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From Suzanne
jsgerber@sympatico.ca (Stratford, ON, Canada)
Q: 15 months ago I gave birth to a son. He was born at 36 weeks due to HELLP Syndrome. My husband and I have been considering trying again. I asked my GP to refer me to a specialist, which he did. The specialist did a complete blood work up on me. He was most concerned about Lupus. I tested negative for Lupus however, I tested positive for AHA Antibodies. He described them as the antibodies that are found in women with Lupus. He felt this would put me at a 25% chance to get Preeclampsia in a future pregnancy. In your extensive research has this come up with other women? Did they have another baby after? Any help you could give me would be greatly appreciated!
A: Women who have HELLP or severe preeclampsia in a pregnancy have a 25 to 50% chance of having preeclampsia in a future pregnancy. The positive ANA probably confirms that you have some "low grade" autoimmune process that predisposed you to preeclampsia.
Although your risk of preeclampsia is high, that does not necessarily mean that it will be as severe. You delivered at 36 weeks. If your were very preterm, the risks of a bad outcome would be greater.
For the most part, we can protect mothers from severe preeclampsia by careful care and delivery prior to severe disease. Since you are "at risk" you would be followed very closely, (probably every week from 32 weeks). Subtle symptoms would be taken very seriously.
It is more difficult to predict outcomes for the baby. Preterm delivery is the major risk. However, even if you delivered 2-4 weeks earlier, your chances of a good outcome are very good.
Many women choose to attempt a second pregnancy after HELLP. I would recommend that you be followed by a specialist in Maternal Fetal Medicine,
(www.smfm.org or www.nasshp.org).
Tom Easterling
Maternal/Fetal Medicine Specialist
University of Washington
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