Miriam F van Oostwaard1, Josje Langenveld2, Ewoud Schuit3, Dimitri N M Papatsonis4, Mark A Brown5, Romano N Byaruhanga6, Sohinee Bhattacharya7, Doris M Campbell8, Lucy C Chappell9, Francesca Chiaffarino10, Isabella Crippa11, Fabio Facchinetti12, Sergio Ferrazzani13, Enrico Ferrazzi14, Ernesto A Figueiró-Filho15, Ingrid P M Gaugler-Senden16, Camilla Haavaldsen17, Jacob A Lykke18, Alfred K Mbah19, Vanessa M Oliveira20, Lucilla Poston9, Christopher W G Redman21, Raed Salim22, Baskaran Thilaganathan23, Patrizia Vergani11, Jun Zhang24, Eric A P Steegers25, Ben Willem J Mol26, Wessel Ganzevoort27. 1. Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: miriamvanoostwaard@gmail.com. 2. Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen, the Netherlands. 3. Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum, Utrecht, the Netherlands; Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands; Stanford Prevention Research Center, Stanford University, Stanford, CA. 4. Department of Obstetrics and Gynecology, Amphia Ziekenhuis, Breda, the Netherlands. 5. Department of Renal Medicine, St. George Hospital, Sydney, NSW, Australia. 6. Department of Obstetrics and Gynecology, St. Raphael of St. Francis Hospital, Nsambya Kampala, Uganda. 7. Dugald Baird Center for Research on Women's Health, Aberdeen Maternity Hospital, Aberdeen, Scotland. 8. Department of Obstetrics and Gynecology, Aberdeen Maternity Hospital, Aberdeen, Scotland. 9. Women's Health Academic Centre, King's College London, London, England, UK. 10. Department of Obstetrics, Gynecology, and Neonatology, IRCSS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. 11. Department of Obstetrics and Gynecology, Ospedale San Gerardo, Università degli Studi di Milano-Bicocca, Monza, Italy. 12. Department of Obstetrics and Gynecology, Universit' degli Studi di Modena e Reggio Emilia, Modena, Italy. 13. Department of Obstetrics and Gynecology, Università Cattolica del S. Cuore, Rome, Italy. 14. Department of Woman, Mother, and Neonate, Buzzi Children's Hospital, Istituti Clinici di Perfezionamento, Biomedical and Clinical School of Medicine University of Milan, Milan, Italy. 15. Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil. 16. Department of Obstetrics and Gynecology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, the Netherlands. 17. Department of Gynecology and Obstetrics and Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Lørenskog, Norway. 18. Department of Obstetrics and Gynecology, Hvidovre Hospital, and Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark. 19. Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL. 20. Center for Biological and Health Sciences, Federal University of Mato Grosso do Sul, Campo Grande, Brazil. 21. Nuffield Department of Obstetrics and Gynecology, John Radcliffe Hospital, University of Oxford, Oxford, England, UK. 22. Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel. 23. Lanesborough Wing, St George's, University of London, London, England, UK. 24. Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 25. Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands. 26. School of Pediatrics and Reproductive Health, Robinson Institute, University of Adelaide, SA, Australia. 27. Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands.
Abstract
OBJECTIVE: We performed an individual participant data (IPD) metaanalysis to calculate the recurrence risk of hypertensive disorders of pregnancy (HDP) and recurrence of individual hypertensive syndromes. STUDY DESIGN: We performed an electronic literature search for cohort studies that reported on women experiencing HDP and who had a subsequent pregnancy. The principal investigators were contacted and informed of our study; we requested their original study data. The data were merged to form one combined database. The results will be presented as percentages with 95% confidence interval (CI) and odds ratios with 95% CI. RESULTS: Of 94 eligible cohort studies, we obtained IPD of 22 studies, including a total of 99,415 women. Pooled data of 64 studies that used published data (IPD where available) showed a recurrence rate of 18.1% (n=152,213; 95% CI, 17.9-18.3%). In the 22 studies that are included in our IPD, the recurrence rate of a HDP was 20.7% (95% CI, 20.4-20.9%). Recurrence manifested as preeclampsia in 13.8% of the studies (95% CI,13.6-14.1%), gestational hypertension in 8.6% of the studies (95% CI, 8.4-8.8%) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome in 0.2% of the studies (95% CI, 0.16-0.25%). The delivery of a small-for-gestational-age child accompanied the recurrent HDP in 3.4% of the studies (95% CI, 3.2-3.6%). Concomitant HELLP syndrome or delivery of a small-for-gestational-age child increased the risk of recurrence of HDP. Recurrence increased with decreasing gestational age at delivery in the index pregnancy. If the HDP recurred, in general it was milder, regarding maximum diastolic blood pressure, proteinuria, the use of oral antihypertensive and anticonvulsive medication, the delivery of a small-for-gestational-age child, premature delivery, and perinatal death. Normotensive women experienced chronic hypertension after pregnancy more often after experiencing recurrence (odds ratio, 3.7; 95% CI, 2.3-6.1). CONCLUSION: Among women that experience hypertension in pregnancy, the recurrence rate in a next pregnancy is relatively low, and the course of disease is milder for most women with recurrent disease. These reassuring data should be used for shared decision-making in women who consider a new pregnancy after a pregnancy that was complicated by hypertension.
OBJECTIVE: We performed an individual participant data (IPD) metaanalysis to calculate the recurrence risk of hypertensive disorders of pregnancy (HDP) and recurrence of individual hypertensive syndromes. STUDY DESIGN: We performed an electronic literature search for cohort studies that reported on women experiencing HDP and who had a subsequent pregnancy. The principal investigators were contacted and informed of our study; we requested their original study data. The data were merged to form one combined database. The results will be presented as percentages with 95% confidence interval (CI) and odds ratios with 95% CI. RESULTS: Of 94 eligible cohort studies, we obtained IPD of 22 studies, including a total of 99,415 women. Pooled data of 64 studies that used published data (IPD where available) showed a recurrence rate of 18.1% (n=152,213; 95% CI, 17.9-18.3%). In the 22 studies that are included in our IPD, the recurrence rate of a HDP was 20.7% (95% CI, 20.4-20.9%). Recurrence manifested as preeclampsia in 13.8% of the studies (95% CI,13.6-14.1%), gestational hypertension in 8.6% of the studies (95% CI, 8.4-8.8%) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome in 0.2% of the studies (95% CI, 0.16-0.25%). The delivery of a small-for-gestational-age child accompanied the recurrent HDP in 3.4% of the studies (95% CI, 3.2-3.6%). Concomitant HELLP syndrome or delivery of a small-for-gestational-age child increased the risk of recurrence of HDP. Recurrence increased with decreasing gestational age at delivery in the index pregnancy. If the HDP recurred, in general it was milder, regarding maximum diastolic blood pressure, proteinuria, the use of oral antihypertensive and anticonvulsive medication, the delivery of a small-for-gestational-age child, premature delivery, and perinatal death. Normotensive women experienced chronic hypertension after pregnancy more often after experiencing recurrence (odds ratio, 3.7; 95% CI, 2.3-6.1). CONCLUSION: Among women that experience hypertension in pregnancy, the recurrence rate in a next pregnancy is relatively low, and the course of disease is milder for most women with recurrent disease. These reassuring data should be used for shared decision-making in women who consider a new pregnancy after a pregnancy that was complicated by hypertension.
Authors: Bethany D Sanders; Melissa G Davis; Sharon L Holley; Julia C Phillippi Journal: J Midwifery Womens Health Date: 2018-01-25 Impact factor: 2.388
Authors: Nir Melamed; Ahmet Baschat; Yoav Yinon; Apostolos Athanasiadis; Federico Mecacci; Francesc Figueras; Vincenzo Berghella; Amala Nazareth; Muna Tahlak; H David McIntyre; Fabrício Da Silva Costa; Anne B Kihara; Eran Hadar; Fionnuala McAuliffe; Mark Hanson; Ronald C Ma; Rachel Gooden; Eyal Sheiner; Anil Kapur; Hema Divakar; Diogo Ayres-de-Campos; Liran Hiersch; Liona C Poon; John Kingdom; Roberto Romero; Moshe Hod Journal: Int J Gynaecol Obstet Date: 2021-03 Impact factor: 3.561