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Original research
Pre-eclampsia in a first pregnancy and subsequent pregnancy outcomes: a nationwide cohort study
  1. Eva Havers-Borgersen1,2,
  2. Emil Fosbøl1,
  3. Marianne Johansen3,
  4. Lars Køber1,
  5. Jonathan M Morris4,5,
  6. Sean K M Seeho4,5
  1. 1 Department of Cardiology, Rigshospitalet, København, Denmark
  2. 2 Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
  3. 3 Department of Obstetrics, Rigshospitalet, København, Denmark
  4. 4 Reproduction and Perinatal Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
  5. 5 Women and Babies Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Eva Havers-Borgersen, Department of Cardiology, Rigshospitalet, København 2100, Denmark; evaborgersen{at}gmail.com

Abstract

Background For women whose first pregnancy was complicated by pre-eclampsia (PE), particularly if severe and requiring early birth, the risk of recurrence and maternal and neonatal outcomes at subsequent birth are important considerations.

Methods In this observational cohort study, all primiparous women who gave birth in Denmark between 1997 and 2016 were identified using nationwide registries. Women were stratified by whether they developed PE and followed from date of birth until subsequent birth, emigration, death or end of study (December 2016). The cumulative incidences of subsequent birth among women with versus without PE were assessed using the Aalen-Johansen estimator. Subsequent outcomes including PE recurrence and maternal and neonatal morbidity and mortality were also examined. Factors associated with subsequent birth and recurrent PE were examined using multivariable Cox regression models.

Results Among 510 615 primiparous women with singleton pregnancies, 21 683 (4.2%) developed PE, with 1819 (0.4%) being early-onset PE (birth <34 weeks). Women with PE had a lower subsequent birth rate (57.4%) compared with women without PE (61.2%), and it was considerably lower among women with early-onset PE (49.4%). Among women with PE who had a subsequent birth, the overall recurrence rate of PE was 15.8% and higher among those with early-onset PE (31.5%). The gestational age increased with a median of 3 days (IQR −5 to 14) overall and 50 days (IQR 35–67) among those with early-onset PE. Moreover, neonatal and maternal morbidity and mortality were substantially improved in a subsequent pregnancy.

Conclusions Primiparous women with PE have a significantly lower rate of a subsequent birth than women without PE, yet the absolute difference was modest. Although the overall risk of recurrent PE is 1 in 6, maternal and neonatal morbidity and mortality at subsequent birth are substantially improved.

  • EPIDEMIOLOGY
  • OBSTETRICS
  • CARDIOVASCULAR DISEASES

Data availability statement

Data may be obtained from a third party and are not publicly available. According to legislation on anonymity, data from Statistics Denmark are not publicly available but access to data can be allowed upon request.

https://doi.org/10.1136/jech-2023-220829

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. According to legislation on anonymity, data from Statistics Denmark are not publicly available but access to data can be allowed upon request.

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    Footnotes

    • Twitter @HaversEva

    • Contributors All the authors have made substantial contributions to the work. EH-B, SKMS and JMM have contributed by designing the study. EH-B, SKMS, EF, MJ and LK have contributed by acquisition, analysis and interpretation of data. EH-B has drafted the manuscript. All authors have revised the manuscript critically and approved the final version. All authors have agreed to be accountable for all aspects of the work. EH-B is responsible for the overall content as the guarantor

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.