Is a second pre-eclampsia more dangerous than the first event?

A second pre-eclampsia does not lead to worse outcomes relative to the first occurrence, suggests a study. On the contrary, some clinical features and effects appear to be better in the second event.

Three teaching hospitals in Guangzhou, China, with a total of 296,405 deliveries between 2010 and 2021 participated in this retrospective longitudinal cohort study. The analysis included two consecutive singleton deliveries complicated with pre-eclampsia.

The researchers obtained the clinical features, laboratory results within 1 week before delivery, and maternal and neonatal outcomes of both deliveries. They conducted univariate analyses using paired Wilcoxon tests and McNemar tests, and multivariable logistic regression and generalized linear models to explore the relationship of adverse maternal and neonatal outcomes with second pre-eclampsia.

The final analysis included 151 women (mean maternal age 28 and 33 years for the first and second deliveries, respectively). The corresponding proportion of preventive acetylsalicylic acid use was 4.6 percent and 15.2 percent for the first and second deliveries.

Differences in blood pressure of admission, gestational weeks of admission and delivery, application of perinatal antihypertensive agents, rates of preterm delivery, and severe features did not differ significantly between the first and second pre-eclampsia.

However, the second occurrence showed lower rates of heart disease, oedema, and intensive care unit (ICU) admission, as well as shorter hospital stays than the first pre-eclampsia.

Similar results were observed in sensitivity analysis involving women who did not use preventive acetylsalicylic acid.

After adjustments for confounders, second pre-eclampsia significantly correlated with lower risks of heart disease, oedema, complications, and admission to the neonatal ICU, with odds ratios ranging from 0.157 to 0.336.