thinking about ttc, and white coat HTN (long)

Are you considering having another child after preeclampsia? Trying again after preeclampsia can be an emotional challenge. You can find support with others who share your concerns here.
lisainnj
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Re : thinking about ttc, and white coat HTN (long)

Postby lisainnj » Fri Jul 18, 2008 09:37 pm

Thanks Stacey. That would be a good study - unfortunately sometimes a drug will work a miracle for one woman, but not for others. If he does the study let us know how it comes out.

I am feeling better now - was it starting the labetalol or a summer cold? I felt like that during the last pregnancy too - like a head cold that I couldn't shake for months.

I was on Norvasc pp, and it was another calcium channel blocker Procardia that finally seemed to make a dent in the hypertension - unfortunately also pp. If I decide to go ahead and do get pg and do get PE I would not let them try only labetalol.

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Re : thinking about ttc, and white coat HTN (long)

Postby staceynw » Fri Jul 18, 2008 06:48 pm

Lisa, I am the person Kara referenced earlier. I finally got a chance to check e-mail, and she asked me to peak at your post (been a long time since I've been here, at least 8 weeks).

I have chronic hypertension, and my first pregnancy went to 30 weeks until I had deliver my daughter due to severe PE. I also was terrified to try again, but determined too. My peri was convinced I would get PE again but I didn't, in large part thanks to the combination of atenolol and Norvasc. He said he was so impressed with my results that he is going to try to get funding to formally study Norvasc in relation to PE. I did make it to 37 weeks with my second daughter. There was some risk related to small gestational size in relation to the atenolol, but he still felt the benefit outweighed the risk. . . afterall, delivering pre-term due to PE would be far more risky. There hasn't been much published about Norvasc in pregnancy that I could find, but again, he felt any benefit outweighed the risk. Definately worth talking to a perinatologist about it!!!

Labetolol definately made me feel yucky too, and it didn't do anything for me.

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Re : thinking about ttc, and white coat HTN (long)

Postby amanda » Mon Jul 14, 2008 09:52 am

Hi Lisa -
I was also told to go into the pregnancy with it controlled - in fact, with my miscarriages it was certainly NOT controlled and they seriously attributed it to that fact! I was on a ACE inhibitor in the first part of pregnancy as well - stopped it when I was at the end of the first trimester per the pedi's direction.

Have you had an immunology workup? I'm just wondering - I never did but since I delivered I'm having all kinds of autoimmune issues - I wish that I could actually talk about it with the peri but since I'm not having any more :( I'm pretty sure he's not interested in me.

I can imagine this is a difficult decision - I am sorry.

There are certainly better HTN drugs than the one that you are on for controlling hbp and are safe for pregnancy - of course there are always risks but there are more risks having uncontrolled hbp - a sick mommy certainly doesn't do anyone any good. :(

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caryn
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Re : thinking about ttc, and white coat HTN (long)

Postby caryn » Sat Jul 12, 2008 11:23 pm

Yep. It's against the placenta, but turned off/modulated by the placenta, at least as I understand things...

They're looking at it for an early detection test. Here's a link or two:

http://www.ncbi.nlm.nih.gov/pubmed/18221926
http://www.ncbi.nlm.nih.gov/pubmed/17433833

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Re : thinking about ttc, and white coat HTN (long)

Postby lisainnj » Sat Jul 12, 2008 11:13 pm

I had a normal placenta, normal placental blood flow, normal renal flow. I am a puzzle to my MFM. He has not seen this in his twenty years experience. I saw one of the doctors on the board and she couldn't give me answers either.

Complement cascade - do you mean the membrane attack complex and all that? Against what? Placenta, endothelium, kidneys? I haven't read about this in connection with PE.

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caryn
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Re : thinking about ttc, and white coat HTN (long)

Postby caryn » Sat Jul 12, 2008 02:32 pm

She had (much like our chronics) either superimposed preeclampsia or a syndrome that was mimicking preeclampsia. The actual underlying problem was lupus, IIRC, and when steroids calmed down that immune response, the placenta and the pregnancy stabilized. I think what Fiona means is that she wasn't dealing with the shallowly implanted placenta or the typical cascade of immune responses; she had her own unique response that was different from the normal chronic superimposed PE with the whole complement cascade...

We've had other posters with lupus and much worse outcomes (one was in ICU by the start of her second trimester, and barely lived; the baby did not survive) so I'm not entirely sure it was lupus.

Here's a PubMed link: http://www.ncbi.nlm.nih.gov/pubmed/1740 ... d_RVDocSum

lisainnj
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Re : thinking about ttc, and white coat HTN (long)

Postby lisainnj » Sat Jul 12, 2008 11:29 am

I did have BP issues before I got pregnant with Francesca, not during any of my earlier pregnancies. The odd thing there was that my BPs were always good in the dr.'s office in the morning but bad at home at night. And my doctor and I dismissed that as stress about taking my own BP but I think now that the medication had just worn off by then. But that meant I never took my BP at night when I was pregnant with Francesca.

Since then there have been the studies that controlling a night time rise is beneficial for people with HTN, and that a night time rise is associated with worse PE outcomes. My htn is worse now but better controlled, and we would adjust the timing to prevent a night time rise.

I am feeling a bit better today. Maybe I'll adjust to the Labetalol.

I have borderline low protein S (protein S is protective against clotting) and the doctors say this can fluctuate. Both Dr. X and the MFM think I should do prophylactic heparin if I conceive, even though Francesca's placenta didn't show any significant evidence of clotting. The last tests Dr. X could think of to run are for anti-mitochondrial antibodies, and for a deficiency in the enzyme that breaks down bilirubin.

And then there's the whole issue of going to work after I graduate, if I'm pregnant. From my clinicals, I've learned that the physically easiest nursing position is NICU by far, followed by L&D. Talk about your emotional stressors. Med-surg, ICU, ER - you're running.

So if CatherineG didn't have PE, what did she have? She had very high BP, very high proteinuria. I thought her doctor said he thought she had some autoimmune reaction, but I took that to be one of the many etiologies of PE.

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Re : thinking about ttc, and white coat HTN (long)

Postby missgamecock » Sat Jul 12, 2008 10:49 am

I would want to go into pregnancy normal. I can tell you the first two appts at my obs office I have had high bps. The first one he said it was understandable because I had a previous loss and was back in the office with a new pregnancy. He said I had a normal bp in my pcp's office a couple of weeks before so he was going with anxiety at that appt. He was right. My bps in my pcp's and urologist's office and at home are perfect. The second appt I had come from work. We know that work totally stresses me out. Which is why he put me on one day a week work at home. So days I am in the office, my bottom number is low 90's. Days out of the office or off work, I am upper 60's to low 80's on the bottom. So my ob is looking at consistency. When they are consistently at one level. I am on Ziac which is a combination of 2 drugs bisopropol and hydrazaline. It's not my ob's first line choice, but it works for me and there is no evidence that it harms a baby. My pcp used my ob and was on ziac (same dose) and was fine.

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Re : thinking about ttc, and white coat HTN (long)

Postby kara » Sat Jul 12, 2008 10:08 am

It may not be appropriate for your case, obviously I'm not a doctor and every patient has different needs, but StaceyNW used a combination of atenelol and norvasc to control chronic hypertension before and during her second pregnancy. Her Peri was against it at first, but after looking at the research he decided it was a good idea (He's also my Peri, and has done research in Preeclampsia). And yes, she had a successful pregnancy with no PE and delivered at 37 weeks, I beleive. I'll see if I can put her in contact with you.

I think having a discussion with your doc, and even a second opinion if you aren't completely comfortable with your docs decision is worthwhile.

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caryn
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Re : thinking about ttc, and white coat HTN (long)

Postby caryn » Sat Jul 12, 2008 02:50 am

Lisa, I'm with you -- I think it would be preferable to go into a pregnancy normalized. Am I understanding you correctly to say that Dr. X did not want to do that because there's probably no way to balance you on drugs that are safe for pregnancy, so just hope for a placenta that works long enough?

I agree with you and Heather that it's theoretically possible that they could balance you on just labetalol or labetalol and aldomet, though from what you've said you would feel *awful*.

This was in the NYTimes this week: http://health.nytimes.com/ref/health/he ... y-ess.html
and made me think of the atenolol I took for performance anxiety. (It didn't work, and I think that's because my blood pressure control has *always* been broken in that particular way. Preeclampsia just added another level of anxiety on top of my normal jitteryness, which is a known symptom of PE in any case.)


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