By Carolyn M. Salafia, MD
Q. I'm curious what the risks would be to me and a future baby. This would be my fifth pregnancy (one at 16, miscarriage at 18, one at 23, one at 24). The last two pregnancies were induced because of chronic hypertension, with the most recent one developing into preeclampsia. It seems that each pregnancy has gotten progressively harder on me, however we would like to have one more child in the next few years. Also, my doctor thinks I have multiple sclerosis, and I was wondering how that would affect things.
A. I would strongly recommend you discuss the concerns regarding multiple sclerosis with your neurologist. Multiple sclerosis is a disease that comes and goes, gets worse, gets better. I'm not certain that there is a real consensus whether or not pregnancy makes symptoms worse or not, or has an affect on the course of the disease, but I have to tell you, as a pathologist, that I am concerned about you that you're twenty-five years old with chronic hypertension.
Chronic hypertension many times is not associated with complications in pregnancy, and it seems that your 1998 pregnancy may have done well despite chronic hypertension, but in 1999 you developed a more generalized systemic response to the pregnancy that caused your vessels to constrict. That's something that gets a doctor concerned when your blood vessels may be getting a little bit "annoyed" with the repeated challenges of pregnancy. Many people who have preeclampsia in pregnancy do not recur, but with you developing preeclampsia in the fourth pregnancy, your history showing the change from no chronic hypertension to chronic hypertension, then hypertension chronically evolving into exacerbated hypertension during pregnancy . . . but you see why, as an "obstetric mechanic" (which is often how I consider my role to be best described) I would be worried about you from the point of view of recurrence, possibly more that I might worry about many women who simply had preeclampsia, not in the context of chronic hypertension, and in their first pregnancy. I'm concerned that your body may be changing its response to pregnancy, and I might worry more that yes, you might be a greater risk for preeclampsia in pregnancy again.
I am concerned about you from recurrence point of view regarding preeclampsia. I have to defer to your neurologist who might be better able to address questions related to impact of pregnancy on multiple sclerosis, but the first is quite enough for me to worry about.