Recurrencia De Preeclmsia

Research
OBSTETRICS

www. AJOG.org

Recurrence of preeclampsia: effects of gestational age at delivery of the first pregnancy, body mass index, paternity, and interval between births
Dorothea Mostello, MD; Dorina Kallogjeri, MD, MPH; Rachata Tungsiripat, MD, MPH; Terry Leet, PhD
OBJECTIVES: The purpose of this study was to establish estimates for recurrence risk of preeclampsia based ongestational age at delivery of the first pregnancy complicated by preeclampsia and to determine whether interbirth interval, paternity, and body mass index (BMI) modify that risk in women with prior preeclampsia. STUDY DESIGN: A population-based, cohort study was conducted us-

ing data from Missouri maternally linked birth certificates. The cohort included women who had 2 singleton births between1989 and 1997: 6157 women with preeclampsia and 97,703 women without preeclampsia at the time of their first deliveries. Data were analyzed using the Poisson regression.
RESULTS: At the time of their second delivery, 14.7% women with

current preeclampsia is inversely related to gestational age at the first delivery: 38.6% for 28 weeks’ gestation or earlier, 29.1% for 29-32 weeks, 21.9% for 33-36weeks, and 12.9% for 37 weeks or more. The recurrent preeclampsia risk was fairly constant if both births occurred within 7 years. Obese and overweight women had higher risks of recurrent preeclampsia (19.3% and 14.2%), compared with women with normal BMI (11.2%). The recurrence risk did not differ according to paternity status.
CONCLUSION: The risk of preeclampsia recurrence increases withearlier gestational age at the first delivery complicated by preeclampsia and with increasing maternal BMI.

prior preeclampsia developed recurrent preeclampsia. The risk of re-

Key words: obesity, preeclampsia, pregnancy complications, recurrence

Cite this article as: Mostello D, Kallogjeri D, Tungsiripat R, et al. Recurrence of preeclampsia: effects of gestational age at delivery of the firstpregnancy, body mass index, paternity, and interval between births. Am J Obstet Gynecol 2008;199:55.e1-55.e7.

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reeclampsia in the first pregnancy is the strongest risk factor for preeclampsia occurring in a subsequent pregnancy.1 Women who have had a pregnancy complicated by preeclampsia, especially those who have endured significant maternal or perinatal morbidity, want and require specificcounseling re-

From the Divisions of Maternal-Fetal Medicine (Dr Mostello) and Research (Dr Leet), Department of Obstetrics, Gynecology and Women’s Health, Saint Louis University School of Medicine, and the Department of Community Health, Saint Louis University School of Public Health (Drs Kallogjeri, Tungsiripat, and Leet), St. Louis, MO.
Presented at the 25th Annual Clinical Meeting of theSociety for Maternal-Fetal Medicine, Reno, NV, Feb. 7-12, 2005. Received June 4, 2007; revised Aug. 31, 2007; accepted Nov. 27, 2007. Reprints not available from the authors. 0002-9378/$34.00 © 2008 Mosby, Inc. All rights reserved. doi: 10.1016/j.ajog.2007.11.058

garding recurrence in order to make decisions about future reproduction. The best data to date for counseling women with priorpreeclampsia regarding recurrence have come mostly from hospitalbased studies. Estimates have ranged from 0%2 to 5%3 and up to 47%.4 Factors such as change in paternity, interbirth interval, small-for-gestationalage birth weight, and prior fetal loss1,5-8 have been identified as important modifiers of risk of preeclampsia in the parous woman. Unfortunately, studies have looked at preeclampsia in a secondpregnancy, regardless of whether preeclampsia occurred in the first,1,2,9 or have specifically excluded women with prior preeclampsia from the analysis.10 Only a third of preeclampsia in a second pregnancy, however, occurs in women who have had prior preeclampsia1; thus, conclusions from the whole group may not apply to the subset of women previously affected. Indeed, when the data from women with...