J J Chang1, L J Muglia, G A Macones. 1. Department of Community Health in Epidemiology, Saint Louis University School of Public Health, 3545 Lafayette Avenue, St. Louis, MO 63104, USA. changdalton@gmail.com
Abstract
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.
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.
Authors: A A Herman; B J McCarthy; J M Bakewell; R H Ward; B A Mueller; N E Maconochie; A W Read; P Zadka; R Skjaerven Journal: Paediatr Perinat Epidemiol Date: 1997-01 Impact factor: 3.980
Authors: B M Sibai; M Ewell; R J Levine; M A Klebanoff; J Esterlitz; P M Catalano; R L Goldenberg; G Joffe Journal: Am J Obstet Gynecol Date: 1997-11 Impact factor: 8.661
Authors: Samantha E Parker; Martha M Werler; Mika Gissler; Minna Tikkanen; Cande V Ananth Journal: Paediatr Perinat Epidemiol Date: 2015-03-11 Impact factor: 3.980