Recurrence of Preeclampsia in Northern Tanzania: A Registry-Based Cohort Study

Michael J Mahande,Rolv T Lie,Anne K Daltveit,Joseph Obure,Rachel Manongi,Blandina T Mmbaga,Gileard Masenga,Andrew Dewan

doi:10.1371/journal.pone.0079116

Abstract

ObjectivePreeclampsia occurs in about 4 per cent of pregnancies worldwide, and may have particularly serious consequences for women in Africa. Studies in western countries have shown that women with preeclampsia in one pregnancy have a substantially increased risk of preeclampsia in subsequent pregnancies. We estimate the recurrence risks of preeclampsia in data from Northern Tanzania.MethodsA prospective cohort study was designed using 19,811 women who delivered singleton infants at a hospital in Northern Tanzania between 2000and2008. A total of 3,909 women were recorded with subsequent deliveries in the hospital with follow up through 2010. Adjusted recurrence risks of preeclampsia were computed using regression models.ResultsThe absolute recurrence risk of preeclampsia was25%, which was 9.2-fold (95% CI: 6.4 - 13.2) compared with the risk for women without prior preeclampsia. When there were signs that the preeclampsia in a previous pregnancy had been serious either because the baby was delivered preterm or had died in the perinatal period, the recurrence risk of preeclampsia was even higher. Women who had preeclampsia had increased risk of a series of adverse pregnancy outcomes in future pregnancies. These include perinatal death (RR= 4.3), a baby with low birth weight (RR= 3.5), or a preterm birth (RR= 2.5). These risks were only partly explained by recurrence of preeclampsia.ConclusionsPreeclampsia in one pregnancy is a strong predictor for preeclampsia and other adverse pregnancy outcomes in subsequent pregnancies in Tanzania. Women with previous preeclampsia may benefit from close follow-up during their pregnancies.

Highlights

Preeclampsia is associated with increased risk of maternal and perinatal morbidity and mortality, as well as long-term complications [1]
Our data show that preeclampsia is a serious complication of a particular pregnancy in Tanzania, and a strong predictor for preeclampsia and other adverse outcomes in future pregnancies
The absolute recurrence risk was as high as 25%.In addition, when there were signs that preeclampsia in the previous pregnancy had serious consequences; the risk of preeclampsia in future pregnancies was even higher

Summary

Introduction

Preeclampsia is associated with increased risk of maternal and perinatal morbidity and mortality, as well as long-term complications [1]. Preeclampsia is a major contributor to death and disability among women of reproductive age in many low income countries [2]. The highest figures are approximately 3-fold of the global prevalence of 4% [4].Preeclampsia remains a major public health problem in sub Saharan Africa. Several risk factors for preeclampsia have been well documented [5,6]. These include first pregnancy, a history of preeclampsia, high maternal age, long inter-pregnancy interval, multiple pregnancy, gestational diabetes, chronic hypertension, family history of preeclampsia and history of preterm delivery. High body weight has been documented to be a risk factor in Africa [7]

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Conclusion