Subsequent pregnancy following severe hypertensive disorders of pregnancy

The impact of the severity of hypertensive disorders of pregnancy (HDP), as defined by current criteria, on future pregnancy outcomes is inadequately described.

This study evaluated the outcomes of subsequent pregnancies following an initial pregnancy complicated by HDP and assessed the influence of disease severity on the recurrence of HDP (rHDP). This was a retrospective study. Data were analyzed for individuals with singleton first pregnancy complicated by HDP and a documented subsequent singleton pregnancy. The primary outcome was rHDP.

1035 individuals met inclusion criteria, of whom 981 (95 %) without severe features (SF) while 54 (5 %) had HDP with SF in the first pregnancy. HDP recurred in 32.6 % of subsequent pregnancies. The rate of rHDP and rHDP with SF was higher among those with a prior history of HDP with SF compared to those without SF (61 %vs31% p < 0.01, and 43 %vs5%, p < 0.01, respectively). The incidence of subsequent adverse pregnancy outcomes was higher among individuals with HDP with SF in their first pregnancy compared to those without SF (70 %vs37% p < 0.01). Multivariable regression analysis identified a history of preterm birth (22.3 %vs11.5 %, OR2.24, 95 %CI 1.49, 3.36) and HDP with SF (6.2 %vs4.7 %, OR2.85, 95 %CI 1.6, 5.1) in the first pregnancy as independent risk factors for rHDP.

Four out of ten individuals with a history of HDP experience rHDP in their subsequent pregnancy. A history of severe disease and preterm birth in the first pregnancy is associated with a higher rate of rHDP.

A history of severe disease and preterm birth in the first pregnancy is associated with a higher rate of recurrent hypertensive disorders in pregnancy.