Risk of pre-eclampsia in first and subsequent pregnancies: Prospective cohort study

Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
BMJ (online) (Impact Factor: 16.38). 02/2009; 338(jun18 1):b2255. DOI: 10.1136/bmj.b2255
Source: PubMed

ABSTRACT To investigate whether pre-eclampsia is more common in first pregnancies solely because fewer affected women, who presumably have a higher risk of recurrence, go on to have subsequent pregnancies.
Prospective cohort study.
Swedish Medical Birth Register.
763 795 primiparous mothers who had their first births in Sweden, 1987-2004.
The risk of pre-eclampsia was 4.1% in the first pregnancy and 1.7% in later pregnancies overall. However, the risk was 14.7% in the second pregnancy for women who had had pre-eclampsia in their first pregnancy and 31.9% for women who had had pre-eclampsia in the previous two pregnancies. The risk for multiparous women without a history of pre-eclampsia was around 1%. The incidence of pre-eclampsia associated with delivery before 34 weeks' gestation was 0.42% in primiparous women, 0.11% in multiparous women without a history of pre-eclampsia, and 6.8% and 12.5% in women who had had one or two previous pregnancies affected, respectively. The proportion of women who went on to have a further pregnancy was 4-5% lower after having a pregnancy with any pre-eclampsia but over 10% lower if pre-eclampsia was associated with very preterm delivery. The estimated risk of pre-eclampsia in parous women did not change with standardisation for pregnancy rates.
Having pre-eclampsia in one pregnancy is a poor predictor of subsequent pregnancy but a strong predictor for recurrence of pre-eclampsia in future gestations. The lower overall risk of pre-eclampsia among parous women was not explained by fewer conceptions among women who had had pre-eclampsia in a previous gestation. Early onset pre-eclampsia might be associated with a reduced likelihood of a future pregnancy and with more recurrences than late onset pre-eclampsia when there are further pregnancies. Findings are consistent with the existence of two distinct conditions: a severe recurrent early onset type affected by chronic factors, genetic or environmental, and a milder sporadic form affected by transient factors.

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    • "Therefore, gynecologists often provide extensive follow-up and counseling to these women, both postpartum and during their next pregnancy. However, only 7% of these former patients will actually develop a recurrent early-onset PE in their next pregnancy [2]. Therefore, current clinical management may be excessive in most former patients [4] [5] [6]. "
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    • "Several complications, such as intrauterine growth restriction (IUGR), gestational hypertension and preeclampsia, are associated with high oxygen concentrations inside the intervillous space in early pregnancy, oxidative stress into the villous trophoblast and reduction in uteroplacental blood flow [2]. These complications are major causes of maternal and fetal morbidity and mortality [3]. The use of Doppler ultrasound (DUS) to assess uteroplacental blood flow is currently the reference method for the clinical management of high-risk pregnancies [4]. "
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