Voorspelling van het herhalingsrisico op hypertensieve complicaties van de zwangerschap

Abstract

Introduction: Hypertensive disorders of pregnancy (gestational hypertension, pre-eclampsia, and the HELLP syndrome) are a common complication of pregnancy, with a high recurrence risk when they lead to preterm delivery. The recurrence risk for these disorders at term is still unclear. The primary aim of the study was to asses the risk of recurrence for women with a hypertensive disorders and a term delivery. The secondary aim of the study was to identify independent risk factors using a prediction model. We also tested the risk of developing chronic hypertension for this group of women. Methods: We performed a retrospective cohort study at the Academic Medical Centre (AMC) in Amsterdam. All patients with hypertensive disorders, who delivered after 37 weeks of gestation between January 2000 and December 2002, were included. The only exclusion criterion was a pregnancy with fetal abnormalities. Data were primarily extracted from medical files. We tried to contact all women to complete data. Moreover we assessed whether age, Body Mass Index, chronic hypertension, changed paternity, being nulliparous, maximum diastolic blood pressure or the clinical syndrome in the index pregnancy were predictive for adverse outcome. Results: In total 261 women were included. Of these women 78 (30%) were lost to follow-up, 74 (28%) refrained from having a subsequent pregnancy and 111 (43%) did have a subsequent pregnancy. Women who conceived again were in comparison 5 years younger and encompassed fewer caucasians, more nulliparous and had had gestational hypertension less often. Hypertensive disease recurred in 44 (40%) of 111 women with a subsequent pregnancy. Of the known 148 previously normotensive women, 41 (28%) eventually developed chronic hypertension later in life with a median follow-up of 11.3 years. After correction with multivariate regression analysis, no independent risk factors were available to create a prediction model.