De Marco Oriana, Ruotolo Chiara, Njanjo Linda, Mariani Chiara, Mazé Béatrice, Santagati Giulia, Fois Antioco, Chevé Marie Therese, Chatrenet Antoine, Salomone Mario, Torreggiani Massimo, Piccoli Giorgina Barbara
Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France.
Department of Obstetrics, Centre Hospitalier Le Mans, Le Mans, France.
Clin Kidney J. 2025 Mar 17;18(4):sfaf070. doi: 10.1093/ckj/sfaf070. eCollection 2025 Apr.
The risk of kidney failure increases after preeclampsia (PE), further increasing after two or more episodes. Recurrence is variably estimated. The aim of this study was to assess the recurrence rate and its predictors in the setting of obstetric-nephrology follow-up of pregnancies after PE.
In a prospective study (2018-24), from 108 pregnancies with prior hypertensive disorders of pregnancy we selected 77 singleton deliveries after excluding twins, miscarriages, terminations, ongoing pregnancies, and drop-outs. PE recurrence and potential associated factors were tested in univariable and multivariable logistic regression models. Gestational age at time of delivery was analyzed using Kaplan-Meier curves and Cox regression. The diagnostic potential of angiogenic placental biomarkers (soluble FMS-like tyrosine kinase-1 and placental growth factor) was likewise tested.
In the context of a high prevalence of previous preterm delivery (53.6%), PE recurrence was 42.9%. Furthermore, 19.5% of the women experienced other complications and only 37.7% had an uneventful pregnancy; 60.6% of recurrences occurred after the 37th gestational week (GW), making later delivery possible (median: 38 GW in the index pregnancy versus 35 GW in the previous pregnancy). The covariates associated with PE recurrence were chronic hypertension (OR 7.662, 95% CI 2.122-33.379) and having had a baby with a centile <10th (OR 7.049, 95% CI 1.56-41.027), while those associated with time to delivery were hypertension and maternal age. Being diagnosed with chronic kidney disease after a previous PE episode was not associated with a significantly increased risk of recurrent PE.
Risk of PE recurrence was high but delayed in this cohort on multidisciplinary follow-up. The question of whether a proactive approach to delivery can help to preserve long-term maternal kidney health is open.
子痫前期（PE）后肾衰竭风险增加，经历两次或更多次子痫前期发作后风险进一步升高。复发率的估计各不相同。本研究的目的是在PE后妊娠的产科-肾脏病学随访背景下评估复发率及其预测因素。
在一项前瞻性研究（2018 - 2024年）中，从108例既往有妊娠高血压疾病的妊娠中，排除双胎、流产、终止妊娠、继续妊娠和失访者后，选取77例单胎分娩。在单变量和多变量逻辑回归模型中测试PE复发及潜在相关因素。使用Kaplan-Meier曲线和Cox回归分析分娩时的孕周。同样测试血管生成性胎盘生物标志物（可溶性FMS样酪氨酸激酶-1和胎盘生长因子）的诊断潜力。
在既往早产发生率较高（53.6%）的情况下，PE复发率为42.9%。此外，19.5%的女性经历了其他并发症，只有37.7%的妊娠过程顺利；60.6%的复发发生在第37孕周（GW）之后，使得晚期分娩成为可能（中位值：本次妊娠为38 GW，上次妊娠为35 GW）。与PE复发相关的协变量是慢性高血压（比值比7.662，95%置信区间2.122 - 33.379）和分娩的婴儿百分位数<第10百分位（比值比7.049，95%置信区间1.56 - 41.027），而与分娩时间相关的协变量是高血压和产妇年龄。既往PE发作后被诊断为慢性肾脏病与复发性PE风险显著增加无关。
在这个多学科随访队列中，PE复发风险较高但出现延迟。积极的分娩方式是否有助于维持产妇长期肾脏健康这一问题尚无定论。
