Preeclampsia In First Pregnancy Research Articles

Abstract 12418: History of Physical or Sexual Abuse in Early Life and Risk of Preeclampsia

Introduction: Women with a history of abuse are more likely to develop chronic hypertension later in life. However, it is unknown whether early life abuse is associated with the risk of developing preeclampsia, a hypertensive disorder that complicates 5-7% of pregnancies. Hypothesis: We hypothesized that women with a history of physical or sexual abuse during early life would have a higher risk of developing preeclampsia during their first pregnancy. Methods: Nurses’ Health Study II participants reported on their histories of physical and sexual abuse in early life (childhood [0-10 years] or adolescence [11-17 years]) in 2001 and pregnancy complications (including preeclampsia) in 2009. Parous women with available information on early life abuse and pregnancy history comprised the study sample (n=46,212). Modified Poisson regression models were used to estimate risk ratios (RR) and 95% confidence intervals (CI) for the associations between physical and sexual abuse in early life and preeclampsia. Models were adjusted for maternal age at pregnancy, year of birth, race/ethnicity, body size (somatogram) at age five, and childhood socioeconomic status. Results: More than half of women (53%; n=24,212) reported a history of physical abuse in early life, with 9% reporting severe abuse. A history of sexual abuse in early life was reported among 33% of women (n=15,389); 22% reported touch only sexual abuse while 11% reported a history of forced sexual activity. History of severe physical abuse in early life was associated with a 37% increased risk of preeclampsia in first pregnancy (CI: 1.19-1.57) compared to no early life physical abuse. History of forced sexual activity in early life was associated with a 33% increased risk of preeclampsia in first pregnancy (CI: 1.19-1.48) compared to no early life sexual abuse. Histories of less severe physical abuse or touch only sexual abuse were not associated with preeclampsia risk. Conclusion: Women with a history of severe physical or sexual abuse in childhood or adolescence appear to have an increased risk of developing preeclampsia during pregnancy.

Risk factors of recurrent preeclampsia and its relation to maternal and offspring outcome

To investigate the risks of recurrent preeclampsia and observe the incidence and long-term prognosis of recurrent preeclampsia. One hundred and fifteen women with preeclampsia history admitted in Women's Hospital, Zhejiang University School of Medicine from January 2009 to December 2013 were enrolled in the study. The clinical data were retrospectively analyzed. Among 115 women with preeclampsia, 82 cases (71.3%)had recurrent preeclampsia. The onset age, the pregnant interval time, regular prenatal check-up, weight gain during pregnancy, body mass index (BMI), hyperlipidemia, fetal growth restriction (FGR), maternal family history were closely associated with recurrent preeclampsia (P<0.05). Logistic regression analysis showed that the pregnant interval time, BMI, FGR were independent risk factors for preeclampsia recurrence. Compared with the preeclampsia in first pregnancy, the mather had earlier onset and termination of pregnancy, higher blood pressure, higher rate of urine protein ≥ 2+ and higher rate of complications in recurrent preeclampsia. The offspring had higher rate of preterm birth, especially the time of birth for 34 weeks or earlier and lower birth weight (P<0.05). The incidence of chronic hypertension in recurrent preeclampsia group was higher than that in no recurrence group (47.5% vs 23.3%, P<0.05); the overweight rate of first pregnant offspring in recurrence group was higher than that in no recurrence group (31.25% vs 6.70%, P<0.05). The onset age, time interval, regular prenatal check-up, weight gain during pregnancy, BMI, hyperlipidemia, FGR, maternal family history are closely associated with recurrent preeclampsia, and the pregnant interval time, BMI, FGR are independent risk factors for preeclampsia recurrence. Recurrent preeclampsia has more serious clinical outcome and complications, and prevention need to be emphasized.

Early onset preeclampsia in subsequent pregnancies correlates with early onset preeclampsia in first pregnancy

ObjectivePreeclampsia is a major complication of pregnancy and its occurrence in a first pregnancy is a major risk factor for recurrence in subsequent pregnancies. Whether the time of onset or the severity of preeclampsia in a first pregnancy is associated with the incidence of recurrent preeclampsia is not clear. We performed a retrospective study to analyse the incidence of recurrent preeclampsia and associations of the time of onset and the severity of preeclampsia between first preeclampsia and recurrent preeclampsia. Study designNinety-two women with previous preeclampsia who had a second pregnancy in a 4 year period were included. Data on the first and second pregnancies were obtained and included maternal age, maternal height and weight, gestation week at onset of preeclampsia and at delivery, blood pressure, proteinuria, interval between pregnancies and birth weights. ResultsFifty-five women with previous preeclampsia developed recurrent preeclampsia (59.8%). The difference in the incidence of recurrent early and late onset preeclampsia was not significant different (65.3% versus 53.4%, p>0.05). The difference in the incidence of mild or severe disease in those who experienced recurrent preeclampsia was also not significant (59.6% versus 60%, p>0.05). The severity of preeclampsia in second pregnancy was not associated with the severity of preeclampsia in first pregnancy. However 93.7% women with previous early onset preeclampsia developed early onset preeclampsia in second pregnancy and 56.5% women with previous late onset preeclampsia developed early onset preeclampsia in second pregnancy. In addition, 76.2% women with previous mild preeclampsia developed severe preeclampsia in second pregnancy. The baby weight in recurrent preeclampsia was significantly decreased compared to that in first pregnancy with preeclampsia. ConclusionOur data demonstrate that there was no association between the incidence of recurrent preeclampsia and the time of onset or severity of preeclampsia in first pregnancy. But our data here may suggest that women with early onset preeclampsia in first pregnancy are more likely to experience early onset preeclampsia in second pregnancy. The severity of recurrent preeclampsia is increased regardless the severity in first pregnancy.

Cardiovascular mortality after pre-eclampsia in one child mothers: prospective, population based cohort study

Objective To assess the association of pre-eclampsia with later cardiovascular death in mothers according to their lifetime number of pregnancies, and particularly after only one child.Design Prospective, population based cohort...

Familial Factors in the Association between Preeclampsia and Later ESRD

Women with preeclampsia have increased risk of developing ESRD. This study assessed whether this can be explained by preeclampsia itself or by familial aggregation of common risk factors. Since 1967, the Medical Birth Registry of Norway has registered data on all births in the country. By linkage with the Norwegian Population Registry, different, but overlapping, cohorts were defined: the first and second cohorts included women and a sibling (first cohort) or child (second cohort) with a registered first birth between 1967 and 2008. Similar cohorts were defined for men. The Norwegian Renal Registry provided data on ESRD from 1980 to June 2009. Cohort 1 was used for the main analyses and included 570,675 women, 291 of whom developed ESRD after a median 18.2 years. Compared with women without preeclampsia and no siblings with preeclampsia, women without preeclampsia but a sibling with preeclampsia had a relative risk (RR) of ESRD of 0.96 (95% confidence interval, 0.59-1.6), women with preeclampsia but no siblings with preeclampsia had a RR of 6.0 (4.4-8.1), and women with preeclampsia and a sibling with preeclampsia had a RR of 2.8 (0.88-8.6). Further analyses of women showed no increased risk of ESRD if a child had preeclampsia in first pregnancy. Familial aggregation of risk factors does not seem to explain increased ESRD risk after preeclampsia. These findings support the hypothesis that preeclampsia per se may lead to kidney damage.

The paternal role in pre-eclampsia and giving birth to a small for gestational age infant; a population-based cohort study

ObjectiveTo estimate the effect of partner change on risks of pre-eclampsia and giving birth to a small for gestational age infant.DesignProspective population study.SettingSweden.ParticipantsWomen with their first and second successive singleton...

Association of early‐onset pre‐eclampsia in first pregnancy with normotensive second pregnancy outcomes: a population‐based study

To evaluate pregnancy outcomes in normotensive second pregnancy following pre-eclampsia in first pregnancy. Population-based retrospective cohort study. State of Missouri in the USA. White European origin or African-American women who delivered their first two non-anomalous singleton pregnancies between 20 and 44 weeks of gestation in Missouri, USA, 1989-2005, without chronic hypertension, renal disease or diabetes mellitus (n = 12 835). Pre-eclampsia or delivery at 34 weeks of gestation or less in first pregnancy was defined as early-onset pre-eclampsia, whereas late-onset pre-eclampsia was defined as pre-eclampsia with delivery after 34 weeks of gestation. Multivariate regression models were fitted to estimate the crude and adjusted odds ratios and 95% confidence intervals. Preterm delivery, large and small-for-gestational-age infant, Apgar scores at 5 minutes, fetal death, caesarean section, placental abruption. Women with early-onset pre-eclampsia in first pregnancy were more likely to be younger, African-American, recipients of Medicaid, unmarried and smokers. Despite a second normotensive pregnancy, women with early-onset pre-eclampsia in their first pregnancy had greater odds of a small-for-gestational-age infant, preterm birth, fetal death, caesarean section and placental abruption in the second pregnancy, relative to women with late-onset pre-eclampsia, after controlling for confounders. Moreover, maternal ethnic origin modified the association between early-onset pre-eclampsia in the first pregnancy and preterm births in the second pregnancy. Having a history of early-onset pre-eclampsia reduces the odds of having a large-for-gestational-age infant in the second pregnancy. A history of early-onset pre-eclampsia is associated with increased odds of adverse pregnancy outcomes despite a normotensive second pregnancy.

Outcomes of subsequent pregnancy after first pregnancy with early-onset preeclampsia

The aim of this study was to report outcome of subsequent pregnancy after early-onset preeclampsia in first pregnancy, and to evaluate potential risk factors for recurrence of preeclampsia and preterm delivery. Reproductive follow-up data were obtained for women with a history of early-onset preeclampsia, resulting in delivery before 34 weeks of gestation at the University Medical Center Utrecht, The Netherlands, between July 1993 and September 2002. The relative contributions of demographic data, outcome variables of first pregnancy, and common thrombophilias to the recurrence risk of preeclampsia and preterm delivery in subsequent pregnancy, were estimated by Cox proportional hazard models. Subsequent pregnancy outcome data were available for 120 women. Overall, preeclampsia reoccurred in the second pregnancy in 30 women (25%). However, 6 women delivered before 34 weeks of gestation (5%), 20 women between 34 and 37 weeks of gestation (17%), and 94 women after 37 weeks of gestation (78%). Forty-one women (34%) had an uneventful pregnancy. Recurrence rates for preeclampsia or preterm delivery were not related to severity of first pregnancy complications, including delivery before 28 weeks of gestation, occurrence of hemolysis, elevated liver enzymes, and low platelet count syndrome, small-for-gestational age infants, and to hereditary or acquired thrombophilias. Chronic hypertension was related to a higher recurrence risk of preeclampsia in the second pregnancy (hazard ratio 2.1, 95% CI 1.0-4.4), and smoking was related to a higher recurrence risk of preterm birth (hazard ratio 2.4, 95% CI 1.1-5.6). Outcomes of subsequent pregnancy after first pregnancy with early-onset preeclampsia is generally favorable.

Obstetric significance of cardiolipin antibodies in subjects without systemic lupus erythematosus

SummaryForty consecutive cardiolipin antibody positive sera were identified and the case notes of the corresponding patients reviewed. Thirteen of these patients were females without systemic lupus erythematosus who had been pregnant at least once. Five (38 per cent) of them had had proteinuric pre-eclampsia in first pregnancy. There was also a high frequency of history of miscarriage in these patients. A review of their known clinical and laboratory features failed to reveal characteristics which could be confidently used to predict cardiolipin antibody positivity in apparently healthy patients, and we suggest that routine antenatal screening for cardiolipin antibodies may be justified.