scholarly journals Can We Predict Preterm Delivery Based on the Previous Pregnancy?

2021 ◽  
Vol 10 (7) ◽  
pp. 1517
Author(s):  
Tamar Wainstock ◽  
Ruslan Sergienko ◽  
Eyal Sheiner
Keyword(s):  
Risk Factors ◽  
Pregnancy Complications ◽  
Maternal Age ◽  
Population Based ◽  
Subsequent Pregnancy ◽  
Interpregnancy Interval ◽  
Multivariable Logistic Regression Model ◽  
Increased Risk ◽  
Nested Case Control

(1) Background: Preterm deliveries (PTD, <37 gestational weeks) which occur in 5–18% of deliveries across the world, are associated with immediate and long-term offspring morbidity, as well as high costs to health systems. Our aim was to identify risk factors during the first pregnancy ending at term for PTD in the subsequent pregnancy. (2) Methods: A retrospective population- based nested case−control study was conducted, including all women with two first singleton consecutive deliveries. Women with PTD in the first pregnancy were excluded. Characteristics and complications of the first pregnancy were compared among cases, defined as women with PTD in their second pregnancy, and the controls, defined as women delivering at term in their second pregnancy. A multivariable logistic regression model was used to study the association between pregnancy complications (in the first pregnancy) and PTD (in the subsequent pregnancy), while adjusting for maternal age and the interpregnancy interval. (3) Results: A total of 39,780 women were included in the study, 5.2% (n = 2088) had PTD in their second pregnancy. Women with PTD, as compared to controls (i.e., delivered at term in second pregnancy), were more likely to have the following complications in their first pregnancy: perinatal mortality (0.4% vs. 1.0%), small for gestational age (12.4% vs. 8.1%), and preeclampsia (7.6% vs. 5.7%). In the multivariable model, after adjusting for maternal age, interpregnancy interval and co-morbidities, having any one of these first pregnancy complications was independently associated with an increased risk for PTD (adjusted OR = 1.44; 95%CI 1.28–1.62), and the risk was greater if two or more complications were diagnosed (adjusted OR = 2.09; 95%CI 1.47–3.00). These complications were also risk factors for early PTD (<34 gestational weeks), PTD with a systematic infectious disease in the background, and possibly with spontaneous PTD. (4) Conclusions: First pregnancy complications are associated with an increased risk for PTD in the subsequent pregnancy. First pregnancy, although ending at term, may serve as a window of opportunity to identify women at risk for future PTD.

scholarly journals Interpregnancy Interval and Subsequent Severe Maternal Morbidity: A Population-based Study from California over 16 years

2021 ◽  
Author(s):  
Can Liu ◽  
Jonathan M Snowden ◽  
Deirdre J Lyell ◽  
Elizabeth Wall-Wieler ◽  
Barbara Abrams ◽  
...  
Keyword(s):  
Maternal Age ◽  
Maternal Morbidity ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Subsequent Pregnancy ◽  
Severe Maternal Morbidity ◽  
Interpregnancy Interval ◽  
Adjusted Risk ◽  
Index Pregnancy ◽  
Increased Risk

Abstract Interpregnancy interval (IPI) associates with adverse perinatal outcomes, but its contribution to severe maternal morbidity (SMM) remains unclear. We examined the association between IPI and SMM, using data linked across sequential pregnancies to women in California 1997-2012. Adjusting for confounders measured at the index pregnancy (i.e. the first in a pair of consecutive pregnancies), we estimated adjusted risk ratios (aRRs) of SMM related to the subsequent pregnancy. We further conducted within-mother comparisons and analyses stratified by parity and maternal age at the index pregnancy. Compared to 18-23 months, IPI&lt;6 months had same risk for SMM in between-mother comparison (aRR=0.96, 95%CI 0.91, 1.02) but lower risk in within-mother comparison (aRR=0.76, 95% confidence interval (CI) 0.67, 0.86). IPI 24-59 months and IPI≥60 months associated with increased risk of SMM in both between-mother (aRR=1.18, 95%CI 1.13, 1.23 and aRR=1.76, 95% CI 1.68, 1.85 respectively) and within-mother comparisons (aRR=1.22, 95%CI 1.11, 1.34 and aRR=1.88, 95% CI 1.66, 2.13 respectively). The association between IPI and SMM did not substantially differ by maternal age and parity. Longer IPI was associated with increased risk of SMM, which may be partly attributed to interpregnancy health.

scholarly journals Arterial and Venous Thromboembolic Safety of Bevacizumab in Patients with High Grade Gliomas

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2280-2280
Author(s):  
Inyoung Lee ◽  
Sruthi Adimadhyam ◽  
Edith A. Nutescu ◽  
Karen Sweiss ◽  
Pritesh Patel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Claims Data ◽  
Population Based ◽  
Recurrent Glioblastoma ◽  
Incidence Density ◽  
High Grade ◽  
Increased Risk ◽  
High Grade Gliomas ◽  
Nested Case Control

Abstract INTRODUCTION Bevacizumab, an angiogenesis inhibitor targeting vascular endothelial growth factor A, is used for the treatment of recurrent glioblastoma, the most common primary brain malignancy in adults. Multiple studies demonstrate the efficacy of bevacizumab on progression-free and overall survival of patients with recurrent glioblastoma. However, real world safety data of bevacizumab in patients with glioblastoma is limited on serious adverse outcomes including arterial and venous thrombosis. Our study aimed to evaluate the risk of arterial thromboembolism (ATE) and venous thromboembolism (VTE) in a population-based sample of adult patients with high grade gliomas. METHOD We conducted a nested case-control study within a retrospective cohort of patients receiving treatment for high grade gliomas under the protocol by Stupp, et al. (radiotherapy plus concomitant/adjuvant temezolomide). Patients were sampled from the Truven Health MarketScan® Research Database, containing administrative health claims data of over 40 million commercially insured enrollees and their dependents, between 2009 and 2015. A validated algorithm was used to identify patients with high grade gliomas that underwent craniotomy (index time) with external beam radiation and temozolomide-based treatment occurring within 91 days (cohort entry time). Patients were excluded if they received craniotomy, radiation, temozolomide or bevacizumab during year prior to surgery or had one of our outcomes of interest (ATE or VTE) during the cohort ascertainment period (between index and cohort entry dates). Patients were required to have continuous health plan enrollment during the 12-month baseline and follow up periods (unless died). Surgical procedures and chemotherapy treatments were identified using diagnostic and procedural medical and pharmacy claims data. These data sources were also used to identify VTE risk factors, including medical conditions, procedures and medication use, and to calculate modified Charlson comorbidity index scores at baseline. Cases of ATE and VTE were each identified in the overall cohort using a validated algorithm for administrative claims data. For ATE and VTE separately, each case was matched to up to ten controls on sex, age group, index time and follow-up duration using incidence density sampling with replacement. Exposure to bevacizumab was characterized as any use (yes vs. no) and recent use (last bevacizumab infusion within 30 days prior event or control censoring). We estimated relative risk of ATE and VTE associated with bevacizumab in separate models using conditional logistic regression models to calculate adjusted odds ratios (aOR) and 95% confidence interval (CI). All multivariable models were adjusted for sex, age, and comorbidity index scores; models for risk of VTE were also adjusted for number of baseline VTE risk factors and VTE prophylaxis received. RESULTS Our final study cohort included 2157 patients undergoing treatment for high grade gliomas. We identified 25 ATE cases and 99 VTE cases and matched incidence density-sampled controls (n=170 for ATE; n=819 for VTE) for our nested case-control analysis. A higher proportion of ATE cases received bevacizumab during follow up compared to the controls (28% vs. 17%). In multivariable analyses, no statistically significant increase in ATE risk was observed with bevacizumab overall (aOR 1.51, 95% CI 0.54-4.24), although confidence intervals were wide given the few events observed. Compared to controls in the VTE analysis, cases had a slightly higher proportion of baseline VTE risk factors (2 or more: 17% vs. 13%) and treatment with bevacizumab (13% vs. 9%). However, we found no significant increased risk of VTE associated with bevacizumab overall (aOR 1.40, 95% CI 0.71-2.75) or recent infusion of bevacizumab (aOR 1.40, 95% CI 0.65-3.01). CONCLUSIONS Our findings from this large retrospective cohort of patients undergoing treatment for high grade glioma provide little evidence in support of the increased risk of ATE and VTE reported with use of bevacizumab in other cancer sites. Our study was limited by an overall small number of ATE events observed, and further research is needed to confirm safety of bevacizumab with respect to arterial thrombosis. These population-based estimates show no significant increase in risk of VTE associated with bevacizumab and suggest its safe use in the treatment of high grade gliomas. Disclosures Lee: AbbVie Inc.: Research Funding. Patel:Celgene: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Janssen: Honoraria.

Long-Term Survival, Causes of Death, and Trends in 5-Year Mortality After Intracerebral Hemorrhage: The Tromsø Study

Stroke ◽  
2021 ◽  
Author(s):  
Maria Carlsson ◽  
Tom Wilsgaard ◽  
Stein Harald Johnsen ◽  
Liv-Hege Johnsen ◽  
Maja-Lisa Løchen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Intracerebral Hemorrhage ◽  
Causes Of Death ◽  
Population Based ◽  
Term Survival ◽  
Long Term Survival ◽  
Risk Of Death ◽  
Increased Risk

Background and Purpose: Data on long-term survival after intracerebral hemorrhage (ICH) are scarce. In a population-based nested case-control study, we compared long-term survival and causes of death within 5 years in 30-day survivors of first-ever ICH and controls, assessed the impact of cardiovascular risk factors on 5-year mortality, and analyzed time trend in 5-year mortality in ICH patients over 2 decades. Methods: We included 219 participants from the population-based Tromsø Study, who after the baseline participation had a first-ever ICH between 1994 to 2013 and 1095 age- and sex-matched participants without ICH. Cumulative survival was presented using the Kaplan-Meier method. Hazard ratios (HRs) for mortality and for the association between cardiovascular risk factors and 5-year mortality in 30-day survivors were estimated by stratified Cox proportional hazards models. Trend in 5-year mortality was assessed by logistic regression. Results: Risk of death during follow-up (median time, 4.8 years) was increased in the ICH group compared with controls (HR, 1.62 [95% CI, 1.27–2.06]). Cardiovascular disease was the leading cause of death, with a higher proportion in ICH patients (22.9% versus 9.0%; P <0.001). Smoking increased the risk of 5-year mortality in cases and controls (HR, 1.59 [95% CI, 1.15–2.19]), whereas serum cholesterol was associated with 5-year mortality in cases only (HR, 1.39 [95% CI, 1.04–1.86]). Use of anticoagulants at ICH onset increased the risk of death (HR, 2.09 [95% CI, 1.09–4.00]). There was no difference according to ICH location (HR, 1.15 [95% CI, 0.56–2.37]). Five-year mortality did not change during the study period (odds ratio per calendar year, 1.01 [95% CI, 0.93–1.09]). Conclusions: Survival rates were significantly lower in cases than in controls, driven by a 2-fold increased risk of cardiovascular death. Smoking, serum cholesterol, and use of anticoagulant drugs were associated with increased risk of death in ICH patients. Five-year mortality rates in ICH patients remained stable over time.

scholarly journals Prevalence and risk factors of intrahepatic cholestasis of pregnancy in a Chinese population

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Xing-Xing Gao ◽  
Meng-Ying Ye ◽  
Yan Liu ◽  
Jin-Yan Li ◽  
Li Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intrahepatic Cholestasis ◽  
Chinese Population ◽  
Maternal Age ◽  
Maternal Education ◽  
Population Based ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Multiple Pregnancies ◽  
Increased Risk ◽  
Cholestasis Of Pregnancy

Abstract Studies on the risk factors for intrahepatic cholestasis of pregnancy (ICP) in a population-based cohort are lacking. We assess the prevalence and risk factors of ICP in a Chinese population. In this study, a cohort study was conducted that included 12,200 eligible pregnant women. The overall incidence of ICP in this cohort was 6.06%. With increasing maternal age, the incidence of ICP decreased in women younger than 30 years of age but increased in those older than 30. With increasing pre-pregnancy BMI, the incidence of ICP decreased if the pre-pregnancy BMI was less than 23 kg/m2 but increased if it was 23 kg/m2 or higher. Further analysis showed that the risk of ICP increased when maternal age was < 25 years (Adjusted RR  2.01; 95% CI 1.64–2.47) or ≥ 35 years (Adjusted RR  1.34; 95% CI 1.02–1.76). Furthermore, an increased risk of ICP was associated with pre-pregnancy underweight (adjusted RR  1.27; 95% CI 1.04–1.56), inadequate gestational weight gain (GWG) (adjusted RR  1.58; 95% CI 1.28–1.96), lower maternal education (adjusted RR  2.96; 95% CI 2.35–3.74), multiparity (adjusted RR  1.54; 95% CI 1.23–1.93), and twin/multiple pregnancies (adjusted RR  2.12; 95% CI 1.25–3.58). Maternal age (< 25 or ≥ 35 years), underweight, inadequate GWG, lower maternal education, multiparity, and twin/multiple pregnancies were identified as risk factors of ICP.

scholarly journals Incidence, Risk Factors, and Outcomes of Neonatal Renal Vein Thrombosis in Ontario: Population-Based Cohort Study

Kidney360 ◽  
2020 ◽  
Vol 1 (7) ◽  
pp. 640-647 ◽  
Author(s):  
Allison C. Ouellette ◽  
Elizabeth K. Darling ◽  
Branavan Sivapathasundaram ◽  
Glenda Babe ◽  
Richard Perez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Renal Vein Thrombosis ◽  
Population Based ◽  
Long Term Outcomes ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Neonatal Renal Vein Thrombosis

BackgroundThere are limited data at a population level on the burden, risk factors, and long-term outcomes of neonatal renal vein thrombosis (nRVT). We conducted a population-based cohort study to understand the epidemiology and outcomes of nRVT over a 25-year period in Ontario.MethodsUsing linked administrative health databases, all hospitalized neonates ≤28 days born in Ontario between 1992 and 2016 with nRVT were identified. The primary outcome was to calculate the incidence of nRVT and trend over time in Ontario. We also determined the risk factors associated with nRVT as well as the risk of long-term outcomes after nRVT, including CKD, ESKD, all-cause mortality, and hypertension (HTN) compared with the healthy neonatal population without nRVT.ResultsThe annual incidence rate of nRVT was 2.6 per 100,000 live births (n=85). Presence of respiratory distress syndrome (OR, 8.01; 95% CI, 4.90 to 13.1), congenital heart disease (OR, 9.1; 95% CI, 5.05 to 16.4), central venous catheterization (OR, 3.9; 95% CI, 1.89 to 7.93), maternal preeclampsia (OR, 2.8; 95% CI, 1.6 to 4.79), and maternal diabetes (OR, 2.36; 95% CI, 1.36 to 4.07) conferred the highest risk for nRVT. Over a median follow-up of 15 years and after adjusting for confounders, neonates with nRVT versus the comparator cohort had a 15.5-fold risk of CKD, HTN, or death (n=49 [58%] versus n=90,050 [3%]; 95% CI, 11.7 to 20.6); 12.3-fold increased risk of CKD or death (n=39 [46%] versus n=32,016 [1%]; 95% CI, 8.9 to 16.8); and a 15.7-fold increased risk of HTN (n=33 [39%] versus n=64,458 [2%]; 95% CI, 11.1 to 21.1). None of the nRVT cohort developed ESKD. The median time to composite outcome of CKD, HTN, or death was 11.1 years.ConclusionsPatients with a history of nRVT remain at higher risk than the general population for long-term morbidity or mortality, indicating the need for long-term follow-up.

Morbidity and mortality in adult-onset IgA vasculitis: a long-term population-based cohort study

Rheumatology ◽  
2021 ◽  
Author(s):  
Johannes Nossent ◽  
Warren Raymond ◽  
Helen Isobel Keen ◽  
David Preen ◽  
Charles Inderjeeth
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Premature Death ◽  
Population Based ◽  
Increased Risk ◽  
Serious Infections ◽  
Comorbidity Index ◽  
Independent Risk Factors

Abstract Objectives With sparse data available, we investigated mortality and risk factors in adults with IgAV. Methods Observational population-based cohort study using state-wide linked longitudinal health data for hospitalised adults with IgAV (n = 267) and matched comparators (n = 1080) between 1980-2015. Charlson comorbidity index (CCI) and serious infections (SI) were recorded over an extensive lookback period prior to diagnosis. Date and causes of death were extracted from WA Death Registry. Mortality rate (deaths/1000 person-years) ratios (MRR) and hazard ratio (HR) for survival were assessed. Results During 9.9 (±9.8) years lookback patients with IgAV accrued higher CCI scores (2.60 vs1.50 p &lt; 0.001) and had higher risk of SI (OR 8.4, p &lt; 0.001), not fully explained by CCI scores. During 19 years follow-up, the rate of death in Patients with IgAV (n = 137) was higher than in comparators (n = 397) (MRR 2.06, CI 1.70-2.50, p &lt; 0.01) and the general population (SMRR 5.64, CI 4.25, 7.53, p &lt; 0.001). Survival in IgAV was reduced at five (72.7 vs. 89.7%) and twenty years (45.2% vs. 65.6%) (both p &lt; 0.05). CCI (HR1.88, CI:1.25 - 2.73, p = 0.001), renal failure (HR 1.48, CI: 1.04 - 2.22, p = 0.03) and prior SI (HR 1.48, CI:1.01 – 2.16, p = 0.04) were independent risk factors. Death from infections (5.8 vs 1.8%, p = 0.02) was significantly more frequent in patients with IgAV. Conclusions Premorbid comorbidity accrual appears increased in hospitalized patients with IgAV and predicts premature death. As comorbidity does not fully explain the increased risk of premorbid infections or the increased mortality due to infections in IgAV, prospective studies are needed.

scholarly journals Association between interpregnancy interval and pregnancy complications by history of complications: a population-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e046962
Author(s):  
Amanuel Tesfay Gebremedhin ◽  
Gizachew Assefa Tessema ◽  
Annette K Regan ◽  
Gavin F Pereira
Keyword(s):  
Cohort Study ◽  
Pregnancy Complications ◽  
Lower Risk ◽  
Population Based ◽  
Adjusted Relative Risk ◽  
Interpregnancy Interval ◽  
Recurrence Rates ◽  
Increased Risk ◽  
History Of ◽  
Restricted Cubic Splines

ObjectiveTo examine if the association between interpregnancy interval (IPI) and pregnancy complications varies by the presence or absence of previous complications.Design and settingPopulation-based longitudinally linked cohort study in Western Australia (WA).ParticipantsMothers who had their first two (n=252 368) and three (n=96 315) consecutive singleton births in WA between 1980 and 2015.Outcome measuresWe estimated absolute risks (AR) of preeclampsia (PE) and gestational diabetes (GDM) for 3–60 months of IPI according to history of each outcome. We modelled IPI using restricted cubic splines and reported adjusted relative risk (RRs) with 95% CI at 3, 6, 12, 24, 36, 48 and 60 months, with 18 months as reference.ResultsRisks of PE and GDM were 9.5%, 2.6% in first pregnancies, with recurrence rates of 19.3% and 41.5% in second pregnancy for PE and GDM, respectively. The AR of GDM ranged from 30% to 43% across the IPI range for mothers with previous GDM compared with 2%–8% for mothers without previous GDM. For mothers with no previous PE, greater risks were observed for IPIs at 3 months (RR 1.24, 95% CI 1.07 to 1.43) and 60 months (RR 1.40, 95% CI 1.29 to 1.53) compared with 18 months. There was insufficient evidence for increased risk of PE at shorter IPIs of <18 months for mothers with previous PE. Shorter IPIs of <18 months were associated with lower risk than at IPIs of 18 months for mothers with no previous GDM.ConclusionsThe associations between IPIs and risk of PE or GDM on subsequent pregnancies are modified by previous experience with these conditions. Mothers with previous complications had higher absolute, but lower RRs than mothers with no previous complications. However, IPI remains a potentially modifiable risk factor for mothers with previous complicated pregnancies.

Cholecystectomy and endometrial cancer: a marker of long-term elevated estrogen exposure?

2006 ◽  
Vol 16 (3) ◽  
pp. 1348-1353 ◽  
Author(s):  
L. M. Morimoto ◽  
P. A. Newcomb ◽  
J. M. Hampton ◽  
A. Trentham-Dietz
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Body Mass ◽  
Population Based ◽  
Estrogen Exposure ◽  
Increased Risk ◽  
History Of ◽  
Community Controls ◽  
The Relationship

Excess hormones, both endogenous and exogenous, are implicated in the etiology of endometrial cancer. We considered whether having had gallstones or a cholecystectomy (surgery to remove the gallbladder), which are more common in women who are obese and who use exogenous hormones, might be a marker for high lifetime levels of estrogen. We conducted a population-based study of endometrial cancer cases and community controls in women aged 40–79 years. Participants completed an interviewer-administered questionnaire that elicited exposures prior to diagnosis or reference date, including history of gallstones and cholecystectomy, as well as reproductive history, lifetime body mass, smoking, postmenopausal hormone (PMH) use, and other risk factors. Compared to controls, cholecystectomy was associated with a 50% increased risk of developing endometrial cancer (odds ratio = 1.5 [1.1–2.0]). The relationship appeared to depend upon PMH user status; the association was observed only among never hormone users. Body mass index did not appear to modify this relationship. Having a diagnosis of gallstones was also associated with endometrial cancer, although to a lesser magnitude. Although other etiologic factors may play a role in the relation between cholecystectomy and endometrial cancer, the current analysis suggests that this association is attributable, at least in part, to the sharing of hormonal risk factors.

scholarly journals Who Is at Risk for Preeclampsia? Risk Factors for Developing Initial Preeclampsia in a Subsequent Pregnancy

2020 ◽  
Vol 9 (4) ◽  
pp. 1103 ◽  
Author(s):  
Tamar Wainstock ◽  
Ruslan Sergienko ◽  
Eyal Sheiner
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Gestational Diabetes ◽  
Perinatal Mortality ◽  
Preterm Delivery ◽  
Pregnancy Complications ◽  
Low Birthweight ◽  
Subsequent Pregnancy ◽  
Increased Risk ◽  
Inter Pregnancy Interval

Background: The incidence of preeclampsia, which may cause significant maternal and perinatal morbidity, has risen in recent years, therefore it is critical to identify women at risk for preeclampsia. We aimed to identify risk factors in the first pregnancy (not complicated by preeclampsia) for preeclampsia in the subsequent pregnancy. Methods: A retrospective population-based nested case-control study was conducted, including all women with first (P1) and second (P2) singleton consecutive deliveries. Women who had experienced preeclampsia in their first pregnancy were excluded. Cases were defined as women with preeclampsia in their second pregnancy, and were compared to the controls, defined as women without this diagnosis in second pregnancy. Characteristics and complications of the first pregnancy were compared between cases and controls, and multivariable regression models were used to study the association between pregnancy complications (in the first pregnancy) and preeclampsia (in the subsequent pregnancy), while adjusting for confounders. Results: A total of 40,673 women were included in the study, 1.5% of second pregnancies were diagnosed with preeclampsia (n = 627, i.e., Cases). Cases, as compared to controls were older in their 1st pregnancy, with longer inter-pregnancy interval, and were more likely to have the following complications in their first pregnancy: preterm delivery (15.0% vs. 7.7%), low birthweight (17.9% vs. 10.3%), perinatal mortality (3.2% vs. 1.1%), and gestational diabetes (7.0% vs. 2.7%). In the multivariable model, adjusted for maternal age, obesity and inter-pregnancy interval, either one of these first pregnancy complications were independently associated with an increased risk for preeclampsia (adjusted OR for either of first pregnancy complication =1.73; 95% CI 1.37–2.14, <0.001), and the risk was greater for each additional complication (adjusted OR for ≥2 risk factors =3.54; 95% CI 2.28–5.52, p < 0.001). Conclusions: Complications in first pregnancy, including preterm delivery, perinatal mortality and gestational diabetes, are risk factors for primary preeclampsia in second pregnancy. First pregnancy may serve as a window of opportunity to identify women at risk for future preeclampsia and other morbidities later in life.

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