Early onset preeclampsia: using population data to assess recurrence risk and adverse pregnancy outcomes

ABSTRACTObjectiveUse linked perinatal data to determine the subsequent pregnancy rate after a pregnancy with early onset preeclampsia and, among those who have a subsequent pregnancy, the risk of recurrence and adverse pregnancy outcomes. ApproachPreeclampsia is a hypertensive disorder of pregnancy associated with adverse outcomes for the mother and baby. Although rare, when preeclampsia occurs before 34 weeks of gestation, the risk of adverse outcomes is markedly increased primarily due to prematurity. Despite the desire for another child, many women are anxious about becoming pregnant again because of concerns of recurrent complications in a next pregnancy but information for counselling is sparse. We undertook a population-based record linkage cohort study using longitudinally-linked birth and hospital records from New South Wales (Australia) to create medical and obstetric histories. The study population included nulliparous women with a singleton pregnancy and early onset preeclampsia who gave birth between 2001 and 2010 (the index pregnancy), with follow-up for a subsequent birth through 2012. Early onset preeclampsia was defined as a hospital record (antenatal and/or delivery hospitalisations) with a diagnosis of preeclampsia and delivery before 34 weeks gestation. Outcomes included subsequent pregnancy, and among women with a consecutive subsequent birth, the preeclampsia recurrence rate and adverse pregnancy outcome rates. ResultsOf 1473 (4.0/1000) nulliparous women who had early onset preeclampsia in the index pregnancy, 60% had evidence of any subsequent pregnancy compared to 66% for women without preeclampsia (P<0.001). Of 758 women with early onset preeclampsia and a subsequent singleton birth ≥20 weeks gestation, 256 (33.8%) had preeclampsia in the subsequent pregnancy but only 57 (7.5%) had recurrent early onset preeclampsia. Most women (717, 94.6%) progressed to a later gestational age in their subsequent pregnancy. The median overall increase in gestational age at delivery was 6 weeks (interquartile range [IQR] 4 to 8) and among the women with recurrent preeclampsia the median increase in gestation in the subsequent pregnancy was 5 weeks (IQR 2 to 7). Outcomes in the subsequent pregnancy included 4.2% postpartum haemorrhage, 3.4% severe maternal morbidity, 2.6% Apgar <7 at 5 minutes, 16.2% small-for gestational-age and 1.7% perinatal deaths. ConclusionsMost women with early onset preeclampsia had good outcomes in their subsequent pregnancy. For rare conditions, linked population data with accurately recorded information can provide robust estimates of outcomes that can inform clinical counselling.

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Risk of Recurrent Adverse Outcomes in Gestational Diabetes: a Retrospective Cohort Study

10.22541/au.162454733.37753521/v1 ◽

2021 ◽

Author(s):

Sue Lynn Lau ◽

Alex Chung ◽

Joanna Kao ◽

Susan Hendon ◽

Wendy Hawke ◽

...

Keyword(s):

High Risk ◽

Gestational Diabetes ◽

Gestational Age ◽

Retrospective Cohort ◽

Adverse Outcome ◽

Subsequent Pregnancy ◽

Adverse Outcomes ◽

Instrumental Delivery ◽

Emergency Caesarean ◽

Index Pregnancy

Objective: Compare the risk of recurrent adverse delivery outcome (ADO) or adverse neonatal outcome (ANO) between consecutive gestational diabetes (GDM) pregnancies. Design: Retrospective cohort Setting: Sydney, Australia Population or Sample: 424 pairs of consecutive singleton GDM pregnancies, 2003-2015 Main Outcome Measures:. ADO: instrumental delivery and emergency Caesarean. ANO: large for gestational age (LGA), small for gestational age (SGA), and composite ANO (LGA/SGA/stillbirth/neonatal death/shoulder dystocia). Methods: Using each pregnancy pair (“index” and “subsequent” pregnancy), we calculated ADO and ANO rates and determined risk factors for subsequent pregnancy outcomes (multivariate regression). Results: Subsequent pregnancies had higher rates of elective Caesarean (30.4% vs 17.0%, p<0.001) and lower rates of instrumental delivery (5% vs 13.9%, p<0.001), emergency Caesarean (7.1% vs 16.3%, p<0.001) and vaginal delivery (62.3% vs 66.3%, p=0.01). ANO rates in index and subsequent pregnancies did not differ. Index pregnancy adverse outcome was associated with a higher risk of repeat outcome: RR 3.09 (95%CI:1.30, 7.34) for instrumental delivery, RR 2.20 (95%CI:1.06, 4.61) for emergency Caesarean, RR 4.55 (95%CI:3.03, 6.82) for LGA, RR 5.01 (95%CI:2.73, 9.22) for SGA and RR 2.10 (95%CI:1.53, 2.87) for composite ANO). The greatest risk factor for subsequent LGA (RR 3.13 (95%CI:2.20, 4.47)), SGA (RR 4.71 (95%CI:2.66, 8.36)) or composite ANO (RR 2.01 (95%CI:1.46, 2.78)) was having the same outcome in the index pregnancy. Conclusions: Women with GDM and an adverse outcome are at very high risk of the same complication in their subsequent GDM pregnancy, representing a high-risk group that should be targeted for directed management over routine care.

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Maternofetal outcomes in early versus late onset pre-eclampsia: a comparative study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190282 ◽

2019 ◽

Vol 8 (2) ◽

pp. 548

Author(s):

Poornima Shankar ◽

Kavitha Karthikeyan ◽

Amrita Priscilla Nalini ◽

Sindhura M. ◽

Gowtham Kim

Keyword(s):

Risk Factors ◽

Gestational Age ◽

Early Onset ◽

Age Of Onset ◽

Late Onset ◽

Fetal Outcomes ◽

Chi Square ◽

Onset Type ◽

Significant Difference ◽

Early Onset Preeclampsia

Background: Preeclampsia is being increasingly recognized as two different entities: early-onset preeclampsia occurring at less than 34 weeks of gestation, and late-onset disease occurring at 34 or more weeks of gestation. Early-onset and late-onset pre-eclampsia are found to have different implications for the mother and neonate. The aim of this study is to compare the risk factors, maternal and fetal outcomes in early (<34 weeks) versus late (≥34weeks) onset preeclampsia.Methods: 208 patients diagnosed with pre-eclampsia in Chettinad Academy of Research and Education over a period of three years (From January 2014 to December 2016) were retrospectively studied. Patients were classified as early onset and late onset pre-eclampsia based on the gestational age of onset. Data on risk factors, maternal and fetal outcomes were collected and analyzed using Chi Square and Fisher’s test and compared.Results: The overall preeclampsia rate was 6.3%. Early onset and late onset were 34.6% and 65.3% respectively and the rate increased with increasing gestational age.35.3% of patients with late onset preeclampsia and 55.6% patients of early onset type required more than one drug which is a statistically significant difference. Proteinuria more than 3gm/l/day was significantly more in late onset preeclampsia than in early onset preeclampsia. 55.5% of patients with early onset pre-eclampsia required MgSO4 when compared to 17.4%. There was no statistically significant difference in the rate of caesarean section (61.1% vs 73.5%). Altered coagulation profile was significantly more in early onset preeclampsia (11.1%). The incidence of oligohydramnios, SGA and low APGAR at 5 minutes of birth were significantly high in early onset pre-eclampsia when compared to late onset type.Conclusions: Patients with early onset pre-eclampsia are found to have significantly higher rates of specific maternal and fetal morbidity when compared to the late onset type.

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Pregnancy outcome in women with previous preeclampsia versus women normotensive in previous pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184964 ◽

2018 ◽

Vol 7 (12) ◽

pp. 5045

Author(s):

Jayshree Mulik ◽

Snehalata Suresh

Keyword(s):

Pregnancy Outcome ◽

Perinatal Outcome ◽

Tertiary Care ◽

Subsequent Pregnancy ◽

Care Centre ◽

Tertiary Care Centre ◽

Previous Pregnancy ◽

Index Pregnancy ◽

History Of ◽

Adverse Pregnancy

Background: Women with history of preeclampsia have reportedly higher risk of development of preeclampsia in subsequent pregnancies, along with other adverse pregnancy outcomes. Authors aimed to study the incidence of recurrent preeclampsia and compare the pregnancy outcome in women with history of preeclampsia in previous pregnancy with those who were normotensive in previous pregnancy and further compare outcomes in women with recurrent preeclampsia between their previous and index pregnancy.Methods: Pregnancy outcome was studied in women with preeclampsia in previous pregnancy (cases) and compared with women normotensive in previous pregnancy (controls). Further analysis of cases was done by dividing them into subgroups: those with recurrent preeclampsia in index pregnancy (A1) and those normotensive in index pregnancy despite being pre-eclamptic in previous pregnancy (A2). Total 100 cases and 100 controls were enrolled in the study, which was conducted at present tertiary care centre from January 2012 to June 2013.Results: Out of total 200 participants (100 cases, 100 controls) enrolled in the study; 58 out of 100 cases had recurrent preeclampsia and remaining 42 remained normo-tensive in index pregnancy. Among 100 controls, 93 were normotensive in index pregnancy.Conclusions: Women with history of preeclampsia in previous pregnancy had adverse maternal and perinatal outcome in subsequent pregnancy when compared to the women who were normotensive in the previous pregnancy. But when compared with their own previous preeclamptic pregnancy, they had better pregnancy outcome with good perinatal outcome in their index pregnancy.

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Outcomes of subsequent pregnancy after first pregnancy with early-onset preeclampsia

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2006.06.044 ◽

2006 ◽

Vol 195 (3) ◽

pp. 723-728 ◽

Cited By ~ 113

Author(s):

Bas B. van Rijn ◽

Lette B. Hoeks ◽

Michiel L. Bots ◽

Arie Franx ◽

Hein W. Bruinse

Keyword(s):

Early Onset ◽

Subsequent Pregnancy ◽

Early Onset Preeclampsia

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Severe Hypothyroidism Causing Pre-Eclampsia-Like Syndrome

Case Reports in Endocrinology ◽

10.1155/2012/586056 ◽

2012 ◽

Vol 2012 ◽

pp. 1-2 ◽

Cited By ~ 2

Author(s):

Annalisa Inversetti ◽

Audrey Serafini ◽

Marco F. Manzoni ◽

Anna Dolcetta Capuzzo ◽

Luca Valsecchi ◽

...

Keyword(s):

Gestational Age ◽

Early Onset ◽

Overt Hypothyroidism ◽

Pregnancy Induced Hypertension ◽

Correct Treatment ◽

Induced Hypertension ◽

Early Onset Preeclampsia

Objective.Analyzing and managing pre-eclampsia-like syndrome due to severe hypothyroidism.Methods.Presentation of a case of severe hypothyroidism due to Hashimoto’s syndrome, associated with a severe early-onset preeclampsia-like syndrome, managed in our Gynecology Department.Results.Severe pre-eclampsia led to miscarriage at 24 weeks of gestational age in a 42-year-old woman, although we attempted to correct hypothyroidism with increasing doses of levothyroxine and liothyronine sodium.Conclusion.Recognizing pre-eclampsia-like syndrome caused by overt hypothyroidism from other forms of pregnancy-induced hypertension is essential for choosing the correct treatment.

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sFlt-1/PlGF ratio as a prognostic marker of adverse outcomes in women with early-onset preeclampsia

Pregnancy Hypertension ◽

10.1016/j.preghy.2013.02.003 ◽

2013 ◽

Vol 3 (3) ◽

pp. 191-195 ◽

Cited By ~ 11

Author(s):

Leandro De Oliveira ◽

José C. Peraçoli ◽

Maria T. Peraçoli ◽

Henri Korkes ◽

Giafranco Zampieri ◽

...

Keyword(s):

Prognostic Marker ◽

Early Onset ◽

Adverse Outcomes ◽

Early Onset Preeclampsia ◽

Plgf Ratio

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Outcomes of Early-onset Preeclampsia With Severe Features at the University Hospital in Southern Thailand: a 15-year Experience

10.21203/rs.3.rs-182687/v1 ◽

2021 ◽

Author(s):

Noppasin Khwankaew ◽

Rapphon Sawaddisan ◽

Chitkasaem Suwanrath ◽

Alan Geater

Keyword(s):

Serum Creatinine ◽

Early Onset ◽

Elevated Serum ◽

Maternal Diabetes ◽

Maternal Serum ◽

Adverse Outcomes ◽

Gestational Age At Delivery ◽

Early Onset Preeclampsia ◽

Serum Aminotransferases ◽

Maternal Diabetes Mellitus

Abstract Purpose: To evaluate outcomes and factors associated with adverse outcomes among patients with early-onset preeclampsia with severe features at Songklanagarind Hospital. Methods: A retrospective study of 326 singleton women with early-onset preeclampsia with severe features treated at Songklanagarind Hospital between 2004-2019 was conducted. Baseline characteristics, management and outcomes were reviewed. Multivariate logistic regression was used to evaluate predictors of adverse outcomes. Statistical significance was set at p < 0.05.Results: There were no maternal mortalities, with 3.1% stillbirths and 6.7% neonatal deaths. High maternal serum creatinine (OR 3.26, 95% CI 1.27-8.36, p = 0.01) was significantly associated with adverse maternal outcomes. Early gestational age at delivery [< 28 weeks (OR 16.63, 95% CI 6.95-39.80, p <0.01), 28-32 weeks (OR 3.24, 95% CI 1.54-6.85, p <0.01)], maternal diabetes mellitus (OR 5.62, 95% CI 1.43-22.06, p = 0.01), high maternal serum creatinine (OR 2.66, 95%CI 1.20-5.93, p = 0.02) and elevated serum aminotransferases (OR 2.26, 95% CI 1.19-4.29, p = 0.01) were associated with serious adverse perinatal outcomes.Conclusions: Early-onset preeclampsia with severe features had favorable outcomes. Maternal diabetes mellitus, high serum creatinine, elevated serum aminotransferases and early gestational age at delivery were factors associated with poor outcomes.

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