Maternal Fetal Medicine visit

Tuesday I visited Maternal-Fetal Medicine at Evergreen Hospital after my initial appointment 3 weeks ago. These are the high-risk pregnancy doctors “perinatologists” (I can’t even imagine how much money they make an hour). I asked for a consult on my pre-eclamsia case and to tell me what the risks are for another pregnancy, if/when we choose to consider this in the future.

The most significant risk factors for pre-eclampsia are:
-Previous history of pre-eclampsia
-History of chronic high blood pressure, diabetes or kidney disorder
-Family history of the disorder
-Women with greater than 30% Body Mass Index (BMI).
-Multiple gestation -Over 40 or under 18 years of age
-Polycystic ovarian syndrome
-Lupus or other autoimmune disorders

I don’t have any of the other risk factors except for the history of pre-eclamsia.

And this is why I wanted to go.

Also, when all this was happening to me so fast in the hospital and the many months after I’ve felt totally out of control with my health. I had no idea what was going on and I had to trust my doctor and many others around me to do the right thing, take care of me and make the right decision.

Partly, I think that I have been very healthy and to now NOT be healthy has been a shock. Also, it’s very cliché … but, when you have your health you don’t think about it much verses when you don’t have your health. And partly, I was so exhausted when Alex was first born I didn’t have the brain power and energy to do anything other that take care of him and myself. I was in pure survival mode.

I asked the doctor about my future likelihood of getting pre-eclamsia again, why it happened in the first place, and what would be different (in terms of monitoring me) if/when we decide to have another baby.

Overall, I was glad to hear what he told me. He told me that although my future likelihood of getting pre-eclamsia was higher, I would be monitored much more. Like ultrasounds at 6, 12, 18 weeks and beyond! I would be monitored by both the normal OB and the high-risk OB.
He told me that the pre-eclamsia can be caused by a deficiency in folic acid due to a problem with metabolizing it and that even though I was taking the recommended 800 micrograms of folic acid in my prenatal vitamins, that wasn’t enough.

They tested me for the gene marker for that folic acid deficiency and I came back homozygous (or positive) for one gene that controls this metabolism. There is data that also suggests that a clotting disorder might play a role in pre-eclamsia and so they tested me for this as well. This came back negative. But, he said that they are finding new genes every day so, just because the 10 or 15 markers that they tested me for came back negative – that doesn’t mean that years down the road when they have more markers to test for that I won’t come back positive for a clotting disorder, as well.

It is very complicated and although I don’t understand much at this point, I will try to explain.
He said that I was a “classic” case. 1) strong family history of high blood pressure (HBP) 2) migraines. He said that blood pressure/pulse rate and pre-eclamsia are connected as well as the clotting disorders, folic acid metabolism and migraines.

I am to take 2 mg of folic acid (4 mg if/when I were pregnant again), baby aspirin (for thinning blood) and 25 mg of Atenolol (beta-blocker for HBP/pulse) a day. These are to treat/prevent problems in the future. All of this medication, along with the fact it will treat/prevent problems related to pre-eclamsia/HBP/pulse/clotting/folic acid disorders, it should help me with my migraines!

Although it took about 6 weeks for my BP to come down to normal after Alex was born and since then it has been fine, the doctor told me that BP isn’t the only measure of heart system health - - - pulse rate is also a measure.

Guess what?

My pulse rate is high (resting pulse rate of ~92-104 bpm compared to the normal person of ~60-70).

I have “pre-hypertension” and that by treating this now it would be much better for me in the long run. Since I’ve been back to work and working hard at work, surviving the layoffs, and working hard at home with an active little boy - I’ve been feeling anxious. Or what I thought was anxiousness.

It seems like it could’ve been the high pulse rate. The feeling that your heart is pumping fast and you need to calm down. Even though, I felt like I didn’t need to calm down. I felt fine, mentally during these episodes.

I knew that I would have hypertension – because of my family history at some point. I just didn’t think it would be at 30 years old.

I guess it’s like the weight loss surgeries - - - the sooner you treat the problem, the better off you are because then you don’t have 20-30 years of damage. In my case, this could’ve been 20-30 years of HBP/High pulse rate taking their toll on my blood vessels and heart systems.
In the end, he said that there was a good likelihood that I would be just fine and that treating me now for these issues will prevent problems in the future.

He also told me to have my parents (MOM and DAD!) take more folic acid since the HBP and folic acid are connected, and that this could help them. I also got one copy of the bad folic acid gene from each of them.

It can’t hurt!

I am still trying to syntesize everything that the Dr. said. So much information!