmune disorders, such as lupus, can similarly increase the likelihood of recurrence.
The time between pregnancies, known as the inter-pregnancy interval, can also play a role. Studies suggest that intervals longer than four years may slightly increase the risk of recurrent preeclampsia compared to intervals of two to four years. Shorter intervals, such as less than two years, do not consistently show an increased risk.
New pregnancy characteristics can also modify the risk profile. Carrying multiple babies, such as twins or triplets, increases the chance of preeclampsia recurring. Other contributing factors include a higher maternal age, particularly over 35 or 40, or a body mass index (BMI) over 30. A family history of preeclampsia also indicates an elevated risk.
Monitoring and Management in Future Pregnancies
For individuals with a history of preeclampsia, planning a subsequent pregnancy often begins with preconception counseling. This allows healthcare providers to assess individual risk factors and discuss a personalized care plan, preparing for the unique monitoring needs of the next pregnancy.
Increased prenatal monitoring becomes a regular practice throughout subsequent pregnancies. This involves frequent blood pressure measurements and urine tests for protein. Blood tests may also assess kidney and liver function, and ultrasounds can monitor fetal growth and well-being. This surveillance aims to detect any early signs of preeclampsia.
Preventive treatments may be recommended to reduce the risk of recurrence. Low-dose aspirin (81 to 162 mg per day) is often advised for individuals at high risk. This treatment is usually started early in pregnancy, ideally before 16 weeks gestation, and continues until delivery, potentially reducing the risk of recurrence by 15% to 30%.
Calcium supplementation is another potential intervention, particularly for those with low dietary calcium intake. Doses from 1.0 to 2.0 grams of elemental calcium per day may be recommended. Collaboration with healthcare providers is important, enabling timely adjustments to the care plan and supporting positive outcomes for both the pregnant individual and the baby.