OBJECTIVES: Current literature suggests that early and late onset preeclampsia should be treated as distinct entities and that early onset preeclampsia shares pathophysiology aspects with intrauterine growth restriction. Our objective was to investigate whether 5th percentile small for gestational age (SGA) in a 1st pregnancy increases 2nd pregnancy risk of early and late onset preeclampsia, and vice versa.
METHODS: We studied a cohort of 1st and 2nd singleton pregnancies of 262.934 women from the Dutch Perinatal Registry who gave birth between 2000 and 2007. We analyzed 2nd pregnancy risk of SGA, early and late onset preeclampsia using logistic regression considering in each case the absence of the outcome in the first pregnancy. Gestational age, maternal age, iatrogenic preterm birth, chronic hypertension, max diastolic pressure, diabetes, ethnicity and socioeconomic status were adjusted for.
RESULTS: In women without 1st pregnancy preeclampsia, prevalences of early and late onset preeclampsia in the 2nd pregnancy were 0.05% and 0.6%, respectively. SGA in the 1st pregnancy increased these prevalences to 0.1% and 1.1%. After adjustment for confounders, 2nd pregnancy late onset preeclampsia risk was increased (aOR 1.3; 95% CI 1.1-1.6) due to SGA in the 1st pregnancy but early onset preeclampsia did not increase (aOR 1.3; 95% 0.7-2.3). In women that did not present SGA in the 1st pregnancy, SGA prevalence in term 2nd pregnancies was 3.3%. Prevalence was higher in women who presented 1st pregnancy late and early preeclampsia: 5.4% (aOR 1.6; 95% CI 1.4-1.9) and 10.2% (aOR 3.2; 95% CI 2.5-4.0), respectively.
CONCLUSIONS: In the absence of preeclampsia in the 1st pregnancy, SGA increased late but not early onset 2nd pregnancy preeclampsia risks. Second pregnancy SGA risk was increased by preeclampsia in the 1st pregnancy, especially in early onset cases.
DISCLOSURES: T.P. Bernardes: None. B.W. Mol: None. A.C. Ravelli: None. P.P. van den Berg: None. R.P. Stolk: None. H. Groen: None.