Recurrence of hypertensive disorders of pregnancy in a strictly controlled multidisciplinary follow-up

Objective. In a 2015 meta-analysis by van Oostwaard of near­ly 100,000 patients with a hypertensive disorder of pregnancy (HDP) who had a subsequent pregnancy, the recurrence rate was 20.7% (95%CI 20.4-20.9). However, studies were hetero­geneous regarding timing of birth in patients with previous HDP. The aim of our study is to evaluate the prevalence and timing of onset of HDP in a small, strictly followed cohort of patients with previous HDP.
Materials and Methods. The patients were enrolled Le Mans (France) in the period 2019-2023. All patients were prescribed acetylsalicylic acid following a positive pregnancy test and were followed with a multidisciplinary obstetric-nephrolog­ical approach.
Delivery was planned if the ACOG criteria for the definition of HDP were met, otherwise a conservative approach was chosen regardless of the appearance of oedema and weight gain, or increase in sFlt-1/PlGF ratio, in the absence of hypertension.
Results. Seventy-four patients with previous HDP were fol­lowed-up and 54% of patients (40/74) developed HDP re­currence (16% PE, 29% pregnancy-induced hypertension, 1% HELLP and 8% IUGR). The median gestational age at delivery increased: in previous complicated pregnancies ‒ 33 weeks; in recurrent HDP ‒ 37 weeks, in non-complicated subsequent pregnancies ‒ 39 weeks. Of note, over 50% of recurrences oc­curred after 37 weeks.
Conclusions. The incidence of recurrence of HDP was high in this strictly followed series of pregnancies after PE; howev­er, most of the cases occurred after 37 weeks, thus raising the question whether a more aggressive approach towards early delivery may limit the risk of HDP recurrence.

Table of Content: Vol. 36 (Supplement No. 1) 2024 – Conference Proceedings

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