Herhaling hypertensieve aandoening tijdens zwangerschap*

Objective

To assess the recurrence risk of late preterm hypertensive disease of pregnancy and to determine whether potential risk factors are predictive.

Design

Retrospective cohort study.

Methods

Our study cohort included 425 women with a pregnancy-related hypertensive disorder who had delivered between 34 and 37 weeks of gestation at three different academic and three tertiary care hospitals in the Netherlands during the 2000-2002 period. Data were collected from medical files and by telephone interviews with the women. An adverse outcome was defined as the recurrence of a hypertensive disorder during the subsequent pregnancy. We also designed a prediction model containing demographic and clinical factors predictive for an adverse outcome.

Results

Of the 425 women who met the inclusion criteria, 351 could be contacted, of whom 189 (54%) had had a subsequent pregnancy. Pregnancy-related hypertensive disorders had recurred in 96 (51%; 95% CI: 43-58) women. Seventeen women (9%; 95% CI: 5-14) had delivered again before the 37th week. Pre-existing hypertension and maternal age were the strongest predictors for recurrence. Women who had experienced a recurrence had a 9-fold chance of developing chronic hypertension (37 vs. 6%; OR 8.7; 95% CI: 3.3-23).

Conclusion

Women with hypertensive disorders and late preterm deliveries have a 50% chance of recurrence of the disorder and a 9% chance of recurrent premature delivery. Women with pre-existing hypertension or who are older are prone to recurrence. Women with a recurrent hypertensive disorder during a subsequent pregnancy often later develop chronic hypertension.

Conflict of interest: none declared. Financial support: this study was made possible in part by a grant issued by the Dutch Society of Obstetrics and Gynaecology (NVOG) in the area of foetomaternal medicine and from a trust-fund grant issued by Erasmus University in Rotterdam.