Exploring unmet needs and family planning among women with a history of preeclampsia: a qualitative study

Abstract Background Preeclampsia (PE) is a hypertensive disorder of pregnancy associated with significant morbidity and mortality in both the mother and baby. Moreover, women with a history of PE are at markedly increased risk of recurrence. Thus, these women and their families face difficult family planning decisions, often with few resources to aid them in making their decision. Purpose We aimed to identify the unmet needs of women with a history of PE, with a focus on decision-making surrounding family planning. Methods We conducted four virtual focus groups with 25 women between February 21, 2024 and March 20, 2024. We recruited potential participants from the “End Preeclampsia” website and newsletter in January 2024. To be eligible, potential participants needed to be at least 18 years old at the time of participation, have a history of PE, and report ever considering another pregnancy. Using rapid qualitative analysis methods, we analyzed the contexts and perspectives that contributed to women’s lived experiences, particularly surrounding their family planning decision-making. Results Four key themes emerged among women we interviewed. Participants reported 1) A lack of knowledge and awareness of PE prior to their diagnosis in past pregnancies; 2). Limited access to quality healthcare, consequently causing a delay in diagnosis and treatment; 3) A lack of emotional, informational, and provider support through their PE journey; and 4) having anxiety about future pregnancies due to the risk of PE recurrence. Altogether these themes heavily impacted participants’ decisions on future family planning, resulting in delayed subsequent pregnancy or foregoing pregnancy altogether. Conclusions Women with a history of PE have substantial unmet needs, including a need for more prenatal education from clinicians, increased emotional support from family, friends and support groups, and a lack of available PE information and counseling to assist them in future family planning decisions.