Can we predict recurrence of pre‐eclampsia or gestational hypertension?

Objective  To estimate the rates of recurrence of pre‐eclampsia or gestational hypertension in a subsequent pregnancy and to determine factors predictive of recurrence. Design  Retrospective cohort study. Setting  St George Public and Private Hospitals, teaching hospitals without neonatal intensive care units. Participants  A total of 1515 women with a diagnosis of pre‐eclampsia or gestational hypertension between 1988 and 1998 were identified from the St George Hypertension in Pregnancy database, a system designed initially for ensuring quality outcomes of hypertensive pregnancies. Of these, 1354 women were followed up, and a further 333 records from women coded as having a normal pregnancy during that period were selected randomly as controls. Main outcome measures  Likelihood of recurrent pre‐eclampsia or gestational hypertension and clinical and routine laboratory factors in the index pregnancy predictive of recurrence of pre‐eclampsia or gestational hypertension. Methods  The index cases from our unit’s database were linked to the matched pregnancy on the State Department of Health database, allowing us to determine whether further pregnancies had occurred at any hospital in the State. The outcome of these pregnancies was determined by review of medical records, using strict criteria for diagnosis of pre‐eclampsia or gestational hypertension. Results  Almost all women with a normal index pregnancy had a further normotensive pregnancy. One in 50 women hypertensive in their index pregnancy had developed essential hypertension by the time of their next pregnancy. Women with pre‐eclampsia in their index pregnancy were equally likely to develop either pre‐eclampsia or gestational hypertension (approximately 14% each), while women with gestational hypertension were more likely to develop gestational hypertension (26%) rather than pre‐eclampsia (6%) in their next pregnancy. Multiparous women with gestational hypertension were more likely than primiparous women to develop pre‐eclampsia (11 versus 4%) or gestational hypertension (45 versus 22%) in their next pregnancy. Early gestation at diagnosis in the index pregnancy, multiparity, uric acid levels in the index pregnancy and booking blood pressure parameters in the next pregnancy significantly influenced the likelihood of recurrence, predominantly for gestational hypertension and less so for pre‐eclampsia. No value for these parameters was significant enough to be clinically useful as a discriminate value predictive of recurrent pre‐eclampsia or gestational hypertension. Conclusions  Approximately 70% of women with pre‐eclampsia or gestational hypertension will have a normotensive next pregnancy. The highest risk group for recurrent hypertension in pregnancy in this study was multiparous women with gestational hypertension. No readily available clinical or laboratory factor in the index pregnancy reliably predicts recurrence of pre‐eclampsia.