Pre-e in subsequent pregnancies

[Changed]

Just wondering what a midwifes perspective on this would be.

1st-preg- pre-e late onset 38 weeks. Induction with mag. Good outcome all around.

2nd-pre-e early onset (unrelated fetal distress) section at 33 weeks with mag. Good outcome for mom...NICU for baby- again unrelated.

3rd- VBAC- PIH starting at 34 weeks. Induced at 36 weeks to prevent pre-e complications. LOOOONG labor and birth mostly at home. No mag because delivery was shortly after arrival at hospital. Good outcome.

Would you take a 4th time mom and VBAC with this history? What form of care do you think would be safe and optimal given the history?

[mwherbs]

what is the basic metaboic problem? Diabetes, autoimmune disease, essential hypertension, genetic, how are your lungs? Get a complete physical, with blood work.Diet evaluation... there are some recent studies that show use of B vitamins and Folate supplements through out pregnancy helps reduce PE that would be where I would start. (the supplements I would use would be sublingual) also something herbal to support liver function- like milk thistle, and eating artichokes. Daily eat lots of green veggies , fresh or frozen berries, protein. Magnesium as an oral supplement NO simple sugars, no diet sodas, how much exercise do you get? walking or swimming a little to start with nothing heroic, 20 to 30 min of exercise a day can make a big difference in bp as well as blood sugar as well as over all health.

[time4another]

Is concurrent care an option?

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No preexisting conditions known. High protein diet with nearly daily exercise. Already on magnesium and folate. No liver issues non pregnant. On a good whole foods prenatal.

I did EVERYTHING last time to prevent it. I'm trying to decide what I need to do for another good outcome. I'd love a homebirth but I'm scared to death to hire a midwife, again, and end up walking in to the ER in transition.

I was told me chance of some form of hypertension this time was nearly 100% and that my chance of getting pre-e again was about 80%. Do you think that's accurate?

And no sadly, I can't do both. I have to choose between planning for home and planning for hospital.

Thank you so much for your responses.

[mwherbs]

yes, I think that your chances are high you will have PE again. You need a complete physical, and blood work that is beyond just a pregnancy panel. You could try concurrent care. How is your kidney function? Something that is a bit on the alternative side that may be what you have going on is rule out gluten intolerance- it is related to immune and absorbtion problems.
I am not so big on a high protein diet- more a veggie filled diet, because of the nutrients and they are easy on the kidneys. The Berries have to do with connective tissue health (including veins and arteries) and they are antioxidant.
Oxidative stress is thought to contribute. The thing with high blood sugar and elevated BP and certain autoimmune diseases is they damage maternal micro-circulation, so does certain metabolic disorders. there is also vascular inflammation - this is where high dose folate may help because in some cases it can reduce homocystine levels and reduce irritation which will result in lower BP . So when I say folate I mean more than the typical 800micrograms recommend for pregnant women- more like that amount several times a day-
the liver support is because of added blood volume and hormones that have to be managed
also consider taking some supplemental vitamin E for placental health.

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Thank you for your honesty and help. My kidney function seems just fine. I don't normally have any health problems at all.

Any further opinions or experience would be greatly appreciated as well.

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Bump!

[lunaliss]

I would recommend OB care but with concurrent care by a homebirth midwife. You may have to pay out of pocket for the midwife, but it's well worth it, if you are able.
Calcium supplementation, make sure you are getting 1500 mg/ day between diet and supp, diet is always superior to pills, when it's possible.
See an OB, but maintain a relationship with a MW.
You are very likely to develop pre-e again. But it's not guaranteed. Stay hopeful, keep doing all the things you have been doing, (but too much protein has rebound effects on your kidneys), and good luck to you.
Melissa, CNM

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Thanks!

Unfortunately, I can't do both. I found an OB that I really like a lot and a great doula.

I haven't heard a lot about the calcium supps or why they are thought to help. Do you know?

[maxmama]

Have you considered antihypertensives and a diuretic prophylactically? I used atenolol and lasix during my last pregnancy (following a preg complicated by HELLP syndrome) to good effect.

How do you know your kidney function is fine? Have you had a nonpregnant baseline 24 hour urine, creatinine clearance, uric acid and BUN levels drawn?

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Uh, no. I just feel like my kidneys are ok. Would I not know? My pee is cloudy but that's about it.

I haven't had those therapies recommended to me yet but I'd be open to them.

[maxmama]

Originally Posted by Jörð

Uh, no. I just feel like my kidneys are ok. Would I not know? My pee is cloudy but that's about it.

I haven't had those therapies recommended to me yet but I'd be open to them.

I have renal damage from the HELLP/pre-e. I feel fine. My baseline 24 hour urine protein is 300mg (normal is <5). My baseline creatinine and uric acid/BUN are in the high-normal to high ranges. So yeah, you can have an underlying kidney issue and feel fine.

Also, because a diagnosis of pre-e requires 300mg/protein/24hrs in addition to elevated pressures, it's good to know your baseline. My baseline meets criteria, but clearly I do't have pre-e, since I'm not pregnant. See what I mean?

[Changed]

Ok, got it. No, this time I haven't had any protein done yet. With my last, they had me do a 24 hour protein very early on to get a baseline but I never heard anything else about it so I assume it wasn't alarming. I had the typical prenatal labs done a few weeks ago if that means anything relative but everything was normal. Actually, other than the rate of new platelets being high. I figured that had to do with increasing blood volume.

Thank you for that info. I'm going to see about doing a 24 hour asap.