Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510150, China.
Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, 528000, China.
Arch Gynecol Obstet. 2024 Nov;310(5):2487-2495. doi: 10.1007/s00404-024-07751-4. Epub 2024 Sep 27.
The aim was to evaluate the pregnancy outcomes and identify risk factors for recurrent preeclampsia (PE).
Retrospective analysis of patients discharged with PE between January 1, 2010, and January 1, 2023, from two tertiary referral hospitals. They were classified into recurrent and non-recurrent groups based on the presence of PE in subsequent pregnancies.
Among 519 women who had a subsequent pregnancy after a history of PE, 153 developed recurrent PE while 366 did not. The recurrent cases included 81 preterm PE, of which 41 were early-onset PE (EOPE). Recurrent PE correlated significantly with prior EOPE, HELLP syndrome, placental abruption, and stillbirth, as well as with current chronic hypertension (CH) and type 2 diabetes. The recurrent group showed a 5.8-fold higher risk of preterm birth (PTB) compared to the non-recurrent group (50.7% vs. 8.7%). Notably, 58.1% of the PTBs in the non-recurrent group were spontaneous. Logistic regression identified previous EOPE (aOR: 4.22 [95% CI: 2.50-7.13]) and current CH (aOR: 1.86 [95% CI: 1.09-3.18]) as independent contributors for recurrent PE. Furthermore, recurrent preterm PE shared the same risk factors: previous EOPE (aOR: 5.27 [95% CI: 2.82-9.85]) and current CH (aOR: 2.99 [95% CI: 1.57-5.71]). The morbidity of CH in subsequent pregnancy peaked at 31.9% when women with a history of EOPE delivered within three years.
Previous EOPE and current CH were sequentially crucial risk factors for the development of PE and preterm PE during the next pregnancy. This may clarify risk stratification in prenatal management for women with a history of PE.
评估妊娠结局并确定复发性子痫前期（PE）的危险因素。
对 2010 年 1 月 1 日至 2023 年 1 月 1 日期间在两家三级转诊医院出院的 PE 患者进行回顾性分析。根据后续妊娠中是否存在 PE 将其分为复发组和非复发组。
在 519 名有 PE 病史的患者中，有 153 名患者发展为复发性 PE，366 名患者未发展为复发性 PE。复发性病例中包括 81 例早产 PE，其中 41 例为早发型 PE（EOPE）。复发性 PE 与既往 EOPE、HELLP 综合征、胎盘早剥和死胎以及当前慢性高血压（CH）和 2 型糖尿病显著相关。与非复发组（50.7% vs. 8.7%）相比，复发组早产的风险高 5.8 倍。值得注意的是，非复发组中 58.1%的早产为自发性。Logistic 回归分析发现，既往 EOPE（OR：4.22[95%CI：2.50-7.13]）和当前 CH（OR：1.86[95%CI：1.09-3.18]）是复发性 PE 的独立危险因素。此外，复发性早产 PE 具有相同的危险因素：既往 EOPE（OR：5.27[95%CI：2.82-9.85]）和当前 CH（OR：2.99[95%CI：1.57-5.71]）。既往 EOPE 的妇女在三年内分娩时，随后妊娠中 CH 的发病率高达 31.9%。
既往 EOPE 和当前 CH 是下一次妊娠中 PE 和早产 PE 发展的顺序性关键危险因素。这可能阐明了有 PE 病史的妇女产前管理的风险分层。
