Objective
We performed an individual participant data (IPD) metaanalysis to calculate the recurrence
risk of hypertensive disorders of pregnancy (HDP) and recurrence of individual hypertensive
syndromes.
Study Design
We performed an electronic literature search for cohort studies that reported on women
experiencing HDP and who had a subsequent pregnancy. The principal investigators were
contacted and informed of our study; we requested their original study data. The data
were merged to form one combined database. The results will be presented as percentages
with 95% confidence interval (CI) and odds ratios with 95% CI.
Results
Of 94 eligible cohort studies, we obtained IPD of 22 studies, including a total of
99,415 women. Pooled data of 64 studies that used published data (IPD where available)
showed a recurrence rate of 18.1% (n = 152,213; 95% CI, 17.9–18.3%). In the 22 studies
that are included in our IPD, the recurrence rate of a HDP was 20.7% (95% CI, 20.4–20.9%).
Recurrence manifested as preeclampsia in 13.8% of the studies (95% CI,13.6–14.1%),
gestational hypertension in 8.6% of the studies (95% CI, 8.4–8.8%) and hemolysis,
elevated liver enzymes and low platelets (HELLP) syndrome in 0.2% of the studies (95%
CI, 0.16–0.25%). The delivery of a small-for-gestational-age child accompanied the
recurrent HDP in 3.4% of the studies (95% CI, 3.2–3.6%). Concomitant HELLP syndrome
or delivery of a small-for-gestational-age child increased the risk of recurrence
of HDP. Recurrence increased with decreasing gestational age at delivery in the index
pregnancy. If the HDP recurred, in general it was milder, regarding maximum diastolic
blood pressure, proteinuria, the use of oral antihypertensive and anticonvulsive medication,
the delivery of a small-for-gestational-age child, premature delivery, and perinatal
death. Normotensive women experienced chronic hypertension after pregnancy more often
after experiencing recurrence (odds ratio, 3.7; 95% CI, 2.3–6.1).
Conclusion
Among women that experience hypertension in pregnancy, the recurrence rate in a next
pregnancy is relatively low, and the course of disease is milder for most women with
recurrent disease. These reassuring data should be used for shared decision-making
in women who consider a new pregnancy after a pregnancy that was complicated by hypertension.
Key words
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Article Info
Publication History
Published online: February 05, 2015
Accepted:
January 7,
2015
Received in revised form:
November 10,
2014
Received:
June 22,
2014
Footnotes
The authors report no conflict of interest.
Cite this article as: van Oostwaard MF, Langenveld J, Schuit E, et al. Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis. Am J Obstet Gynecol 2015;212:624.e1-17.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- May 2015 (vol. 212, no. 5, page 624)American Journal of Obstetrics & GynecologyVol. 213Issue 3
