Recurrence Risk of a Delivery before 34 Weeks of Pregnancy Due to an Early Onset Hypertensive Disorder: A Systematic Review

ABSTRACT

Early onset hypertensive disorders of pregnancy are associated with adverse maternal and neonatal outcome. The risk of recurrence influences parents' choices on subsequent pregnancies and the counseling obstetrician, but evidence so far has been limited. We performed the first systematic review on the risk of recurrence of hypertensive disorders that had caused delivery <34 weeks. We searched Medline, Embase, and the Cochrane Library for articles published until September 2009 that report on pregnancy outcome after an earlier pregnancy complicated by early hypertension, preeclampsia, or hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, which resulted in a delivery before 34 weeks. Recurrence rates of premature deliveries due to hypertensive disorders were calculated for each study separately. Pooled data were calculated. The search retrieved 36 relevant articles, of which 11 fulfilled the inclusion criteria. These 11 studies reported on 2377 patients (range 18 to 1754 patients per study), who had 2461 deliveries. Seven studies were included for further calculation. The pooled risk of a delivery before 34 weeks due to recurrence of hypertension, preeclampsia, or HELLP was 7.8% (95% confidence interval 6.7 to 9.0%). Opposed to some previous studies, the overall recurrence rate is generally low. The pooled recurrence risk of an early onset hypertensive disorder is ~8%.

KEYWORDS

Preeclampsia - fetal growth restriction - recurrence - severe - review

REFERENCES

• 1 Sibai B M. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count.  Obstet Gynecol. 2004;  103(5 Pt 1) 981-991
• 2 Sibai B M, Ewell M, Levine R J The Calcium for Preeclampsia Prevention (CPEP) Study Group et al. Risk factors associated with preeclampsia in healthy nulliparous women.  Am J Obstet Gynecol. 1997;  177 1003-1010
• 3 Sibai B M, el-Nazer A, Gonzalez-Ruiz A. Severe preeclampsia-eclampsia in young primigravid women: subsequent pregnancy outcome and remote prognosis.  Am J Obstet Gynecol. 1986;  155 1011-1016
• 4 Witlin A G, Saade G R, Mattar F, Sibai B M. Predictors of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks' gestation.  Am J Obstet Gynecol. 2000;  182 607-611
• 5 Lie R T, Rasmussen S, Brunborg H, Gjessing H K, Lie-Nielsen E, Irgens L M. Fetal and maternal contributions to risk of pre-eclampsia: population based study.  BMJ. 1998;  316 1343-1347
• 6 Ganzevoort W, Rep A, de Vries J I, Bonsel G J, Wolf H. PETRA-investigators . Prediction of maternal complications and adverse infant outcome at admission for temporizing management of early-onset severe hypertensive disorders of pregnancy.  Am J Obstet Gynecol. 2006;  195 495-503
• 7 Zhang J, Meikle S, Trumble A. Severe maternal morbidity associated with hypertensive disorders in pregnancy in the United States.  Hypertens Pregnancy. 2003;  22 203-212
• 8 Sibai B M. Diagnosis and management of gestational hypertension and preeclampsia.  Obstet Gynecol. 2003;  102 181-192 , (Review)
• 9 van Pampus M G, Wolf H, Weijmar Schultz W C, Neeleman J, Aarnoudse J G. Posttraumatic stress disorder following preeclampsia and HELLP syndrome.  J Psychosom Obstet Gynaecol. 2004;  25 183-187
• 10 van Pampus M G, Wolf H, Mayruhu G, Treffers P E, Bleker O P. Long-term follow-up in patients with a history of (H)ELLP syndrome.  Hypertens Pregnancy. 2001;  20 15-23
• 11 Dildy III G A, Belfort M A, Smulian J C. Preeclampsia recurrence and prevention.  Semin Perinatol. 2007;  31 135-141
• 12 Sibai B, Dekker G, Kupferminc M. Pre-eclampsia.  Lancet. 2005;  365 785-799
• 13 Rep A, Ganzevoort W, Bonsel G J, Wolf H, de Vries J I. Psychosocial impact of early-onset hypertensive disorders and related complications in pregnancy.  Am J Obstet Gynecol. 2007;  197 158.e1-158.e6
• 14 Sibai B M, Mercer B, Sarinoglu C. Severe preeclampsia in the second trimester: recurrence risk and long-term prognosis.  Am J Obstet Gynecol. 1991;  165(5 Pt 1) 1408-1412
• 15 Milne F, Redman C, Walker J et al.. The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community.  BMJ. 2005;  330 576-580
• 16 Whiting P, Rutjes A W, Reitsma J B, Bossuyt P M, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews.  BMC Med Res Methodol. 2003;  3 25
• 17 Windt van der D AWM, Zeegers M PA, Scholten R JPM. Systematische reviews van observationeel onderzoek. In: Offringa M, Assendelft WJJ, Scholten RJPM Inleiding Is Evidence-Based Medicine. 2nd ed. Houten, the Netherlands; Bohn Stafleu Van Loghum 2003: 108-119
• 18 Chames M C, Haddad B, Barton J R, Livingston J C, Sibai B M. Subsequent pregnancy outcome in women with a history of HELLP syndrome at <or = 28 weeks of gestation.  Am J Obstet Gynecol. 2003;  188 1504-1507 discussion 1507-1508
• 19 Gaugler-Senden I P, Berends A L, de Groot C J, Steegers E A. Severe, very early onset preeclampsia: subsequent pregnancies and future parental cardiovascular health.  Eur J Obstet Gynecol Reprod Biol. 2008;  140 171-177
• 20 Sullivan C A, Magann E F, Perry Jr K G, Roberts W E, Blake P G, Martin Jr J N. The recurrence risk of the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) in subsequent gestations.  Am J Obstet Gynecol. 1994;  171 940-943
• 21 van Rijn B B, Hoeks L B, Bots M L, Franx A, Bruinse H W. Outcomes of subsequent pregnancy after first pregnancy with early-onset preeclampsia.  Am J Obstet Gynecol. 2006;  195 723-728
• 22 Visser G H, Huisman A, Saathof P W, Sinnige H A. Early fetal growth retardation: obstetric background and recurrence rate.  Obstet Gynecol. 1986;  67 40-43
• 23 Kupferminc M J, Fait G, Many A et al.. Low-molecular-weight heparin for the prevention of obstetric complications in women with thrombophilias.  Hypertens Pregnancy. 2001;  20 35-44
• 24 Ferrazzari S, D'Alessio M C, Fatigante G, Soreca G, De Carolis S, Paradisi G et al.. Prophylaxis of recurrent preeclampsia: low-molecular-weight heparin plus low-dose aspirin versus low-dose aspirin alone.  Hypertens Pregnancy. 2006;  25 115-127
• 25 Kalk J J, Huisjes A J, de Groot C J et al.. Recurrence rate of pre-eclampsia in women with thrombophilia influenced by low-molecular-weight heparin treatment?.  Neth J Med. 2004;  62 83-87
• 26 Sep S J, Smits L J, Prins M H, Spaanderman M E, Peeters L L. Simple prepregnant prediction rule for recurrent early-onset hypertensive disease in pregnancy.  Reprod Sci. 2009;  16 80-87
• 27 Hernández-Díaz S, Toh S, Cnattingius S. Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study.  BMJ. 2009;  338 b2255