Epidemiology and Associated Factors of Superimposed Preeclampsia in Pregnant Women With Chronic Hypertension: A Retrospective Multicenter Cohort Study

Objectives The objective of the study is To to determine the incidence of superimposed preeclampsia among pregnant women with chronic hypertension and associated factors of superimposed preeclampsia:preeclampsia. Material and Methods A retrospective multicenter cohort study was conducted at Srinagarind Hospital, Khon Kaen University, and Khon Kaen hospitalHospital, Thailand, involving women who were admitted between November 1, 2017, to and October 31, 2022. The pregnant women who had been diagnosed with chronic hypertension were identified and their medical records were reviewed for incidence of superimposed preeclampsia. Various characteristics were examined to compare maternal complications, perinatal outcomes, and associated factors. Logisticfactors.Logistic regression analysis was performed to identify factors associated with superimposed preeclampsia. Results There was a total of 33,018 deliveries during the study period, out of which 406 (1.2%) women with chronic hypertension were identified. Superimposed preeclampsia occurred in 199 women, accounting for a rate of 49.0% (95% confidence interval; [CI] 44.1–53.9). One hundred and nineteen women (59.8%) were diagnosed with superimposed preeclampsia with severe features, and 80 (40.2%) without severe features. A mean arterial pressure (MAP) ≥100≥ 100 mmHg during pregnancy, the requirement of two or more antihypertensive agents, and a history of previous preeclampsia were significantly associated with an increased risk of superimposed preeclampsia (adjusted odds ratio; [OR] 9.97, 95% CI95%CI 5.95 – 16.71, adjusted OR 2.31, 95% CI95%CI 1.30 – 4.12, and adjusted OR 4.52, 95% CI95%CI 1.86 – 10.98, respectively). Conclusion Approximately half of the women with chronic hypertension developed superimposed preeclampsia. MAP ≥ 100 mmHg, the requirement of two or more antihypertensive agents, and a history of previous preeclampsia might be useful tools for predicting superimposed preeclampsia.