Considering another pregnancy after HG

There’s no right answer for everyone, but information and asking the right questions can definitely help with navigating this decision. 

If you are definitely planning another pregnancy, check here for practical tips to help improve your chances of avoiding the worst of HG next time. 

Will it happen again? 

It’s more likely to happen again than not. 

Firstly, the recurrence rate for HG is high - exact estimates vary by study, but 80% is a common figure. So of 10 women who’ve had at least one HG pregnancy, 8 will have it again in another. 

You may be at the higher side of that 80% if you have a family history of HG and/or your HG was severe or persisted throughout pregnancy (in one study in the Netherlands, the recurrence rate was 89%). You may be on the lower side if you’ve had at least one other pregnancy without HG. But there is currently no way to know for sure - therefore we say to assume that you will, and make your decisions and plans accordingly. 

Why does HG vary between pregnancies? 

The exact science of HG is still being worked out, but we know that it is likely caused by a genetic variant which makes us more sensitive to a normal hormone produced by the placenta, called GDF15. So both your sensitivity to the hormone, and the amount produced by your baby’s placenta, contribute to HG. 

As each baby’s genes are different, that means a person may have HG in one pregnancy where that placenta produces a higher amount of GDF15, and have normal pregnancy nausea in the next pregnancy if the second placenta produces less GDF15 - and vice versa. 

GDF15 levels in the body pre-pregnancy may also vary due to lifestyle factors, age, etc. - there is lots of research still to be done! Bottom line - if 8 people out of 10 with a history of HG will have another HG pregnancy,  there is no way yet to predict whether you will be one of those 8 or the lucky 2. 

We recommend considering the following questions carefully, taking as much time as you need...

What happened in your HG pregnancy? And how has your recovery been? 

It is often very useful to look back at your HG pregnancy and compare the care you got with the care pathways in the medical guidelines. 

Unfortunately, not every GP or hospital is up to date yet, and we hear from too many women who don’t know, for example, that there are treatments other than Cariban; or that they should have got regular IV rehydration; or who don’t get the correct mental health support.

If you had extra complications because of HG (such as blood clots, IUGR, preterm birth, perinatal depression, or PTSD), how well have you recovered from these - do you need more treatment? And how easily can these complications be treated in another pregnancy?

Get your maternity notes and go through them, ideally with a healthcare professional who wasn’t involved in your care the first time around (this could be a new GP, a private midwife, or consultant). 

What support do you have? 

Firstly, support from your partner. How do they feel about going through another difficult pregnancy (especially if you now have another child at home to take care of)? 

Medical support is absolutely crucial to your experience. Do you have a GP who take HG seriously and is up to date on the guidelines? A supportive GP can make a world of difference in proactive treatment which can keep hospital visits to a minimum. If your GP was unsupportive last time, and isn't open to learning about the new HG guidelines, can you switch GP or practices? How does your nearest maternity hospital(s) treat HG? Our private support group is a good place to ask for questions and recommendations. 

You’ll also want to consider your financial situation. Will your family cope if you cannot work+/take care of other chidlren for a few weeks or months, or potentially the whole pregnancy? If you are employed, do you know your sick leave entitlements and will your workplace be flexible about working from home and/or reduced hours during pregnancy?

Finally, supportive family and friends can make a huge difference. Is anyone else willing and able to help with childcare and the basics of living like cleaning, cooking, looking after pets, giving lifts to hospital, etc. - possibly for months? If you don't have family and friends locally, could they contribute to support like a meal service, childcare, or a cleaner?

How can I decide? 

There is no right answer and no one right way to feel. You may rightfully dread another pregnancy like your HG pregnancy. You may decide one way now and change your mind in the future. But it can be helpful to ask yourself:

• Are there things you didn’t have access to or didn’t try last time that could make a difference in the future? 
• Are there things within your control that would make another pregnancy different to the last - even if HG hits again?