Increased Maternal Mortality Risk Associated With Recurrent Preeclampsia

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Women with at least 2 affected pregnancies had increased mortality from all causes, diabetes, ischemic heart disease, and stroke.
Women with at least 2 affected pregnancies had increased mortality from all causes, diabetes, ischemic heart disease, and stroke.

Recurrent hypertensive disease of pregnancy is associated with an increased risk for early all-cause and some cause-specific mortality, according to a study published in the American Journal of Obstetrics & Gynecology.

Lauren H. Theilen, MD, from the Department of Obstetrics and Gynecology at the University of Utah Health in Salt Lake City, and colleagues used the Utah Population Database to identify women who gave birth between 1939 and 2012. Birth certificate data were used to identify hypertensive disease of pregnancy (gestational hypertension, preeclampsia, HELLP [hemolysis, elevated liver enzymes, low platelet count] syndrome, and eclampsia) associated with each affected patient.  Pregnancies were categorized as no affected pregnancies (unexposed), 1 affected pregnancy (exposed), or at least 2 affected pregnancies (exposed).

The primary outcome was mortality, the cause of which was identified using Utah death certificates. Mortality risks by underlying cause of death were compared between exposed and unexposed women as a function of number of affected pregnancies. Cox regression was used to control for such confounders as infant sex; gestational age; and parental education, ethnicity, and marital status.

A total of 57,384 women, matched with 114,768 controls, were included in the analysis: 49,598 had 1 affected pregnancy and 7786 women had at least affected pregnancies. Affected pregnancies comprised 27,546 cases of gestational hypertension, 27,818 cases of preeclampsia, 884 cases of HELLP syndrome, and 1136 cases of eclampsia. A total of 11,894 women had died by 2016: 4722 (8.2%) exposed and 7172 (6.3%) unexposed.

Women with at least 2 affected pregnancies had increased mortality from all causes (adjusted hazard ratio [aHR], 2.04), diabetes (aHR 4.33), ischemic heart disease (aHR 3.30), and stroke (aHR 5.10). These women also had shorter life expectancies than mothers who had only 1 or 0 hypertensive pregnancies (48.92 vs 51.91 vs 55.48 years, respectively).

“We found that recurrent hypertensive disease of pregnancy is associated with increased risks for early all-cause and some cause-specific mortality,” the authors concluded. “This association is significant for deaths occurring at age ≤50 years.”

References

Theilen LH, Meeks H, Fraser A, Esplin MS, Smith KR, Varner MW. Long-term mortality risk and life expectancy following recurrent hypertensive disease of pregnancy [published online April 7, 2018]. Am J Obstet Gynecol. doi: 10.1016/j.ajog.2018.04.002

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