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Risks of hypertensive disorders in the second pregnancy.

J Zhang1, J F Troendle, R J Levine

  • 1Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA. Jun_Zhang@nih.gov

Paediatric and Perinatal Epidemiology
|August 8, 2001
PubMed
Summary

Hypertensive disorders recur in 20-50% of second pregnancies. Early onset of hypertension in the first pregnancy and severe small-for-gestational-age births increase recurrence risk.

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Area of Science:

  • Obstetrics and Gynecology
  • Cardiovascular Health
  • Perinatal Medicine

Background:

  • Hypertensive disorders of pregnancy are significant maternal health concerns.
  • Understanding recurrence and new development in subsequent pregnancies is crucial for risk stratification.
  • Previous research highlights various risk factors but requires further investigation into specific patterns.

Purpose of the Study:

  • To determine the incidence and identify risk factors for recurrent and newly developed hypertensive disorders in a second pregnancy.
  • To analyze recurrence rates based on the type and severity of hypertensive disorders in the first pregnancy.
  • To investigate the impact of early-onset hypertension and postpartum persistence on recurrence.

Main Methods:

  • Analysis of prospective cohort data from 1641 women in the Collaborative Perinatal Project.

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  • Inclusion criteria: women with first and second pregnancies documented in the study.
  • Statistical analysis to identify risk factors and calculate recurrence rates (e.g., relative risk, confidence intervals).

    • Main Results:

    • Recurrence rates ranged from 19% for gestational hypertension to 46% for superimposed chronic hypertension.
    • Key risk factors for recurrence included chronic hypertension history, thromboembolism, early onset, and persistent postpartum hypertension.
    • Severe small-for-gestational-age birth in a normotensive first pregnancy doubled the risk of developing hypertension in the second pregnancy (RR = 2.1).

    Conclusions:

    • Hypertensive disorders exhibit a substantial recurrence rate (20-50%) in subsequent pregnancies.
    • Earlier onset of hypertension in the first pregnancy is associated with higher recurrence rates.
    • Intrauterine growth restriction from the first pregnancy is an independent risk factor for developing hypertension in the second pregnancy.