Recurrence risk and prediction of a delivery under 34 weeks of gestation after a history of a severe hypertensive disorder

Abstract

Objective: The aim of this study was to report outcomes of the subsequent pregnancy after early-onset pre-eclampsia in a first pregnancy (index), and to evaluate the potential risk factors for recurrence of pre-eclampsia and preterm delivery. Design: We performed a retrospective cohort study of all women who developed early-onset pre-eclampsia (delivery before 34 weeks of gestation) in their first pregnancy between January 1996 and December 2004 in two perinatal centres with regional function. All patients were included consecutively. Information was retrieved on the course of subsequent pregnancies. Setting: Two tertiair centres with regional function. Population: Women with a delivery under 34 weeks due to a hypertensive disorder (N = 380). Main outcome measures: We determined the absolute risk of recurrence of an adverse outcome, defined as a hypertensive complication resulting in delivery before 34 weeks of gestation. The available clinical parameters were evaluated as predictors for recurrence using logistic regression analysis. Results: We identified 380 patients, of whom 46 were lost to follow-up. In total, 123 patients refrained from subsequent pregnancy (79 [64%] from fear of recurrence). Of the 211 patients with a subsequent pregnancy, 36 (17%, 95% CI 12–22%) had a recurrent delivery before 34 weeks of gestation, 30 (14%, 95% CI 9.5–19%) delivered between 34 and 37 weeks of gestation, and 145 (69%, 95% CI 62–75%) delivered later than 37 weeks of gestation. Of this last group, only 67 (32%, 95% CI 25–38%) pregnancies were completely uneventful. Chronic hypertension, maximum diastolic blood pressure, caesarean delivery and level of 24-h proteinuria were independent predictors for an adverse pregnancy outcome. Conclusions: Women that had early severe pre-eclampsia in their first pregnancy have a 17% risk of recurrence, with a delivery before 34 weeks of gestation. Only 32% had a completely uneventful pregnancy.