Association of early-onset pre-eclampsia in first pregnancy with normotensive second pregnancy outcomes: a population-based study.
OBJECTIVE
To evaluate pregnancy outcomes in normotensive second pregnancy following pre-eclampsia in first pregnancy.


METHODS
Population-based retrospective cohort study.


METHODS
State of Missouri in the USA.


METHODS
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).


METHODS
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.


METHODS
Preterm delivery, large and small-for-gestational-age infant, Apgar scores at 5 minutes, fetal death, caesarean section, placental abruption.


RESULTS
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.


CONCLUSIONS
A history of early-onset pre-eclampsia is associated with increased odds of adverse pregnancy outcomes despite a normotensive second pregnancy.
Chang
J J
JJ
Department of Community Health in Epidemiology, Saint Louis University School of Public Health, 3545 Lafayette Avenue, St. Louis, MO 63104, USA. changdalton@gmail.com
Muglia
L J
LJ
Macones
G A
GA
D000037:Abruptio Placentae / Q000209:etiology; D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005313:Fetal Death / Q000209:etiology; D020073:Gravidity; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011225:Pre-Eclampsia; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult