Recurrent preeclampsia and perinatal outcome: a study of women with recurrent preeclampsia compared with women with preeclampsia who remained normotensive during their prior pregnancies

Comparing the severity of second preeclampsia with first preeclampsia: a multicenter retrospective longitudinal cohort study

OBJECTIVE

Compare the clinical severity of second preeclampsia with the first preeclampsia.

METHODS

This retrospective longitudinal cohort study was conducted in three teaching hospitals in Guangzhou, where there were a total of 296 405 deliveries between 2010 and 2021. Two consecutive singleton deliveries complicated with preeclampsia were included. Clinical features, laboratory results within 1 week before delivery, and maternal and neonatal outcomes of both deliveries were collected. Univariate analyses were made using paired Wilcoxon tests and McNemar tests. Multivariable logistic regression and generalized linear models were performed to assess the association of adverse maternal and neonatal outcomes with second preeclampsia.

RESULTS

A total of 151 women were included in the study. The mean maternal age was 28 and 33 years for the first and second deliveries, respectively. The proportion of preventive acetylsalicylic acid use was 4.6% for the first delivery and 15.2% for the second delivery. No significant differences were observed in terms of blood pressure on admission, gestational weeks of admission and delivery, application of perinatal antihypertensive agents, rates of preterm delivery, and severe features between the two occurrences. However, the rates of heart disease, edema, and admission to the ICU were lower, and hospital stays were shorter in the second preeclampsia compared with the first preeclampsia. Sensitivity analysis conducted among women who did not use preventive acetylsalicylic acid yielded similar results. After adjusting for potential confounding variables, the occurrence of second preeclampsia was associated with significantly decreased risks of heart disease, edema, complications, and admission to the NICU, with odds ratios ranging between 0.157 and 0.336.

CONCLUSION

Contrary to expectations, the second preeclampsia did not exhibit worse manifestations or outcomes to the first occurrence. In fact, some clinical features and outcomes appeared to be better in the second preeclampsia.

Recurrent or first preeclampsia in multiparae: A case-control study of singleton pregnancies in Reunion Island

Recurrent or first preeclampsia in multiparae : a case-control study of singleton pregnancies in Reunion Island Phuong Lien Tran, Pierre-Yves Robillard, Coralie Dumont, Chloé Schweizer, Asma Omarjee, Glorianne Lazaro, Silvia Iacobelli, Malik Boukerrou OBJECTIVE: To compare multiparous women with a first occurrence of preeclampsia and those with recurrent preeclampsia in singleton pregnancies.

STUDY DESIGN

a 17.5-year (2001-2018) case-control study conducted in the University's maternity of South Reunion (Indian Ocean), comparing 125 patients with recurrent preeclampsia and 742 patients with a first episode of the disease (controls). Statistical analyses were performed with use of the Student t-test for comparison of continuous data and the Chi-square or Fisher exact test for comparison of categorical variables.

RESULTS

There was no difference between the two groups concerning socio-demographic characteristics, post-partum haemorrhage, perinatal mortality rates. Nevertheless, recurrent preeclamptic women had a higher risk to present with prior chronic hypertension (OR 2.05 [1.30-3.23], p = 0.002), and to experience an early onset preeclampsia (< 34 weeks) compared to controls (OR 1.69 [1.15-2.48], p = 0.007). Women with recurrent preeclampsia were more prone to have C-sections (OR 1.63 [1.06-2.51], p = 0.024) mainly because of maternal indications (89.2% vs 76.4%, p = 0.008). Newborns from recurrent preeclampsia were more likely to have very low birthweight < 1500 g (OR 1.79 [1.16-2.77], p = 0.001), while there was no significant difference for gestational ages (34.1 vs 34.7 weeks).

CONCLUSION

Recurrent multiparous preeclamptic women presented more severe maternal disease (with a higher rate of early onset preeclampsia). Persistent hypertension in women with a history of preeclampsia is a risk factor for developing recurrent preeclampsia, and these patients should be monitored more closely.

Adverse neonatal outcomes in women with pre-eclampsia in Mulago Hospital, Kampala, Uganda: a cross-sectional study

INTRODUCTION

Pre-eclampsia, which is more prevalent in resource-limited settings, contributes significantly to maternal, fetal and neonatal morbidity and mortality. However, the factors associated with these adverse outcomes are poorly understood in low resource settings. In this paper we examine the risk factors for adverse neonatal outcomes among women with pre-eclampsia at Mulago Hospital in Kampala, Uganda.

METHODS

Pre-eclampsia, which is more prevalent in resource-limited settings, contributes significantly to maternal, fetal and neonatal morbidity and mortality. However, the factors associated with these adverse outcomes are poorly understood in low resource settings. In this paper we examine the risk factors for adverse neonatal outcomes among women with pre-eclampsia at Mulago Hospital in Kampala, Uganda.

RESULTS

Predictors of adverse neonatal outcomes were: preterm delivery (OR 5.97, 95% CI: 2.97-12.7) and severe pre-eclampsia (OR 5.17, 95% CI: 2.36-11.3).

CONCLUSION

Predictors of adverse neonatal outcomes among women with pre-eclampsia were preterm delivery and severe pre-eclampsia. Health workers need to identify women at risk, offer them counseling and, refer them if necessary to a hospital where they can be managed successfully. This may in turn reduce the neonatal morbidity and mortality associated with pre-eclampsia.

Social representations of mothers about gestational hypertension and premature birth

OBJECTIVE

To identify the meanings attributed by mothers to hypertensive disorders of pregnancy (HDPs) and their consequences, such as premature birth and hospitalization of the infant in the neonatal intensive care unit (NICU).

METHOD

A qualitative study, based on the Central Nucleus Theory, with 70 women who had hypertensive disorders of pregnancy and preterm delivery. We used the technique of free word association (FWAT) with three stimuli: high blood pressure during pregnancy, prematurity and NICU.

RESULTS

We obtained 1007 evocations, distributed as follows: high blood pressure during pregnancy (335) prematurity (333) and NICU (339). These constituted three thematic units: representation of HDPs, prematurity and the NICU. The categories death and negative aspects were inherent to the three units analyzed, followed by coping strategies and needs for care present in HDPs and prematurity.

CONCLUSION

The study had death as its central nucleus, and highlighted the subjective aspects present in the high risk pregnancy and postpartum cycle. It is hoped that this research will contribute to qualifying nursing care for women confronting the problem of HDPs, so that they can cope with less impacts from the adverse effects of high risk pregnancy and birth.

The possible options for the prevention of preeclampsia

This review summarizes the possible options for the prevention of preeclampsia based on important factors of patomechanism. The effects of antioxidants have been described in numerous clinical researches based on the oxidative hypothesis. Another important factor is the change of nitric oxide activity. Nitric oxide donors are able to compensate the symptoms of preeclampsia. The inverse relationship between the calcium intake and gestational hypertension has been known for a long time. The calcium supplementation seems to be a good opportunity to prevent preeclampsia. With low molecular weight heparins we can intervene in the patomechanisms of preeclampsia by antithrombocyte effects, vasoactive properties and impact on throphoblast cell morphology and differentiation. Thrombocyte aggregation inhibitors were examined in number of studies because they reduced thromboxane mediated vasoconstriction and inhibited placental thrombosis. Several studies verify whether prophylaxis with low molecular weight heparins and low dose aspirin could improve pregnancy outcome in preeclampsia. Orv. Hetil., 2012, 153, 144–151.

Association of early-onset pre-eclampsia in first pregnancy with normotensive second pregnancy outcomes: a population-based study

OBJECTIVE

To evaluate pregnancy outcomes in normotensive second pregnancy following pre-eclampsia in first pregnancy.

DESIGN

Population-based retrospective cohort study.

SETTING

State of Missouri in the USA.

SAMPLE

White European origin or African-American women who delivered their first two non-anomalous singleton pregnancies between 20 and 44 weeks of gestation in Missouri, USA, 1989-2005, without chronic hypertension, renal disease or diabetes mellitus (n = 12 835).

METHODS

Pre-eclampsia or delivery at 34 weeks of gestation or less in first pregnancy was defined as early-onset pre-eclampsia, whereas late-onset pre-eclampsia was defined as pre-eclampsia with delivery after 34 weeks of gestation. Multivariate regression models were fitted to estimate the crude and adjusted odds ratios and 95% confidence intervals.

MAIN OUTCOME MEASURES

Preterm delivery, large and small-for-gestational-age infant, Apgar scores at 5 minutes, fetal death, caesarean section, placental abruption.

RESULTS

Women with early-onset pre-eclampsia in first pregnancy were more likely to be younger, African-American, recipients of Medicaid, unmarried and smokers. Despite a second normotensive pregnancy, women with early-onset pre-eclampsia in their first pregnancy had greater odds of a small-for-gestational-age infant, preterm birth, fetal death, caesarean section and placental abruption in the second pregnancy, relative to women with late-onset pre-eclampsia, after controlling for confounders. Moreover, maternal ethnic origin modified the association between early-onset pre-eclampsia in the first pregnancy and preterm births in the second pregnancy. Having a history of early-onset pre-eclampsia reduces the odds of having a large-for-gestational-age infant in the second pregnancy.

CONCLUSION

A history of early-onset pre-eclampsia is associated with increased odds of adverse pregnancy outcomes despite a normotensive second pregnancy.

Perinatal outcome of recurrent pre-eclampsia versus pre-eclampsia in nulliparas

AIM

The aim of the study was to compare the perinatal outcome of recurrent pre-eclampsia in multiparas with that of pre-eclampsia in nulliparas.

METHODS

This retrospective study was performed by collecting maternal and perinatal data from records of women with pre-eclampsia who delivered at Mackay Memorial Hospital over a 10-year period. Fifty women with recurrent pre-eclampsia were compared with 207 women who developed pre-eclampsia as nulliparas. In the 50 multiparas, the outcome of recurrent pre-eclampsia was also compared with that of their earlier episodes of pre-eclampsia. Maternal and fetal variables compared included maternal blood pressure, serum biochemistry, rate of preterm delivery, rate of abruptio placentae and neonatal outcome.

RESULTS

Compared with nulliparous women with pre-eclampsia (n = 50), women with recurrent pre-eclampsia (n = 207) had a smaller increase in mean maternal blood pressure (27.0 +/- 18.9 mmHg vs 34.3 +/- 19.3 mmHg, P = 0.021), less dipstick proteinuria (>or=++; 36.0 vs 58.5%, P = 0.004), and bore children with a heavier mean birthweight (2909.1 +/- 895.5 g vs 2551.1 +/- 933.0 g, P = 0.017). No significant statistical difference was found in the gestational age of delivery, maternal serum biochemical levels and rate of abruptio placentae or preterm delivery. Within the multiparous group (n = 50), recurrent disease was associated with a lower mean maternal blood pressure and dipstick proteinuria and with higher birthweight than in their previous pre-eclamptic pregnancies.

CONCLUSION

Recurrent pre-eclampsia appears to be less severe and to have a better perinatal outcome than pre-eclampsia in nulliparas.

Prophylaxis of recurrent preeclampsia: low-molecular-weight heparin plus low-dose aspirin versus low-dose aspirin alone

OBJECTIVE

To verify whether prophylaxis with low-molecular-weight heparin (LMWH) and low-dose aspirin (LDA) could positively affect pregnancy outcome in women with a history of severe preeclampsia.

METHODS

We compared 23 pregnancies treated with LDA alone to 31 pregnancies treated with LMWH plus LDA.

RESULTS

Women treated with LMWH-LDA (n = 31) showed a better pregnancy outcome than those treated with LDA alone (n = 23) in terms of gestational age at delivery (p < 0.05), birth weight (p < 0.01), birth weight percentile (p < 0.01), and rate of preeclampsia (p < 0.01). Furthermore, comparing the intra-group outcome variation between previous and index pregnancies, an improvement appeared in each group, but a more pronounced gain was noted in the LMWH-LDA group in terms of gestational age at delivery (p< 0.005), birth weight (p < 0.005), and birth weight percentile (p < 0.005).

CONCLUSIONS

Thromboprophylaxis with LMWH plus LDA can improve pregnancy outcome in women with previous severe preeclampsia.