Severe preeclampsia in the second trimester: recurrence risk and long-term prognosis

A total of 125 women with severe preeclampsia that developed in the second trimester underwent follow-up for an average of 5.4 years. Seventeen women had no further pregnancies and 108 had 169 subsequent pregnancies: 59 (35%) were normotensive and 110 (65%) were complicated by preeclampsia (32% of these developing in the second trimester, 32% at 28 to 36 weeks, and 36% at 37 to 40 weeks). Overall, 21% of subsequent pregnancies were complicated by severe preeclampsia in the second trimester. Forty-four patients (35%) had chronic hypertension, the highest incidence being in those with recurrent severe preeclampsia in the second trimester and the lowest in those with only normotensive subsequent pregnancies (67% vs 4%, p less than 0.0001). Long-term maternal complications included two maternal deaths and two other patients with end-stage renal disease requiring dialysis. We conclude that these women are at increased risk for repeat preeclampsia, particularly in the second trimester, and are at increased risk for chronic hypertension and maternal mortality and morbidity.