Please cite this paper as: Chang J, Muglia L, Macones G. Association of early-onset pre-eclampsia in first pregnancy with normotensive second pregnancy outcomes: a population-based study. BJOG 2010;117:946–953.
Objective To evaluate pregnancy outcomes in normotensive second pregnancy following pre-eclampsia in first pregnancy.
Design Population-based retrospective cohort study.
Setting State of Missouri in the USA.
Sample White European origin or African-American women who delivered their first two non-anomalous singleton pregnancies between 20 and 44 weeks of gestation in Missouri, USA, 1989–2005, without chronic hypertension, renal disease or diabetes mellitus (n = 12 835).
Methods Pre-eclampsia or delivery at 34 weeks of gestation or less in first pregnancy was defined as early-onset pre-eclampsia, whereas late-onset pre-eclampsia was defined as pre-eclampsia with delivery after 34 weeks of gestation. Multivariate regression models were fitted to estimate the crude and adjusted odds ratios and 95% confidence intervals.
Main outcome measures Preterm delivery, large and small-for-gestational-age infant, Apgar scores at 5 minutes, fetal death, caesarean section, placental abruption.
Results Women with early-onset pre-eclampsia in first pregnancy were more likely to be younger, African-American, recipients of Medicaid, unmarried and smokers. Despite a second normotensive pregnancy, women with early-onset pre-eclampsia in their first pregnancy had greater odds of a small-for-gestational-age infant, preterm birth, fetal death, caesarean section and placental abruption in the second pregnancy, relative to women with late-onset pre-eclampsia, after controlling for confounders. Moreover, maternal ethnic origin modified the association between early-onset pre-eclampsia in the first pregnancy and preterm births in the second pregnancy. Having a history of early-onset pre-eclampsia reduces the odds of having a large-for-gestational-age infant in the second pregnancy.
Conclusion A history of early-onset pre-eclampsia is associated with increased odds of adverse pregnancy outcomes despite a normotensive second pregnancy.