Introduction:
Preeclampsia (PE) and hypertensive disorders of pregnancy (HDPs) complicate up to 10% of pregnancies. The risk of developing kidney failure is increased by 4-8 times after one episode of PE and over 15 times in case of 2 or more episodes. The risk of recurrence is high, but estimates vary between 15 and 50%. After PE, a nephrology control is advocated by some experts, but few dedicated programs exist. Aim of this study easy to assess the recurrence rate in the setting of a pilot experience of obstetric-nephrology follow-up of pregnancy following one or more PE episodes.
Methods:
Prospective study on pregnancies followed-up between March 2018 and February 2024 in women who had previously experienced a PE episode: from 108 pregnancies, we excluded 3 twin pregnancies, 14 miscarriages-terminations, 1 patient with a consultation only and 10 ongoing pregnancies. The main outcomes were PE recurrence and time to delivery. Time to event (delivery) was analyzed according to Kaplan Meier curves; multivariable regression and Cox analysis were performed (outcome: PE; variables: age, ethnicity, BMI, hypertension, presence of chronic kidney disease (CKD), week of delivery and baby’s centile in the previous pregnancy).
Results:
In the context of a high prevalence of previous early preterm delivery (median 35GW), and severe PE (7 intrauterine deaths), 42.9% of the 77 singleton pregnancies in our cohort experienced PE recurrence, 19.5% had other complications and only 37.7% had an uneventful pregnancy. Recurrences occurred after the 37th gestational week (GW) in 60.6% of cases, allowing for later delivery (median: 38 GW versus 35 GW). The covariates associated with PE recurrence were chronic hypertension (OR 7.662, 95%CI 2.122- 33.379) and having had a baby with a centile <10th (OR 7.049, 95%CI 1.56-41.027), while those associated with time to delivery were hypertension and maternal age (HR 2.103, 95%CI 1.218-3.629 and 1.086, 95%CI 1.025-1.150, respectively). Having been diagnosed with CKD after the previous PE episode or during the new pregnancy was not associated with a significantly increased recurrence risk.
Conclusions:
In this study cohort, the risk of PE recurrence was high but delayed compared to the previous episode, mostly at term of the 37th weeks. The question if a proactive approach towards delivery, once 37 GW is reached, may help preserving long-term maternal kidney health is open.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.