Early and late onset pre-eclampsia and small for gestational age risk in subsequent pregnancies

Thomas P. Bernardes; Ben W. Mol; Anita C.J. Ravelli; Paul van den Berg; H. Marike Boezen; Henk Groen

doi:10.1371/journal.pone.0230483

Early and late onset pre-eclampsia and small for gestational age risk in subsequent pregnancies

Thomas P. Bernardes^*, Ben W. Mol, Anita C.J. Ravelli, Paul van den Berg, H. Marike Boezen, Henk Groen

^*Corresponding author for this work

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Abstract

Background Pre-eclampsia shares pathophysiology with intrauterine growth restriction. Objective To investigate whether delivery of a small for gestational age (SGA) infant in the 1^st pregnancy increases the risk of early and late onset pre-eclampsia in the 2^nd pregnancy. Conversely, we investigated whether pre-eclampsia in the 1^st pregnancy impacts SGA risk in the 2^nd pregnancy. Study design We studied a cohort from the Dutch Perinatal Registry of 265,031 women with 1^st and 2^nd singleton pregnancies who delivered between 2000 and 2007. We analyzed 2^nd pregnancy risks of early and late onset pre-eclampsia—defined by delivery before or after 34 gestational weeks—as well as SGA below the 5^th and between the 5^th and 10^th percentiles risks with multivariable logistic regressions. Interaction terms between 1^st pregnancy hypertension, pre-eclampsia, SGA, and delivery before or after 34 gestational weeks were included in the regressions. Results First pregnancy early onset pre-eclampsia increased risk of SGA <5^th percentile (OR 2.1, 95% CI 1.7–2.7) in the 2^nd pregnancy. Late onset pre-eclampsia increased the SGA <5^th percentile marginally (OR 1.1, 95% CI 1.0–1.3). In the absence of 1^st pregnancy hypertensive disorder, women who delivered an SGA infant in their 1^st pregnancy were at increased risk of 2^nd pregnancy late onset pre-eclampsia (SGA <5^th: OR 2.05, 95% CI 1.58–2.66; SGA 5–10^th: OR 1.39, 95% CI 1.01–1.93). Early onset 2^nd pregnancy pre-eclampsia risk was also increased, but this was only statistically significant for women who delivered an SGA infant below the 5^th percentile in the 1^st pregnancy (SGA <5^th: OR 2.44, 95% CI 1.19–5.00; SGA 5–10^th: OR 1.69, 95% CI 0.68–4.24;). Conclusion Women with 1^st pregnancy early onset pre-eclampsia have increased risk of SGA <5^th percentile in the 2^nd pregnancy. SGA in the 1^st pregnancy increases pre-eclampsia risk in the 2^nd pregnancy even in the absence of hypertensive disorders in the 1^st pregnancy, although absolute risks remain low. These findings strengthen the evidence base associating intrauterine growth restriction with early onset pre-eclampsia.

Original language	English
Article number	0230483
Number of pages	13
Journal	PloS ONE
Volume	15
Issue number	3
DOIs	https://doi.org/10.1371/journal.pone.0230483
Publication status	Published - 27 Mar 2020

Bibliographical note

Data Availability: Data used in this study belongs to the Dutch Perinatal Registry (https://www.perined.nl/). Access is subject to approval by the Dutch Perinatal Registry (Perined). Perined grants access to researchers who meet its criteria for access to confidential data. The authors confirm that they did not receive special access privileges to the data that others would not have. Researchers may contact Perined at Mercatorlaan 1200, 3528 BL Utrecht (phone: 030 - 3690800, email: info@perined.nl).

Keywords

Adult
Age Factors
Female
Humans
Infant, Small for Gestational Age
Netherlands/epidemiology
Pre-Eclampsia/epidemiology
Pregnancy
Prospective Studies
Registries
Risk Factors
DIAGNOSIS
HYPERTENSIVE DISORDERS
FETAL-GROWTH
PREVENTION
BIRTH-WEIGHT
LOW-DOSE ASPIRIN
1ST PREGNANCY
RECURRENCE
INTRAUTERINE GROWTH RESTRICTION
OUTCOMES

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10.1371/journal.pone.0230483Licence: CC BY

Bernardes_etal_pone_Early_and_late_VOR
Copyright: © 2020 Bernardes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Copyright: © 2020 Bernardes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. https://creativecommons.org/licenses/by/4.0/
Final published version, 1.37 MBLicence: CC BY

Cite this

@article{89a458cb74fe4793af955c7b021144df,

title = "Early and late onset pre-eclampsia and small for gestational age risk in subsequent pregnancies",

abstract = "Background Pre-eclampsia shares pathophysiology with intrauterine growth restriction. Objective To investigate whether delivery of a small for gestational age (SGA) infant in the 1st pregnancy increases the risk of early and late onset pre-eclampsia in the 2nd pregnancy. Conversely, we investigated whether pre-eclampsia in the 1st pregnancy impacts SGA risk in the 2nd pregnancy. Study design We studied a cohort from the Dutch Perinatal Registry of 265,031 women with 1st and 2nd singleton pregnancies who delivered between 2000 and 2007. We analyzed 2nd pregnancy risks of early and late onset pre-eclampsia—defined by delivery before or after 34 gestational weeks—as well as SGA below the 5th and between the 5th and 10th percentiles risks with multivariable logistic regressions. Interaction terms between 1st pregnancy hypertension, pre-eclampsia, SGA, and delivery before or after 34 gestational weeks were included in the regressions. Results First pregnancy early onset pre-eclampsia increased risk of SGA <5th percentile (OR 2.1, 95% CI 1.7–2.7) in the 2nd pregnancy. Late onset pre-eclampsia increased the SGA <5th percentile marginally (OR 1.1, 95% CI 1.0–1.3). In the absence of 1st pregnancy hypertensive disorder, women who delivered an SGA infant in their 1st pregnancy were at increased risk of 2nd pregnancy late onset pre-eclampsia (SGA <5th: OR 2.05, 95% CI 1.58–2.66; SGA 5–10th: OR 1.39, 95% CI 1.01–1.93). Early onset 2nd pregnancy pre-eclampsia risk was also increased, but this was only statistically significant for women who delivered an SGA infant below the 5th percentile in the 1st pregnancy (SGA <5th: OR 2.44, 95% CI 1.19–5.00; SGA 5–10th: OR 1.69, 95% CI 0.68–4.24;). Conclusion Women with 1st pregnancy early onset pre-eclampsia have increased risk of SGA <5th percentile in the 2nd pregnancy. SGA in the 1st pregnancy increases pre-eclampsia risk in the 2nd pregnancy even in the absence of hypertensive disorders in the 1st pregnancy, although absolute risks remain low. These findings strengthen the evidence base associating intrauterine growth restriction with early onset pre-eclampsia.",

keywords = "Adult, Age Factors, Female, Humans, Infant, Small for Gestational Age, Netherlands/epidemiology, Pre-Eclampsia/epidemiology, Pregnancy, Prospective Studies, Registries, Risk Factors, DIAGNOSIS, HYPERTENSIVE DISORDERS, FETAL-GROWTH, PREVENTION, BIRTH-WEIGHT, LOW-DOSE ASPIRIN, 1ST PREGNANCY, RECURRENCE, INTRAUTERINE GROWTH RESTRICTION, OUTCOMES",

author = "Bernardes, {Thomas P.} and Mol, {Ben W.} and Ravelli, {Anita C.J.} and {van den Berg}, Paul and {Marike Boezen}, H. and Henk Groen",

note = "Data Availability: Data used in this study belongs to the Dutch Perinatal Registry (https://www.perined.nl/). Access is subject to approval by the Dutch Perinatal Registry (Perined). Perined grants access to researchers who meet its criteria for access to confidential data. The authors confirm that they did not receive special access privileges to the data that others would not have. Researchers may contact Perined at Mercatorlaan 1200, 3528 BL Utrecht (phone: 030 - 3690800, email: info@perined.nl). ",

year = "2020",

month = mar,

day = "27",

doi = "10.1371/journal.pone.0230483",

language = "English",

volume = "15",

journal = "PloS ONE",

issn = "1932-6203",

publisher = "PUBLIC LIBRARY SCIENCE",

number = "3",

}

TY - JOUR

T1 - Early and late onset pre-eclampsia and small for gestational age risk in subsequent pregnancies

AU - Bernardes, Thomas P.

AU - Mol, Ben W.

AU - Ravelli, Anita C.J.

AU - van den Berg, Paul

AU - Marike Boezen, H.

AU - Groen, Henk

N1 - Data Availability: Data used in this study belongs to the Dutch Perinatal Registry (https://www.perined.nl/). Access is subject to approval by the Dutch Perinatal Registry (Perined). Perined grants access to researchers who meet its criteria for access to confidential data. The authors confirm that they did not receive special access privileges to the data that others would not have. Researchers may contact Perined at Mercatorlaan 1200, 3528 BL Utrecht (phone: 030 - 3690800, email: info@perined.nl).

PY - 2020/3/27

Y1 - 2020/3/27

N2 - Background Pre-eclampsia shares pathophysiology with intrauterine growth restriction. Objective To investigate whether delivery of a small for gestational age (SGA) infant in the 1st pregnancy increases the risk of early and late onset pre-eclampsia in the 2nd pregnancy. Conversely, we investigated whether pre-eclampsia in the 1st pregnancy impacts SGA risk in the 2nd pregnancy. Study design We studied a cohort from the Dutch Perinatal Registry of 265,031 women with 1st and 2nd singleton pregnancies who delivered between 2000 and 2007. We analyzed 2nd pregnancy risks of early and late onset pre-eclampsia—defined by delivery before or after 34 gestational weeks—as well as SGA below the 5th and between the 5th and 10th percentiles risks with multivariable logistic regressions. Interaction terms between 1st pregnancy hypertension, pre-eclampsia, SGA, and delivery before or after 34 gestational weeks were included in the regressions. Results First pregnancy early onset pre-eclampsia increased risk of SGA <5th percentile (OR 2.1, 95% CI 1.7–2.7) in the 2nd pregnancy. Late onset pre-eclampsia increased the SGA <5th percentile marginally (OR 1.1, 95% CI 1.0–1.3). In the absence of 1st pregnancy hypertensive disorder, women who delivered an SGA infant in their 1st pregnancy were at increased risk of 2nd pregnancy late onset pre-eclampsia (SGA <5th: OR 2.05, 95% CI 1.58–2.66; SGA 5–10th: OR 1.39, 95% CI 1.01–1.93). Early onset 2nd pregnancy pre-eclampsia risk was also increased, but this was only statistically significant for women who delivered an SGA infant below the 5th percentile in the 1st pregnancy (SGA <5th: OR 2.44, 95% CI 1.19–5.00; SGA 5–10th: OR 1.69, 95% CI 0.68–4.24;). Conclusion Women with 1st pregnancy early onset pre-eclampsia have increased risk of SGA <5th percentile in the 2nd pregnancy. SGA in the 1st pregnancy increases pre-eclampsia risk in the 2nd pregnancy even in the absence of hypertensive disorders in the 1st pregnancy, although absolute risks remain low. These findings strengthen the evidence base associating intrauterine growth restriction with early onset pre-eclampsia.

AB - Background Pre-eclampsia shares pathophysiology with intrauterine growth restriction. Objective To investigate whether delivery of a small for gestational age (SGA) infant in the 1st pregnancy increases the risk of early and late onset pre-eclampsia in the 2nd pregnancy. Conversely, we investigated whether pre-eclampsia in the 1st pregnancy impacts SGA risk in the 2nd pregnancy. Study design We studied a cohort from the Dutch Perinatal Registry of 265,031 women with 1st and 2nd singleton pregnancies who delivered between 2000 and 2007. We analyzed 2nd pregnancy risks of early and late onset pre-eclampsia—defined by delivery before or after 34 gestational weeks—as well as SGA below the 5th and between the 5th and 10th percentiles risks with multivariable logistic regressions. Interaction terms between 1st pregnancy hypertension, pre-eclampsia, SGA, and delivery before or after 34 gestational weeks were included in the regressions. Results First pregnancy early onset pre-eclampsia increased risk of SGA <5th percentile (OR 2.1, 95% CI 1.7–2.7) in the 2nd pregnancy. Late onset pre-eclampsia increased the SGA <5th percentile marginally (OR 1.1, 95% CI 1.0–1.3). In the absence of 1st pregnancy hypertensive disorder, women who delivered an SGA infant in their 1st pregnancy were at increased risk of 2nd pregnancy late onset pre-eclampsia (SGA <5th: OR 2.05, 95% CI 1.58–2.66; SGA 5–10th: OR 1.39, 95% CI 1.01–1.93). Early onset 2nd pregnancy pre-eclampsia risk was also increased, but this was only statistically significant for women who delivered an SGA infant below the 5th percentile in the 1st pregnancy (SGA <5th: OR 2.44, 95% CI 1.19–5.00; SGA 5–10th: OR 1.69, 95% CI 0.68–4.24;). Conclusion Women with 1st pregnancy early onset pre-eclampsia have increased risk of SGA <5th percentile in the 2nd pregnancy. SGA in the 1st pregnancy increases pre-eclampsia risk in the 2nd pregnancy even in the absence of hypertensive disorders in the 1st pregnancy, although absolute risks remain low. These findings strengthen the evidence base associating intrauterine growth restriction with early onset pre-eclampsia.

KW - Adult

KW - Age Factors

KW - Female

KW - Humans

KW - Infant, Small for Gestational Age

KW - Netherlands/epidemiology

KW - Pre-Eclampsia/epidemiology

KW - Pregnancy

KW - Prospective Studies

KW - Registries

KW - Risk Factors

KW - DIAGNOSIS

KW - HYPERTENSIVE DISORDERS

KW - FETAL-GROWTH

KW - PREVENTION

KW - BIRTH-WEIGHT

KW - LOW-DOSE ASPIRIN

KW - 1ST PREGNANCY

KW - RECURRENCE

KW - INTRAUTERINE GROWTH RESTRICTION

KW - OUTCOMES

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U2 - 10.1371/journal.pone.0230483

DO - 10.1371/journal.pone.0230483

M3 - Article

C2 - 32218582

AN - SCOPUS:85082490350

SN - 1932-6203

VL - 15

JO - PloS ONE

JF - PloS ONE

IS - 3

M1 - 0230483

ER -

Early and late onset pre-eclampsia and small for gestational age risk in subsequent pregnancies

Abstract

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Keywords

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