“Mailbag 18: What does the Fox say” – with Dr. Nathan Fox

Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB/GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.

Welcome to our mailbag podcast. Our first question is from Leah, “Hi, Dr. Fox. Love the podcast,” thanks, Leah, “Have enjoyed listening throughout my pregnancy. I’m a few weeks away from delivering, and my baby has been breech for a long time. So, I have a C-section scheduled. The baby has been in the same exact position every time I get an ultrasound, which has been once a week for a while due to some high risk factors. It has me wondering what typically causes a baby to stay breech until the end. I know uterus shape can be a factor, but no one has mentioned that being the cause in my situation. Thank you.”

So, Leah, you are correct that we don’t really know for most babies why they stay breech until the end of the pregnancy when they do. The likelihood of a baby being breech at the time of delivery, meaning head up and butt down, is actually pretty low. It’s under 5%. Earlier than that in pregnancy, along the third trimester, a lot of people have ultrasounds or exams that say, “Hey, your baby’s breech. Hey, your baby’s breech,” you know, much, much higher percentage than that like up to 50%. But almost all those babies find their way to head down by the end of pregnancy. Now, how do they do that?

So, we’re not 100% sure. We think there might be some sort of brain stimulus for them to do that, to sort of find their way head down. Others think it’s just more a function of geometry, that since the bottom of the uterus is sort of shaped like a funnel, that when the feet are there, they just sort of kick around and they don’t really wedge in there. But once the head gets down there, it sort of pushes into the funnel and stays that way. Ultimately, these are theories. We’re not sure 100% why it might be. And we also don’t understand why some of the babies don’t end up head down. Probably most of the time, it’s just luck that it just didn’t happen for that particular baby.

There are certain reasons it could be more likely. One of them that you mentioned was having an abnormal uterine shape. So, yes, there are some people who are born with an abnormally shaped uterus, maybe more like a heart, for example, or sometimes they have something called a unicorn uterus, which is just one horn of a uterus. And that’s its own separate topic, abnormal uterine shapes. But that can happen. And when that happens, the babies don’t have the same space and room to sort of navigate to head down, so there is a higher chance of them not being head down.

Now you often would not know if you had an abnormal uterine shape before you got pregnant because it’s not… The testing that’s done to figure that out is not routinely done on people. You wouldn’t have any typical reason to have those imaging tests done before you get pregnant. And then when you deliver, if it’s by C-section, usually the surgeon would know if the uterus was shaped abnormally, not always but usually. If you deliver vaginally, sometimes the obstetrician midwife would be able to know, sometimes not. And so it is possible for people to have one or two pregnancies and not know if their uterus is shaped abnormally.

If someone had a breech baby or several times they had a breech baby in several pregnancies and they weren’t really sure and it was not clear to me maybe from the surgeon’s operative report or it wasn’t us, sometimes I will recommend that imaging to see if the uterus is shaped abnormal. That would either be a form of an ultrasound called a saline infusion sonohysterogram or sometimes an MRI and we can figure it out that way. There are other reasons. Sometimes if there’s a low amniotic fluid, the baby can’t turn from breech to head down. Sometimes if let’s say there’s a short umbilical cord or maybe it’s wrapped around the baby’s body or the baby’s neck several times, just sort of physically not allowing the baby to do that. But we don’t often know that until delivery.

So, the short answer to your question is I don’t know but nobody knows. So, hopefully since this was recorded after your delivery, I believe, hopefully everything went well. Whether the baby did turn and you had a vaginal delivery or whether you ended up with a C-section, I hope it went well. Sorry I couldn’t give you a better answer to your excellent question.

All right, next question is from one of our anonymous listeners, “Here’s my question. I had gestational diabetes with my most recent pregnancy. Going forward, is there anything I should do differently diet-wise when, A, trying to become pregnant and, B, once I become pregnant, how can I lower my chances of having it again?

All right. Thank you for the question. So, gestational diabetes, again, just as a review for our listeners is something that occurs during pregnancy. It’s generally thought to be a more marked response to the placental hormones than normal. So, what do I mean by that? So, pretty much in pregnancy, everybody’s blood sugar goes up a little because of the pregnancy hormones. And gestational diabetes is sort of when we think it’s crossed the line, that maybe it’s too high, exactly what the cutoffs are, are complicated and why those are the cutoffs and whatnot. That’s for a different podcast.

But ultimately what happens is someone’s blood sugar is higher than we want it to be from the pregnancy and then we adjust their diet, sometimes give them medication, you know, to sort of get their blood sugars back in order. Okay. So, if you have gestational diabetes in pregnancy, there are several things that are important not just for the pregnancy but for the future. So, number one, some people who have gestational diabetes actually have a form of diabetes or pre-diabetes and were just finding out about it during pregnancy, right? There are definitely people who come into pregnancy who have not been tested for diabetes in several years, right? That’d be typical because you wouldn’t normally test someone for diabetes when they’re 20s or 30s unless there was a reason to. So, if they get diagnosed with gestational diabetes, we assume it’s from the pregnancy, but we don’t know that 100%. So, what do we do after delivery? We recommend usually around one to two months later when the pregnancy hormones are sort of out of your system to repeat the screening to make sure you don’t have a form of diabetes or pre-diabetes in your life when you’re not pregnant. So, that’s number one thing for planning for the next pregnancy is to make sure you don’t actually have a form of diabetes or pre-diabetes in your life. So, either that was done after you delivered, in which case if it was normal, you’re good, or if it wasn’t done, that’s something I always recommend between pregnancies for someone whose last pregnancy was complicated by gestational diabetes.

Okay, so let’s say that’s done and let’s assume that it’s normal. You do not have diabetes or pre-diabetes in life, and now you’re just coming into the next pregnancy. So, there is an increased risk of getting gestational diabetes in a subsequent pregnancy when you had it in the first pregnancy, and that’s been shown in many, many, many studies. Now some of those studies, not all the women were tested in between, so maybe some of them actually have something going on in their life. But even amongst people who are tested in between and it is assured that they don’t have a form of diabetes or pre-diabetes in life, when they get pregnant again, there is a higher chance of getting gestational diabetes again than somebody else. Now it’s not 100% based on the study, somewhere in the range of let’s say 30% to 50%. So, call it a coin toss, 50-50.

Some of that’s related to other risk factors for diabetes, like PCOS or weight or family history. Some of it might be related to how severe the gestational diabetes was in the first pregnancy, right? Was it just something you needed to adjust your diet a little bit and it was fine versus being on a boatload of insulin? So, there are some factors, but let’s say it’s 50-50 the next pregnancy. So, your question is, “Well, what can I do to lower that chance from 50% to something lower?” Interestingly, there are some things that might be helpful but some things that really just aren’t going to work. So, if someone has risk factors coming into pregnancy, so if you have PCOS, well then you have PCOS. You can’t really get rid of that, right? And things that people do to manage PCOS don’t “cure” it. They just sort of manage it. If it’s related, sometimes people have a higher risk of diabetes because of their weight. So, yes, maybe losing weight before pregnancy or an early pregnancy might be helpful, but it’s not simply a weight related thing. It’s really how does the body respond to the placenta. And some of that’s related to the body, to you, and some of it’s related to the placenta, which is why again, it’s not 100%. You could have the same person who gets pregnant twice in two years. First time, she has gestational diabetes. Second time, there’s nothing really different about her and she doesn’t get gestational diabetes. So, some of that is related to the placenta and obviously you can’t pick your placenta.

I would say that, in general, there is some evidence that being on a Mediterranean diet lowers your risk of gestational diabetes. There’s mixed data on whether exercise and pregnancy lowers the risk of gestational diabetes. It’s good to exercise in pregnancy for many reasons. Whether that does or does not prevent or reduce your risk of gestational diabetes is mixed. Some studies suggest it does. Some studies suggest it does not. And interestingly, also, what you eat, people think that if you get gestational diabetes, it’s like, “Oh, if I could only go back in time and not eat sweets for the past month, I will not have gotten gestational diabetes.” That’s actually not true because again, the way we test for gestational diabetes is not what have you eaten in the past month. It’s how does your body respond to sugar that you eat. And there’s so many variables that go into that, that are not related to what you’re actually eating, that it may not be possible to lower your risk.

So, to summarize, I would say if you have risk factors that are modifiable, fine. Most people don’t or can’t modify them by that much. In pregnancy, maybe being on a Mediterranean type of diet could be helpful to lower your chances. Exercise is always good to do, you know, from a general health perspective, but not clear they will lower it. And I think ultimately, a lot of this is out of your hands, whether you’re going to get it again or not. Whether you find that reassuring or the opposite is definitely based on how you view things that are out of your control, but that seems to be what the data shows.

Okay, next question is from two listeners. One is Rachel, one is Leslie. They asked similar questions. I’m going to put them together. So, here’s from Rachel, “Hi, I’ve been binging your podcast ever since being introduced to it from a guest of yours and recently listened to the episode on PROM. Of my four labors, three started with SROM in the classic movie-like big gush, at least one I felt a pop beforehand, though thankfully I was at home and laying down with each of those. And the other one was a trickle followed by contractions and a later gross rupture in transition. I know you mentioned from an earlier podcast that the incidence of PROM is about 10% of the population and that there isn’t good data to predict who it will affect or recurrence. But I feel pretty confident that I’m just in the 10%. Even the labor that started with a trickle, I would think that is considered PROM. Do you feel the recurrence would still be a low likelihood for someone like me?” And then Leslie’s question, “So, with my first, my water had a slow leak in it. I was 39 weeks. I came into the hospital two days in a row with this issue. The first day ultimately was decided that it was not amniotic fluid and I went home. The next morning, the test came back as positive for amniotic fluid. So, once we finally figured this out, they admitted me and started an induction. I wasn’t yet feeling contractions. I’m wondering what are the chances of this slow leak of my waters happening again in the subsequent pregnancy?”

All right. Thank you, Rachel. Thank you, Leslie. I’m going to try to tackle all of this. Okay, so as some background, again, the term PROM stands for premature rupture of membranes. So, what does that mean? So, rupture of membranes means your water breaks. Premature means it happens before going into labor, right? So, for most people who go into labor 9 out of 10 times, they’re going to have contractions. They’re going to get worse. They’re going to go into labor. Their cervix is going to dilate. And then at some point thereafter, their water is going to break on its own, or sometimes the doctor, midwife or nurse will do that for you in the hospital. The other 10% of the time, give or take, it’s the opposite order. First, your water breaks, and then you go into labor sometime thereafter, or sometimes if you get to the hospital first, we will induce you instead of waiting for you to go into labor, so that’s what PROM means.

And then in Leslie’s question, SROM basically just means spontaneous rupture of membranes, which means your water breaks on its own. And that typically is used when someone is already in labor and then your water breaks. That’s what we call SROM, spontaneous, which differentiates it from artificial rupture of membranes, AROM, which is when we do it for you. So, again, PROM means your water breaks before you go into labor. SROM means your water breaks while you’re in labor on its own. And AROM means we broke your water for you, which can be done to put you into labor or while you’re already in labor. All right. Those are definitions.

The other thing that came up with both Rachel and Leslie was this idea of a slow leak. So, what do they mean? So, the classic, when Rachel said movie sense description of your water breaking, so you’re standing around and like, boom, a huge gush of water comes out. It’s obvious to everyone that your water broke, that that’s what it is. There’s no confusion. And that’s sort of like the classic picture of someone breaking their water. And that actually is what happens for most people. Maybe they won’t feel a pop. Maybe it won’t be a huge gush, but usually it’s obvious that a lot of water starts coming out and everyone is pretty sure that your water broke.

A slow leak is when there’s a very… We think of it like a very small hole in the membranes and that there’s a trickle of fluid, like a little drip, drip, drip that’s happening. And that’s very difficult sometimes to diagnose because the tests that we do to diagnose that someone’s water broke relies on the fact that there’s sort of amniotic fluid coming out or if we do an exam, it’s like in the vagina. So, if there’s just a little trickle coming out, it’s possible we could do our tests and they can come back negative when, in fact, there is a tiny slow leak going on or sometimes that leak comes and goes based on let’s say the baby’s head is compressing that hole or lifting off that hole. So, it can come and go and come and go. And that does happen from time to time where people are pretty clear that they’re leaking a little bit of fluid and then they come to us and we can’t find any evidence of it. And then several hours later or a day later, it picks up and we do diagnose them. And then the question is, “Well, does that mean that previously when they came in, it was actually broken at the time?” And we don’t know. It’s possible that it was broken and we didn’t find it or it’s possible that it wasn’t broken and it was something else and it broke later. We don’t really know.

In terms of the recurrence, we don’t know why people fall into that 10% or their water breaks before labor versus a 90% when their labor happens before their water breaks. And since we don’t know why that happens for most people, it’s very poorly understood, which is fascinating as a side note that we don’t understand this. It’s hard to say whether it’s going to happen again. So, yes, I do think that there’s probably some reasons that would be recurrent, that would happen over and over, right, because that’s true with most conditions, that there are some reasons for things that are going to happen in each pregnancy and some reasons that aren’t. And so let’s say for you, Rachel, who’s had it several times in a row, I would agree with you. Although I can’t prove to you that you’re more likely than 10% to have it the next pregnancy, it would seem possible or probable that you are. But it could also be that maybe you’re just the 1 in 100 or 1 in 1,000 who’s going to have a 2 or 3 in a row and everyone else doesn’t. And so it’s very hard to say for sure.

In terms of your question, Leslie, if you have a slow leak, is that going to happen in the next pregnancy? Again, we don’t know for sure, but that has not been my experience, right, that the sort of type of PROM like big gush versus slow leak, does that recur in subsequent pregnancies? Again, that has not been my experience, although it is certainly possible. I would say probably not a higher chance compared to someone else. So, that’s what I would say. All right. Good questions.

All right. The next is from another anonymous listener and it’s about having your gallbladder removed in pregnancy, “Hi, I’m so obsessed with your podcast. I’m currently binge listening to all of them and find them so informative and entertaining.” All right. To this anonymous listener, thank you. What a plug. Appreciate it. Back to her question, “I would love to hear your opinion on the following topic. What’s your take on getting the gallbladder removed during pregnancy? I have severe gallstones, which caused me to get attacks a few times a week. Each attack lasts a few hours. I’m on a low/no fat diet, but it isn’t helping much. The biggest complication is that after every attack, I have a couple of days of super itchy palms and feet and elevated liver enzymes bordering on cholestasis. I know that surgery during pregnancy is risky, but how do we weigh the benefits and risk of waiting it out versus doing surgery now? I would love to hear all the info you can share on this topic. Please keep this anonymous.”

All right. Well, you are correct, a complicated decision about whether to have the surgery or whether to wait until after the surgery, and it definitely has to be individualized. So, how do we do that? So, as some background, the gallbladder is an organ that sits under our liver on the upper right side of our belly, so just under the ribs. And essentially, the gallbladder sits there and it fills up with digestive juices. And then when you eat certain meals, it squeezes and squirts some of that into the intestines to help digest certain foods. Okay, that’s what the gallbladder does. Some people, for reasons we don’t completely understand compared to others, that fluid starts to crystallize and they develop first what we call sludge, which is like thicker fluid, right? Instead of viscous, it becomes a little thicker and then sometimes what we call gallstones, which are actually like rock hard stones that form inside the gallbladder. Now, having a stone inside your gallbladder does not tend to cause any symptoms or any issues or anything like that. But if the stone gets lodged in the duct, in the tube where the gallbladder uses to squirt the digestive juices from it into the intestines, right? It’s going through a little tunnel. If the stone gets stuck in there, then it can be very painful because the gallbladder is squeezing and squeezing and squeezing to try to get that juice into the intestines, but the stone is blocking it. And so similar to a kidney stone, which is the same concept where a stone gets stuck in a ureter, which is another little tube that connects your kidney and your bladder, this is a stone getting stuck in the tube that connects your gallbladder and your intestines and it hurts very, very much. That’s problem number one. Problem number two, because of sort of like the backup and the digestive juices sort of backing up and not getting into it, you’re getting other sort of gastrointestinal symptoms from it. You can get nausea, you can get vomiting, you can get bloating. It can affect some of your blood test results like this listener was talking about.

And the treatment for gallstones causing attacks, usually the only thing that’s going to work is surgery where basically you remove the gallbladder and that solves the problem. Now you would say, “Well, don’t you need the gallbladder?” Well, you do and you don’t. I mean, you can definitely live without it. There may be some issues with digestion afterwards, but typically it’s not a vital organ. So, you can have it removed and people do have it removed. So, if the treatment is to have surgery, the question is what happens if someone gets gallstones and gallbladder attacks when they’re pregnant? What do you do? So, as I said, it has to be individualized. And so what are the factors that help us decide whether to recommend surgery or whether to recommend waiting? So, the first one in no particular order is, well, how bad is it? If the attacks are rare and they’re mild and they don’t cause severe symptoms, then we’re obviously more likely to wait. That’s number one. Or, number two, if the attacks can be diminished either in severity or in frequency by changing someone’s diet, right? So, there are certain foods that will cause the gallbladder to squeeze more than others. So, this listener mentioned, for example, being on a low fat or a no fat diet. So, fatty foods are typically the thing that will stimulate your body to squeeze the gallbladder. So, for some people, they may get a gallbladder attack once a week or twice a week. But if they go on a low fat or a no fat diet, they may not get them at all. They may only get them once a month or two. So, that’s another factor. If it’s something that we can change with a diet, that’s something that maybe we’ll wait on.

Also, where are you in pregnancy, right? So, the earlier you are in pregnancy, the more likely in general we are to recommend surgery because, number one, you have a lot more time till you deliver. So, if it’s going to get worse, it can get worse later in pregnancy. Number two, it is technically easier to do the surgery earlier in pregnancy because the uterus is smaller and not in the way of doing the surgery in general. And also, you can still do the surgery laparoscopically, which is through small holes in your belly versus a big incision on your belly. So, the earlier in pregnancy this is happening, the more likely we are to recommend surgery. Now, if you’re already in the third trimester, then it’s sort of like same thing. How close are we to delivery? Can we wait it out until delivery and then do it afterwards versus does it seem like that’s not going to be able to happen?

And so I would say that that’s the most typical factors that will help us decide what to do is basically how bad is it and how likely are we going to be able to sort of wait it out until the end of pregnancy. And those are sort of related, obviously. So, if we think we can wait it out till the end of pregnancy, we will do our best to wait it out to the end of pregnancy and then take care of it after delivery. But if we don’t think that’s a possibility and there’s a window in time to do it earlier, then we will usually recommend to have the surgery earlier. But again, overall, it has to be decided person by person, case by case. So, this is the discussion that needs to happen with your obstetrician, with or without input from a maternal-fetal medicine specialist. Doesn’t always need to be but with or without. And the surgeon who’s operating. And if it’s the surgeon taking care of you and the gallbladder is the same person or if it’s, let’s say, a gastroenterologist taking care of the gallbladder, that team has to discuss together what is the best course of action taking into account all the possible risks and benefits of doing it earlier versus later.

All right. Last question from Megan, “Hello. I recently discovered your podcast due to a friend’s recommendation because of my personal situation. I had preeclampsia with both pregnancies. I had almost identical experiences with each child. At my prenatal appointment, my blood pressure spiked and I was sent to the hospital to be induced 39 weeks with my first, 37 weeks with my second. My blood pressure remained elevated during delivery and postpartum, and I was discharged on blood pressure medication. Two days later, I experienced extreme high blood pressure and went to the ER. I went on magnesium and stayed in the hospital for three more days and remained on blood pressure medicine for six weeks. I did take a baby aspirin with my second pregnancy. Fast forward to now, we would love a third baby, but we want to make a wise decision. We’ve met with an MFM, my OB and spend time researching. Are there specific tests that I should consider before moving forward? Should I meet with a cardiologist to see if my blood vessels or heart have been damaged from the experience of having preeclampsia? Is the compounding effect of preeclampsia three times in a row too high of a risk for my future health? I don’t have any of the common risk factors besides high cholesterol, which is an indicator of future heart disease. Is there anything at all I can do to help prepare differently this pregnancy? Our conversations with doctors have been helpful, but mostly they have told us, ‘We don’t know when it’s up to you.’ We are hopeful but anxious. Thanks for considering, Megan.”

So, Megan, you’re asking terrific questions. Very well thought out, very detailed. I don’t really like the answer, “We don’t know, and it’s up to you.” So, let’s see if we can do something a little bit better for you. So, as you mentioned, having preeclampsia once or twice as you had it, there are a few things to consider. First, you were talking about your own future health and whether having preeclampsia is going to somehow harm you or damage you or hurt you in the future. And that alone is a really interesting question. So, we know that women who have preeclampsia in pregnancy do have an increased risk later in life of things like high blood pressure, heart disease potentially. And the question is, “Why?”

So, there are a few theories, right? One theory is that, well, it’s really just related to risk factors, right? People who are more likely to get preeclampsia from certain risk factors like maybe age, maybe other medical issues, maybe weight, whatever it might be, those risk factors are the same ones that put you in increased risk for having heart disease or high blood pressure later in life, you know, 10, 20 years down the road. So, it’s not the preeclampsia that you got it or whatever, but it’s just the people who get preeclampsia are the same people who get it. In which case, it would not really matter if you got pregnant or not, right? If you have risk factors, you have risk factors. Fine. So, that’s one theory.

The second theory is that it’s not really risk factors but preeclampsia unmasks something about your physiology, your anatomy, whatever it is that we wouldn’t be able to identify otherwise that gives us sort of like… Think of it like a window into your future health, that if you get preeclampsia when you’re pregnant, even though we don’t know why and it’s not related to risk factors, there’s something about maybe your genetics, maybe your physiology, maybe your anatomy, whatever it might be that also indicates you’re at increased risk of getting it later in life. So, that’s kind of similar to the first reason, but it’s not like a risk factor we can identify. It’s this sort of like unknown risk that you have for later in life, so it’s just unmasking it. And in that case, if that’s the reason, also getting preeclampsia should not… Whether you get it or don’t get it or get pregnant or don’t get it should not affect your future health. And that way, it’s just unmasking what you’re at risk for anyways.

Now the third theory is that there’s something about getting preeclampsia that alters your body physiology or anatomy or whatever it is that actually puts you at increased risk for getting hypertension later in life. And in which case, yes, getting it over and over is going to increase your chances compared to not getting it over and over. And so what I would say is our current state of understanding is we don’t really know which of those three is the reason or if all three are reasons, how much each of them is weighed, meaning which is the most common or the most important reason compared to the others. I would think my best guess is probably the third one, the one where getting preeclampsia is the thing that actually harms you for future life, I think is probably the least likely, again, unless someone got preeclampsia that then caused them to have heart failure or something like, which is very, very unusual but just sort of like the typical scenario, so to speak, where your blood pressure goes up, plus/minus some blood test abnormalities. You get medicine, you don’t get medicine, and then it goes away. I don’t believe that that really causes in most people long-term heart damage. Again, it’s always possible, but it doesn’t seem to be the most common thing.

If you have a concern about that, then yes, I think it would make sense maybe to see a cardiologist, get an echocardiogram, maybe an EKG, have them take a look at you, and they can tell you as far as they know, how is your heart working, how is everything working there. If it looks pretty good and normal, then you probably have not been damaged by the preeclampsia or if you have, it’s not something we can really discern and shouldn’t probably give you a huge risk in your future. So, that is a possibility. It’s not a standard recommendation that everybody who has preeclampsia needs to see a cardiologist before their next pregnancy, but certainly if you’ve had it twice and it’s something you’re concerned about and you’re trying to make a decision about, “Should I have a third baby? Should I not have a third baby?” knowing that your heart function is normal might give you some reassurance that, even after having it twice, and it sounds like one was pretty severe, you’re still okay and doing well and that should give you some reassurance that getting pregnant wouldn’t necessarily be an issue.

Okay, the other thing is there is an option to take… I don’t know how much baby aspirin you were on in pregnancy, but there’s some data that taking a double dose of baby aspirin, which in the U.S. is 162 milligrams because one baby aspirin is 81 milligrams, might lower your risk to some degree. Certainly if your blood pressure is elevated at the beginning of pregnancy, that would indicate it’s not preeclampsia but rather a form of hypertension itself and then taking blood pressure medicine should lower the risk of getting it in the next pregnancy. So, I don’t think I would say to you, “We don’t know and it’s up to you.” That might be true, right? We don’t really know, and obviously every pregnancy is up to you, but what I would say is the most likely thing if you’ve had preeclampsia twice is that you are at increased risk for getting it again. How high is that risk? It’s not 100%, but let’s say it’s 50% or more. It does not mean you’ll get it as severe. It is possible that if you took a double dose of baby aspirin, you could lower that risk and not get preeclampsia or have a milder form of it. And if/when you do get it again, assuming you’re treated well and on top of it, the likelihood that it’s going to harm you in the long-term for your life is probably not that high, particularly if you have normal cardiac function beforehand.

There are some other circumstances where you would be at increased risk for getting preeclampsia. One of them is antiphospholipid syndrome. Traditionally, people who have antiphospholipid syndrome, when they get preeclampsia from it, they get it earlier than you did. They usually get it under 34 weeks. For someone who has severe preeclampsia under 34 weeks, the standard recommendation is to test for this condition called antiphospholipid syndrome, which is just a set of blood tests and then you repeat it a couple months later. And so you don’t technically meet the definition for that, but that’s something that if you really wanted to test everything possible to say, “Maybe I’m an outlier,” you could have blood work for that to see if it’s something that you do have… Although again, that would not be a standard recommendation, but that’s just thinking a little bit out of the box to maybe give you a little bit more reassurance for your next pregnancy.

All right. Thank you for that really, really interesting question, Megan. Thank you to all of our listeners and for your questions this week. We will see you next week.

Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.

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