TY - JOUR

T1 - Recurrence of hypertensive disorders of pregnancy

T2 - an individual patient data metaanalysis

AU - van Oostwaard, Miriam F

AU - Langenveld, Josje

AU - Schuit, Ewoud

AU - Papatsonis, Dimitri N M

AU - Brown, Mark A

AU - Byaruhanga, Romano N

AU - Bhattacharya, Sohinee

AU - Campbell, Doris M

AU - Chappell, Lucy C

AU - Chiaffarino, Francesca

AU - Crippa, Isabella

AU - Facchinetti, Fabio

AU - Ferrazzani, Sergio

AU - Ferrazzi, Enrico

AU - Figueiró-Filho, Ernesto A

AU - Gaugler-Senden, Ingrid P M

AU - Haavaldsen, Camilla

AU - Lykke, Jacob A

AU - Mbah, Alfred K

AU - Oliveira, Vanessa M

AU - Poston, Lucilla

AU - Redman, Christopher W G

AU - Salim, Raed

AU - Thilaganathan, Baskaran

AU - Vergani, Patrizia

AU - Zhang, Jun

AU - Steegers, Eric A P

AU - Mol, Ben Willem J

AU - Ganzevoort, Wessel

N1 - Copyright © 2015 Elsevier Inc. All rights reserved.

PY - 2015/5

Y1 - 2015/5

N2 - 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.

AB - 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.

KW - Adult

KW - Anticonvulsants

KW - Antihypertensive Agents

KW - Chronic Disease

KW - Cohort Studies

KW - Female

KW - HELLP Syndrome

KW - Humans

KW - Hypertension

KW - Hypertension, Pregnancy-Induced

KW - Infant, Newborn

KW - Infant, Small for Gestational Age

KW - Postpartum Period

KW - Pre-Eclampsia

KW - Pregnancy

KW - Premature Birth

KW - Recurrence

KW - Severity of Illness Index

KW - Young Adult

U2 - 10.1016/j.ajog.2015.01.009

DO - 10.1016/j.ajog.2015.01.009

M3 - Journal article

C2 - 25582098

VL - 212

SP - 624.e1-624.e17

JO - American Journal of Obstetrics & Gynecology

JF - American Journal of Obstetrics & Gynecology

SN - 0002-9378

IS - 5

ER -