Reproductive outcome after early-onset pre-eclampsia.
BACKGROUND
Early-onset pre-eclampsia is an important cause of maternal and neonatal morbidity and mortality and is believed to have a significant impact on future maternal physical and psychological health. However, structured follow-up data of women with a history of early-onset pre-eclampsia are lacking. This study aims to present comprehensive data of a large cohort of women with a history of early-onset pre-eclampsia with respect to future reproductive health, family planning and subsequent pregnancy rates.


METHODS
A tertiary referral cohort of 304 women entered the follow-up study at 6-12 months after their first delivery. Detailed data on maternal and neonatal outcomes, family planning and subsequent pregnancies were recorded. In addition, data on perspectives, major concerns and decision-making of women who had not achieved a second pregnancy were collected by questionnaire and structured interviews. Data were compared with a population of 268 low-risk primiparous women with an uncomplicated delivery.


RESULTS
At a mean of 5.5 years after first delivery, 65.8% of women with a history of early-onset pre-eclampsia had achieved a second pregnancy compared with 77.6% of healthy controls. At follow-up, 19.1% of women with a history of early-onset pre-eclampsia had an active wish to become pregnant, whereas 15.1% of women did not wish to achieve a future pregnancy. In the latter group, decision-making was most commonly influenced by fear of recurrent disease (33%) and fear of delivering another premature child (33%) among others reasons, e.g. post-partum counseling and concerns of the partner.


CONCLUSIONS
The majority of women with a history of early-onset pre-eclampsia achieve or wish to achieve a second pregnancy within a few years of their delivery. Nonetheless, first pregnancy early-onset pre-eclampsia appears to have a significant impact on future reproductive health and decision-making, emphasizing the importance of careful post-partum counseling.
Division of Perinatology and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Jelle M
JM
Schaaf
Hein W
HW
Bruinse
Loes
L
van der Leeuw-Harmsen
Els
E
Groeneveld
Corine
C
Koopman
Arie
A
Franx
Bas B
BB
van Rijn
D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D020073:Gravidity; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology* / Q000523:psychology; D011247:Pregnancy; D018873:Pregnancy Rate; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third