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Published on: June 10, 2013
Divergent profiles in early and late postpartum preeclampsia
Ran Matot1, Bar Narkis1, Yossi Geron1
1Helen Schneider Hospital for Women, Rabin Medical Center, Tel Aviv University School of Medicine, Petach Tikva, Israel.
Objective:
To investigate the differential clinical characteristics and perinatal outcomes of early (≤48 h) versus late (>48 h-6 wk) postpartum preeclampsia (PP-PE) in a large retrospective cohort.
Study Design:
Single-centre retrospective cohort study. Women with severe-feature PP-PE were classified as early (n = 121) or late (n = 26). Controls were healthy postpartum women (n = 658) and those with severe ante-partum PE (AP-PE; n = 494). Multivariable logistic regression adjusted for age, parity and other significant covariates.
Main Outcome Measures:
Comparing maternal comorbidities, mode of delivery and obstetrical complications.
Results:
Versus healthy controls, PP-PE showed more chronic hypertension (26.5% vs 13.2%, p < 0.01), gestational hypertension (13.6% vs 1.7%, p < 0.01) and gestational diabetes (22.4% vs 12.3%, p < 0.01). Early PP-PE had higher Cesarean (74.4% vs 46.2%, p = 0.02) and preterm birth rates (33.1% vs 16.0%, p = 0.09) than late PP-PE. Early disease independently increased odds of Cesarean (adjusted odds ratio [aOR] 9.3, 95% CI 4.8-17.8) and prematurity (aOR 3.5, 1.9-6.3); late disease was strongly linked to chronic hypertension (aOR 4.6, 1.9-10.8). Compared with AP-PE, chronic hypertension was lower in early PP-PE (23.1% vs 43.5%, p < 0.01) but similar in late PP-PE; small for gestational age infants were fewer in late PP-PE (3.8% vs 15.0%, p = 0.01).
Conclusions:
Our findings suggest that early and late PP-PE may reflect distinct clinical phenotypes. While early PP-PE shares features with placental dysfunction, late PP-PE appears more closely linked to chronic hypertension. These differences warrant further investigation in larger prospective studies.
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