Single vs. Recurrent Episodes of Preeclampsia-population–based Epidemiological and Clinical Characteristics

Abstract Objective: The aims of this study were to determine the differences between women with single vs. recurrent episodes of preeclampsia in term of: (1) the outcome of the first pregnancy affected by preeclampsia; and (2) the perinatal outcomes of subsequent pregnancies. Methods: This population based retrospective cohort study included all multiparous patients with a singleton gestation who delivered at Soroka University Medical Center (Beer Sheva, Israel) from January 1988 until December 2012, meeting the inclusion criteria, those who had fetuses with chromosomal or anatomical abnormalities were exclude. Our cohort included 213,558 deliveries that met the inclusion criteria, of them 208,017 had normotensive pregnancies and 5541 had preeclampsia. The latter group was further divided into those who had a single episode of preeclampsia followed by normotensive gestations (n = 3879), and women who had recurrent preeclampsia (n = 1662). We used parametric and non-parametric statistics as appropriate. Results: (1) Women with recurrent preeclampsia had an increased rate of early ((130/1662) 7.8% vs. (171/3879) 4.4%, P < 0.001) and late ((268/1662) 16.1% vs. (438/3879) 11.3%, P < 0.001) preterm deliveries than a single episode of preeclampsia; (2) of interest, the rate of chronic hypertension is higher in the first pregnancy of those with a single preeclampsia episode (P < 0.001), while women with recurrent preeclampsia developed it in the subsequent gestations (P < 0.001); (3) the rate of small for gestational age neonates in the index pregnancy was higher in those with recurrent rather than a single episode of preeclampsia (single episode 450/3879,11.6%, recurrent preeclampsia 244/1662, 14.7%, P = 0.002); (4) patients with recurrent disease had an increased rate of cesarean deliveries in the subsequent pregnancies (P < 0.001); and (5) patients who developed severe preeclampsia in the subsequent gestations had lower mean birthweight (P < 0.001), a higher rate of perinatal mortality (P < 0.001), and a lower Apgar score at 1 and 5 minutes (P < 0.001), than those who developed mild preeclampsia in subsequent pregnancies, those with a single episode of preeclampsia and the control group. Conclusion: Recurrent preeclampsia increases the rate of pregnancy complications in the following gestations. Early onset preeclampsia at the index pregnancy of women with recurrent preeclampsia, is associated with increased risk for severe preeclampsia, placental abruption and perinatal mortality in subsequent pregnancies.