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

Abstract

Please cite this paper as: Chang J, Muglia L, Macones G. Association of early‐onset pre‐eclampsia in first pregnancy with normotensive second pregnancy outcomes: a population‐based study. BJOG 2010;117:946–953. 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.