Women with a history of preeclampsia are at increased
risk for the development of recurrent disease. The overall
recurrence rate has been reported to be as high as 40%,
which is ~3 to 6 times the rate reported for nulliparous
In addition, women who experience pre-
eclampsia in the second trimester have a 65% rate of the
disease in a subsequent pregnancy.
Women who experience preeclampsia are at risk for
adverse outcomes. The rate of adverse outcomes is de-
pendent on the severity of the disease as well as the gesta-
tional age at the time of disease onset and at delivery.
Previous studies have compared the severity and timing
of preeclampsia to perinatal outcome. In general, women
with preeclampsia that occurs at <37 weeks of gestation
have worse perinatal outcomes than those who have pre-
eclampsia at term.
The rates of perinatal mortality, fetal
growth restriction, and abruptio placentae are usually in-
creased when preeclampsia develops preterm. In con-
trast, women who experience mild preeclampsia at term
have similar outcomes to those who remain normoten-
From the Department of Obstetrics and Gynecology, University of Cincin-
Supported by grants HD19897, HD21410, HD21414, HD21434,
HD27860, HD27861, HD27869, HD27883, HD27889, HD27905,
HD27915, and HD27917 from the National Institute for Child Health
and Human Development.
Presented at the Twenty-first Annual Meeting of the Society for Maternal-
Fetal Medicine, Reno, Nev, February 5-10, 2001.
*A complete list of members of the Network and their institutional affili-
ations appears at the end of the article.
Received for publication April 13, 2001; revised June 81, 2001; ac-
cepted September 12, 2001.
Reprint requests: Baha M. Sibai, MD, University of Cincinnati Medical
Center, PO Box 670526, Cincinnati, OH 45267-0526.
Copyright 2002, Mosby, Inc. All rights reserved.
0022-9378/2002 $35.00 + 0 6/1/120280
Perinatal outcome in women with recurrent preeclampsia
compared with women who develop preeclampsia as nulliparas
Michael D. Hnat, DO, Baha M. Sibai, MD, Steve Caritis, MD, John Hauth, MD,
Marshall D. Lindheimer, MD, PhD, Cora MacPherson, PhD, J. Peter VanDorsten, MD,
Mark Landon, MD, Menachem Miodovnik, MD, Richard Paul, MD, Paul Meis, MD,
Gary Thurnau, MD, and Mitchell Dombrowski, MD, for the National Institute of Child Health and
Human Development Network of Maternal-Fetal Medicine Units*
OBJECTIVE: To compare the rates and perinatal outcome in women who experienced preeclampsia in a
previous pregnancy to those in women who developed preeclampsia as nulliparas.
STUDY DESIGN: This is a secondary analysis of data from 2 separate multi-center trials of aspirin for pre-
vention of preeclampsia.Women who had preeclampsia in a previous pregnancy (n = 598) were compared
with nulliparous women (n = 2934). Outcome variables were rates of preeclampsia, preterm delivery at <37
and <35 weeks of gestation, small-for-gestational-age infant, abruptio placentae, and perinatal death. Data
were compared by using chi-square analysis and Wilcoxon rank sum test.
RESULTS: The rates of preeclampsia and of severe preeclampsia were significantly higher in the previous
preeclamptic group as compared to the nulliparous group (17.9% vs 5.3%, P < .0001, and 7.5% vs. 2.4%,
P < .0001, respectively).Women who had recurrent preeclampsia experienced more preterm deliveries be-
fore 37 and 35 weeks of gestation than nulliparous women who developed preeclampsia.In addition, among
women who developed severe preeclampsia, those with recurrent preeclampsia had higher rates of preterm
delivery both before 37 weeks (67% vs 33%, P = .0004) and before 35 weeks of gestation (36% vs 19%,
P = .041), and higher rates of abruptio placentae (6.7% vs 1.5%) and fetal death (6.7% vs 1.4%) than did
CONCLUSION: Compared to nulliparous women, women with preeclampsia in a previous pregnancy had
significantly higher rates of preeclampsia and adverse perinatal outcomes associated with preterm delivery
as a result of preeclampsia. (Am J Obstet Gynecol 2002;186:422-6.)
Key words: Preeclampsia, recurrence, perinatal outcome