Is a history of preeclampsia associated with an increased risk of a small for gestational age infant in a future pregnancy?

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Abstract

BACKGROUND:

A history of preeclampsia is associated with an increased risk of subsequent preeclampsia, but it is unclear whether women with prior preeclampsia are at increased risk of having a small-for-gestational-age infant in their subsequent pregnancy, even if they do not develop preeclampsia.

OBJECTIVE:

The objective of this study was to evaluate whether women with preeclampsia in a prior pregnancy are at increased risk of having a pregnancy complicated by a small-for-gestational-age infant, even in the absence of recurrent preeclampsia.

STUDY DESIGN:

This was a secondary analysis of data from 2 multicenter, randomized controlled trials evaluating the role of aspirin in preeclampsia prevention in healthy nulliparas and women at high risk of preeclampsia (ie, with chronic hypertension or a history of preeclampsia). Women who developed preeclampsia in a subsequent pregnancy and women with pregestational diabetes or with a multiple gestation were excluded. The association between a history of preeclampsia and the subsequent birth of a small-for-gestational-age infant was determined in both a univariable and multivariable analysis.

RESULTS:

A total of 4052 women were included in the analysis: 2972 healthy nulliparas, 499 women with a history of preeclampsia, and 581 women with chronic hypertension. The frequency of delivery of a small-for-gestational-age infant significantly differed by clinical history (5.1% vs 9.2% vs 12.1% in healthy nulliparas, women with a history of preeclampsia, and women with chronic hypertension, respectively, P < .001). Compared with healthy nulliparas, a history of preeclampsia was associated with a significantly increased odds for a small-for-gestational-age infant, even if recurrent preeclampsia did not occur (adjusted odds ratio, 1.48, 95% confidence interval, 1.02–2.17).

CONCLUSION:

Even in the absence of recurrent preeclampsia, women with a history of preeclampsia are at a higher risk of delivering a small-for-gestational-age infant in a subsequent pregnancy.

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