I Had Pregnancy Complications the First Time. Will They Happen for the Second Pregnancy?

I had severe nausea, fatigue, anxiety, and depression and preeclampsia (that one toward the end only) in my first pregnancy with my daughter. I want so much to give her a sibling but despised being pregnant — I’ve never been more unhappy or unwell. What is the likelihood of a similar pregnancy?
—Anonymous

I hope people will weigh in in the comments on this question, because it reflects so much of what I hear from the many, many readers with complicated first pregnancies. Most of us enter our first pregnancy with cautious optimism. We often enter our second with more complicated feelings, especially when things were hard.

There is a glass-half-empty answer to your question, and a glass-half-full.

On the half-empty side: Most pregnancy complications have a risk of recurrence that is higher than the baseline risk. For the ones you cite, if you take something like severe nausea, the recurrence rate is probably around 50% (depending on how it is measured). For the kind of later-onset preeclampsia you describe, the recurrence rate is around 16%. So your risks are higher than they would be if you hadn’t had these complications before. Does this mean that these things will happen for sure? No. A 16% recurrence risk means an 84% chance of no recurrence.

On the glass-half-full side: In a second pregnancy, you will be better prepared. In some areas, this may help you lower your risk (i.e. low-dose aspirin reduces the risk of preeclampsia by about 20%). Even if you cannot lower your risk, you may be better able to access treatment (for example, for depression) if you know it might be coming. The awareness, the ability to know what you are facing, could make it easier.