Outcomes of subsequent pregnancy after ﬁrst pregnancy
with early-onset preeclampsia
Bas B. van Rijn, MD,
Lette B. Hoeks, MD,
Michiel L. Bots, MD, PhD,
Arie Franx, MD, PhD,
Hein W. Bruinse, MD, PhD
Division of Perinatology and Gynecology,
Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, The Netherlands; Department of Obstetrics and Gynecology,
St Elisabeth Hospital,
Tilburg, The Netherlands
Received for publication March 15, 2006; revised June 6, 2006; accepted June 10, 2006
Objective: The aim of this study was to report outcome of subsequent pregnancy after early-onset
preeclampsia in first pregnancy, and to evaluate potential risk factors for recurrence of pre-
eclampsia and preterm delivery.
Study design: Reproductive follow-up data were obtained for women with a history of early-
onset preeclampsia, resulting in delivery before 34 weeks of gestation at the University Medical
Center Utrecht, The Netherlands, between July 1993 and September 2002. The relative contribu-
tions of demographic data, outcome variables of first pregnancy, and common thrombophilias to
the recurrence risk of preeclampsia and preterm delivery in subsequent pregnancy, were estimated
by Cox proportional hazard models.
Results: Subsequent pregnancy outcome data were available for 120 women. Overall, preeclamp-
sia reoccurred in the second pregnancy in 30 women (25%). However, 6 women delivered before
34 weeks of gestation (5%), 20 women between 34 and 37 weeks of gestation (17%), and 94
women after 37 weeks of gestation (78%). Forty-one women (34%) had an uneventful preg-
nancy. Recurrence rates for preeclampsia or preterm delivery were not related to severity of
first pregnancy complications, including delivery before 28 weeks of gestation, occurrence of
hemolysis, elevated liver enzymes, and low platelet count syndrome, small-for-gestational age
infants, and to hereditary or acquired thrombophilias. Chronic hypertension was related to
a higher recurrence risk of preeclampsia in the second pregnancy (hazard ratio 2.1, 95% CI
1.0-4.4), and smoking was related to a higher recurrence risk of preterm birth (hazard ratio
2.4, 95% CI 1.1-5.6).
Conclusion: Outcomes of subsequent pregnancy after first pregnancy with early-onset
preeclampsia is generally favorable.
Ó 2006 Mosby, Inc. All rights reserved.
Presented at the 26th Annual Meeting of the Society for Maternal Fetal Medicine, January 30-February 4, 2006, Miami, FL.
Reprints not available from the authors.
0002-9378/$ - see front matter Ó 2006 Mosby, Inc. All rights reserved.
American Journal of Obstetrics and Gynecology (2006) 195, 723–8