title: The impact of prior preeclampsia on the risk of superimposed preeclampsia and other adverse pregnancy outcomes in patients with chronic hypertension.
abstract: OBJECTIVE
  We sought to compare the rates of superimposed preeclampsia and adverse outcomes in women with chronic hypertension with or without prior preeclampsia.
  
  
  METHODS
  We conducted secondary analysis of 369 women with chronic hypertension (104 with prior preeclampsia) enrolled at 12-19 weeks as part of a multisite trial of antioxidants to prevent preeclampsia (no reduction was found). Outcome measures were rates of superimposed preeclampsia and other adverse perinatal outcomes.
  
  
  RESULTS
  Prepregnancy body mass index, blood pressure, and smoking status at enrollment were similar between groups. The rates of superimposed preeclampsia (17.3% vs 17.7%), abruptio placentae (1.0% vs 3.1%), perinatal death (6.7% vs 8.7%), and small for gestational age (18.4% vs 14.3%) were similar between groups, but preterm delivery <37 weeks was higher in the prior preeclampsia group (36.9% vs 27.1%; adjusted risk ratio, 1.46; 95% confidence interval, 1.05-2.03; P = .032).
  
  
  CONCLUSIONS
  In women with chronic hypertension, a history of preeclampsia does not increase the rate of superimposed preeclampsia, but is associated with an increased rate of delivery at <37 weeks.
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, OH, USA. baha.sibai@uc.edu
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Koch
authors.forename: Salvio
authors.initials: S
authors.lastname: Freire
authors.forename: Joao Luiz
authors.initials: JL
authors.lastname: Pinto e Silva
authors.forename: Marilza Vieira Cunha
authors.initials: MV
authors.lastname: Rudge
authors.forename: Sérgio
authors.initials: S
authors.lastname: Martins-Costa
authors.forename: Janet
authors.initials: J
authors.lastname: Moore
authors.forename: Cleide de Barros
authors.initials: Cde B
authors.lastname: Santos
authors.forename: Jose Guilherme
authors.initials: JG
authors.lastname: Cecatti
authors.forename: Roberto
authors.initials: R
authors.lastname: Costa
authors.forename: José Geraldo
authors.initials: JG
authors.lastname: Ramos
authors.forename: Nancy
authors.initials: N
authors.lastname: Moss
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Spinnato
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D005865:Gestational Age; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology*; D012008:Recurrence