Hello doctor,
I am currently in my third pregnancy and 20 weeks pregnant. My first pregnancy was characterized by gestational hypertension in late pregnancy. In my second pregnancy, I experienced gestational hypertension with fetal growth restriction. The child was also born with microcephaly. There were no genetic tests or infection tests that explained the microcephaly. It was possibly due to growth restrictions. I have never had any protein in my urine, and all kidney and liver tests throughout have been normal. I have noted that my blood pressure has elevated more after each pregnancy, particularly my diastolic pressure. Before my first pregnancy, my diastolic never exceeded 70 mm Hg in the office. Now I am lucky if I get a reading under 90 mm Hg in the office. However, it is acceptable in the ambulatory readings. Before my third pregnancy, my ambulatory blood pressure reading was 104/73 mm Hg on average, 104/77 mm Hg during the daytime, and 90/50 mm Hg at nighttime. My last ambulatory BP reading at 16 weeks was 108/76 mm Hg on average, 110/82 mm Hg during the daytime, and 90/50 mm Hg at nighttime. I have noticed my diastolic pressure to be 90 mm Hg in the evening on my home machine.
I am worried this pregnancy will result in worse outcomes than ever before. I have struggled to gain access to a specialist in my early pregnancy, and my general practitioner (GP) seems clueless about these things. Because of poor support in my previous pregnancy, I have extensively researched preventive measures for pre-eclampsia and fetal growth restriction. Still, I need expert advice. Upon my insistence, I have been prescribed 81 mg Aspirin from 12 weeks, which I also took during my first pregnancy. I wish to do more prevention if possible. Please enlighten me as to what treatment combination is best. Nitric oxide supplementation might benefit, particularly in avoiding growth restriction. I try to eat a beetroot daily.
- I am taking three grams of L-Arginine from 20 weeks and 81 grams of Aspirin. I have read that caution should be taken when supplementing L-Arginine with blood thinners. Is it fine to combine these two medicines, or should I discontinue them at some point before delivery?
- Do I have to take vitamin-C together with L-Arginine?
- I am concerned about interactions between all these medications, which I do not fully understand. Please advice. Do you have any other suggestions for supplementation?
I have to mention that I have grandparents, aunts, and uncles on both sides of the family who have had brain hemorrhages at a young age. Neither of my parents nor siblings has experienced this, though. I was taken for a screening brain magnetic resonance imaging (MRI) because of this a couple of years ago, and there was no indication of any aneurysms in my brain. However, I have mild cerebral palsy, probably had a brain bleed in the uterus, and was also growth restricted before birth.
Thank you.