Superimposed pre-eclampsia (SPE) is resolved only with the termination of the pregnancy. Therefore, the risk prediction and prevention is very important. We aimed to evaluate the characteristics of patients who develop SPE and their controllable risk factors during mid-trimester.Design and Method:
A total of 283 pregnant women with chronic hypertension were included for the study. Blood pressure (BP) and body weight were recorded at 10, 20, 24, 28, and 32 weeks of gestation and pregnancy outcomes were evaluated.Results:
75 women finally developed SPE. There were no significant differences of maternal age, obesity, body weight before the pregnancy, and the prevalence of multiple pregnancy between patients with and without SPE. BPs were not different by the development of SPE before 20 weeks of gestation, however those who developed SPE showed significantly higher systolic and diastolic BP compared to those who did not after 24 weeks of gestation (at 24 weeks, SBP 132.9 ± 11.5 mmHg vs 140.0 ± 17.1 mmHg, p < 0.001; DBP 82.6 ± 9.5 mmHg vs 86.9 ± 12.7 mmHg, p = 0.005). SBP at 24 weeks predicted SPE with the area under the curve (AUC) of 0.622 by receiver operating characteristic curve. Body weight was not significantly different throughout pregnancy, however, patients who developed SPE showed greater weight gain during mid-trimester (4.9 ± 2.6 kg vs 5.9 ± 2.2 kg, p = 0.014) and predicted SPE with the AUC of 0. 610. Patients with SPE showed more frequent preterm labor (p < 0.001), intrauterine growth restriction (p < 0.001) and lower birth weight (p < 0.001).Conclusions:
SPE was more prevalent in women with higher BP at 24 weeks and greater weight gain during mid-trimester. More intensive monitoring of patients with higher BP and proper body weight control during mid-trimester may improve the prognosis of the pregnancy by decreasing the development of SPE.