Preeclampsia: What Could Happen in a Subsequent Pregnancy?

Importance Preeclampsia is the most common type of the hypertensive disorders of pregnancy, affecting nearly 5% of pregnant women. The risk of recurrence influences the choices of parents regarding subsequent pregnancies and necessitates the counseling of obstetricians. Objective To review the risk of recurrence of hypertensive disorders in a subsequent pregnancy. Evidence Acquisition Women with a history of preeclampsia are at an increased risk of preeclampsia and other adverse pregnancy outcomes in subsequent pregnancies. The magnitude of this risk is dependent on gestational age at the time of disease onset, severity of disease, and presence or absence of preexisting medical disorders. Results For preeclamptic women with severe features in an initial pregnancy, recurrence rates for any type of preeclampsia are very high, approaching 50% in some studies. Significant maternal and fetal complications are more common in recurrent preeclampsia compared with an initial episode. Because women with previous preeclampsia are at an increased risk for adverse pregnancy outcomes (preterm delivery, fetal growth restriction, abruptio placentae, and fetal death) in subsequent pregnancies, we recommend more frequent monitoring for signs and symptoms of severe hypertension or preeclampsia than that recommended for normal pregnancy. Conclusions The best option is to review the existing literature with patients, allow them to make informed decisions, and provide them the best available prenatal care. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completing this CME activity, physicians should be better able to assess the overall risk of preeclampsia recurrence in a subsequent pregnancy, evaluate the personal risk factors for recurrence of preeclampsia, explain the obstetric risk factors for recurrence of preeclampsia, and assist patients in decision for a future pregnancy.