Risks of hypertensive disorders in the second pregnancy

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Abstract
Objective: To examine the incidence of and risk factors for recurrent and newly developed hypertensive disorders in the second pregnancy; and to determine if hypertension in the first pregnancy is associated with adverse perinatal outcomes in the second pregnancy. Methods: We analyzed data on 1,641 women who had both the first and second births recorded in the Collaborative Perinatal Project, a large prospective cohort study at 12 U.S. hospitals that collected extensive prenatal and perinatal information. Incidence of and risk factors for hypertension in the second pregnancy were computed according to hypertensive status in the first pregnancy. Birth weight and gestational age at delivery of the second birth were examined by hypertensive status of the first and second pregnancies. Results: Nineteen percent (95% CI 14–24%) of women who had gestational hypertension in the first pregnancy, 32% (95% CI 17–48%) of those with preeclampsia, and 46% (95% CI 32–60%) of patients with gestational hypertension or preeclampsia superimposed on chronic hypertension had recurrent hypertensive disorders in the second pregnancy. The earlier the onset of hypertension in the first pregnancy, the higher the overall recurrence rate. Seventy-six percent of recurrent cases had mild hypertension, which did not affect perinatal outcomes in the second pregnancy. However, patients with a history of hypertension in the first pregnancy and severe hypertension in the second pregnancy had a sixfold increased risk of very premature birth (P <0.05). Conclusions: Hypertensive disorders have a 20–50% recurrence rate in the second pregnancy. Most recurrent cases are mild and do not have adverse effects on perinatal outcomes.

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