The short answer is, nothing. You didn't cause this and the only preventative is low-dose aspirin, which currently works in about 15% of pregnancies, if you have no contraindications for use. That means lowering stress, stopping work, bedrest, eating a special diet, supplementing special vitamins, using herbal remedies, cleanses, and just about anything else you can think of to "try", won't actually change your outcomes. That is because these disorders are not caused by lifestlye. Many of us learned growing up that high blood pressure was for old, sick or obese people, people who eat too much salt or junk food, or unhealthy people. That is simply not true, and the type of hypertension we get with preeclampsia is controlled by the placenta. Preeclampsia begins at implantation and continues to be set up through implantation of the spiral arteries in the days and weeks after conception. There is no diet or special protocol that changes that, with the exception of aspirin for some people. We all want to "DO SOMETHING" and we are willing to "JUST TRY IT, IT CAN'T HURT", but the fact is that you didn't do something wrong that you have to fix, and, sometimes things that are not evidenced-based can actually hurt. Preeclampsia is caused in part by oxidative stress. In the late 90's someone decided that by introducing antioxidants, especially in large quantities, to women developing preeclampsia that we might reverse or stop the oxidative stress. In subsequent research, it was determined that the addition of these antioxidants, like seemingly innocuous vitamins C, E, Cod Fish Oils, and CoQ10, actually made preeclampsia worse, faster. These things were prescribed, especially by midwives into the mid-2000's. Herbal remedies, oils, special protein drinks and other seemingly healthful things haven't been tested in pregnancy and could cause harm. They also tested high protein diets and found those can cause harm to already struggling kidneys of the pregnant woman and cause preeclampsia to get worse, faster, in addition to causing problem for the baby. We talk more about supplements and diets in another unit. Things you can do: See your doctor for a physical every year, including checks of: Cholesterol BP Glucose Well woman checks (pelvic exam, pap smear, breast exam) Any other routine tests as recommended Get baseline proteinuria levels Treat any health issues currently existing (thyroid, diabetes, high bp, etc) Lose a few pounds if you are obese. It may not prevent preeclampsia, but it is a risk factor, and if nothing else recovery will be easier if you shed a few pounds Take 400mcg of folic acid preconception Eat healthfully Move your body Have a a preconception appointment with an OB or MFM and ask if you are a candidate for low dose aspirin Check with your doctor before you use any natural remedies Take your meds regularly if you have any Set up schedule with a therapist if you are nervous about the next pregnancy, or if you haven't talked to someone about the last pregnancy experience. Pregnancy can bring up traumas that you thought you dealt with. At least you will be an established patient, should you find the next pregnancy difficult Drink plenty of water Remember that you didn't cause this so be easy on yourself

For women who have a history of preeclampsia, what is the risk of recurrence in subsequent pregnancies? A large prospective cohort study found the following: In a first-time pregnancy, the risk of developing preeclampsia is 4.1%. For women who do not have a history of preeclampsia, the risk of developing preeclampsia in subsequent pregnancies is 1.7% overall. For women who developed preeclampsia in their first pregnancy, the risk of developing it in their second pregnancy is 14.7%. For women who developed preeclampsia in their first and second pregnancies, the risk of developing it in their third pregnancy is 31.9% For women who developed preeclampsia for the first time in their second pregnancy, the risk of developing it in their third pregnancy is 15.9% and the risk of developing it in their fourth pregnancy is 29% if they developed it in both their second and third pregnancy. For women who developed preeclampsia for the first time in their third pregnancy, the risk of developing it in their fourth pregnancy is 14.7%. For women who developed preeclampsia and delivered before 34 weeks in their first pregnancy, the risk of developing any preeclampsia in their second pregnancy is 29% and the risk of it being preeclampsia with delivery before 34 weeks is 6.8%. For women who developed preeclampsia and delivered before 34 weeks in both their first and second pregnancies, the risk of developing preeclampsia and delivering before 34 weeks in their third pregnancy is 12.5%.

Statistics of Recurrence Risk One of the most common questions we get here is, how likely am I to get preeclampsia/HELLP again? Here are the statistics researchers have compiled. Most women who get preeclampsia only get it once. The overall recurrence rate is around 20%, which means 80% do not get it again. Of those who get it more than once, most get it later and milder the second time. There is a lot of hope for a happy outcome, even if you get preeclampsia again. An individual's risk may be higher or lower than that average depending on their circumstances. The biggest factors seem to be how early you had to deliver and whether you have any known underlying conditions. The final risk range goes from 5% to 80% for various subgroups. HELLP has a lower recurrence risk range from 2% to 20%, again depending on circumstances. We often advise women to meet with a Maternal Fetal Medicine specialist for a preconception appointment. They are the experts in high risk pregnancies. They can review your history, recommend any testing for underlying conditions, and give you a more personalized risk profile. But no one can tell you which side of the odds you'll fall, whether you will or won't actually get preeclampsia/HELLP again. Statistics are useful for seeing trends in large groups, and can be useful in making decisions, but they ultimately tell you nothing about what will happen to you as an individual. Because for the lowest risk group who only have a 5% risk, if you happen to be part of the 5%, you get preeclampsia, 100%. And for the highest risk group who have an 80% risk, if you happen to be part of the 20%, you do not get preeclampsia, 0%. During my 10+ years in preeclampsia support groups, I have seen very high risk women who end up totally fine, and very low risk women who are The One Rare Case. The uncertainty and not knowing can be very hard to live with, and anxiety in second pregnancies is often high. No matter how high or low your personal risk is, you should be monitored closely and take any symptoms seriously. If preeclampsia does happen again (and it may not), catching it as early as possible gives you the best chance at a happy outcome. And if the anxiety gets overwhelming, please do not hesitate to reach out for help. Therapy and/or medication can do wonders.

We want to hear your stories about trying again after preeclampsia! We often get questions about next pregnancies, and we would like to collect short summaries in one place for easy reference. You are, of course, always welcome to make a post with a longer version of your birth story if you need support or want to share. For comments on this post, we would like to stick to the following information:

#YouAskedWeAnswered Questions to ask OB/MFM

#youaskedweanswered I had preeclampsia and/or a related condition. How long should I wait to try again? There are a lot of factors that can go into this decision, and what is right for one person may not be right for another. As far as preeclampsia risk, one study found that conceiving in less than two years did not raise the risk compared with conceiving two to four years later, but waiting longer than four years had a slightly higher risk. However, this is not a guarantee! There are women who get pregnant quickly and still end up with preeclampsia, and plenty who wait longer and are fine. No one should rush to conceive before they are ready, or worry they have missed their chance if it has already been a few years. Preeclampsia risk is just one thing to think about. There are other considerations. For example, if you had a c-section, you may want to wait longer for full healing, especially if you are hoping for a VBAC. If you are older and running out of fertile time, you may move forward more quickly. Our members who have lost a child balance grieving for the previous baby while longing for another. Being emotionally ready is helpful, too. Preeclampsia is a traumatic experience. Many of us deal with some combination of anxiety, depression, and post traumatic stress after going through it. Being pregnant again, or even considering another pregnancy, can bring these feelings to the surface and intensify them. We encourage you to talk with your doctor. They can go over your history and current health status. They may even suggest some testing for underlying conditions first. Then they can make a recommendation specific to you. It can also be helpful to work with a mental health therapist. They can help you process what you have already been through, think through the various considerations for a new pregnancy, and teach you coping strategies for when moments of anxiety come up. Have a story to share? How long did you wait to try again? What things did you think about when making the decision? Share your experience in the comments below.