Pregnancy complications: What are the chances that they’ll happen again?
January 29, 2019
The joy and anticipation of pregnancy can be tarnished when complications arise. When problems do occur, women often ask us whether it means they are more likely to experience the same issues in the future.
The answer isn’t always simple. A woman’s risk for recurrent pregnancy complications largely depends on her situation and condition. As maternal-fetal medicine specialists, we frequently review pregnant women’s prior pregnancies to help determine their risk of future challenges. Let’s discuss some of the most common pregnancy complications women experience – and what the chances are that they’ll happen again.
Pregnancy loss in the first trimester is more common than most people think. It occurs in about 20 percent of the pregnancies we see. Devastated couples often ask whether we think a miscarriage will happen again during their next pregnancy. The answer? The risk is only about 3 percent higher than the average overall miscarriage risk of 9 percent for first-time pregnancies.
Additional individual factors also can come into play, such as the age of the mother – miscarriage rates rise as women get older – or the presence of certain medical conditions. However, we generally are optimistic with patients and let them know that their likelihood of having a successful pregnancy in the future is high.
If genetic anomalies are not a factor, strategies that can help prevent a second early miscarriage include eating healthy, well-balanced meals; avoiding smoking and secondhand smoke; and not consuming alcohol.
In our experience, few first-time moms think about the risk of preterm birth (when babies are born before 37 weeks of pregnancy). However, once that occurs and they experience life as a parent of a baby in the neonatal intensive care unit (NICU), the thought of it becomes a constant stress during their next pregnancy.
The overall risk for preterm birth is about 10 percent – and 75 to 80 percent of those preterm births occur following spontaneous labor or spontaneous rupture of membranes (when a woman’s “water breaks”). After a spontaneous preterm birth, the risk of it happening again during a second pregnancy is about 31 percent, but that comes with the caveat that the earlier the first preterm birth was, the higher the possibility is during the second pregnancy. Women who delivered their first baby between 24 and 28 weeks, for example, have a 40 percent chance of delivering early in their next pregnancy.
Similarly to preventing a second miscarriage, women can help decrease their risk of having a second preterm birth by implementing lifestyle modifications such as avoiding alcohol and cigarettes, managing stress, and exercising regularly.
The overall risk of developing preeclampsia (pregnancy-based high blood pressure) is approximately 3.4 percent in the U.S. And if women have it during their first pregnancy, the risk of recurrence is about 20 percent if they deliver near term and up to 70 percent if they deliver before 30 weeks of gestation. Make sure to talk to your doctor about strategies to reduce risk – one of which might include taking aspirin in a future pregnancy, which is associated with a low likelihood of serious maternal or fetal complications.
Many women want to try to have a vaginal birth after having undergone a C-section in their first birth, a proposition known by the acronym VBAC. The likelihood of having a successful VBAC, however, will depend on the reason they had the C-section previously. Some common scenarios for a C-section and the subsequent probability for VBAC success include:
● The baby had some sort of compromise or distress: Women we see typically have about an 80 percent chance of being able to give birth vaginally
● The baby was is in a breech position: Women have a fairly high chance (75 percent) of later giving birth vaginally
● The cervix didn’t dilate or the baby didn’t descend properly in the birth canal: Women we see typically manage to have their baby vaginally around 60 percent of the time
To better determine the probability of a successful VBAC, women can add some information additional informational about themselves into this calculator.
Related reading: Who is a good candidate for a VBAC?
Although every situation is different, just because a woman has a complication during one pregnancy doesn’t mean it’s certain to happen again. Women should speak to their doctor if they have any questions pertaining to recurrence risk or how to help prevent future complications.