Late Prenatal Care as a Risk Factor for Preeclampsia [ID: 1377685

Abstract

INTRODUCTION: Hypertensive disorders of pregnancy including preeclampsia account for 16% of maternal deaths in high-income countries. The American College of Obstetricians and Gynecologists lists a number of known risk factors for preeclampsia in its Practice Bulletin No. 222, “Gestational Hypertension and Preeclampsia.” The objective of this study was to identify whether late prenatal care, not a documented risk factor, is associated with an increased risk of preeclampsia. METHODS: A secondary analysis was performed on a dataset from an IRB-approved research study looking at chronic hypertension and contraception after pregnancy. As chronic hypertension is associated with preeclampsia and can be diagnosed in pregnancy by elevated blood pressures before 20 weeks of gestation, the dataset allowed comparison of patients who presented to care before 20 weeks versus after 20 weeks. Data were analyzed using descriptive statistics, chi-square, Student t test, and multivariate logistic regression. RESULTS: A total of 2,147 patients were included. 1,826 patients had early prenatal care (before 20 weeks) and 321 patients had late prenatal care (after 20 weeks). 8.5% of patients with early prenatal care had preeclampsia, compared to 12.1% of patients with late prenatal care (odds ratio 1.49, P=.0359, 95% CI 1.0266–2.1652). After multivariate logistic regression modeling, late prenatal care was a risk factor significantly associated with preeclampsia in African American patients (P=.030). CONCLUSION: Patients presenting for prenatal care in the second half of pregnancy are at increased risk of developing preeclampsia. Anticipatory guidance and education should be targeted for these patients.