P 17 Pregnancy outcomes in women with previous gestational hypertension – A cohort study to guide counselling and management

• Published in: Pregnancy hypertension 2017-07, Vol.9, p.44-45
• Main Authors: Nzelu, Diane, Dumitrascu-Biris, Dan, Hunt, Katharine, Mark, Cordina, Kametas, Nikos
• Format: Article
• Language: English
• ISSN: 2210-7789; 2210-7797
• DOI: 10.1016/j.preghy.2017.07.095

The risks of developing adverse pregnancy outcomes aside from recurrence of preeclampsia (PE), such as gestational diabetes (GDM), in women with previous gestational hypertension have not been widely reported. In addition, most existing studies include women with chronic hypertension, a significant predictor for the PE recurrence. Finally, since the revised criteria for PE published by the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2014, the impact on the reported recurrence rate of PE is unknown. In pregnant women with previous gestational hypertension, our objectives were to determine the rates of adverse pregnancy outcomes (e.g. GDM and fetal growth restriction (FGR)), to determine the impact of maternal characteristics on the risk of developing these outcomes and to compare the prevalence of PE as defined by the ISSHP-2001 and 2014 criteria. This study was carried out at the Antenatal Hypertension Clinic, Kings College Hospital, London. We identified 773 singleton pregnancies who booked between 2011–2016 with previous gestational hypertension. All women had normal renal and liver function at booking and those with chronic hypertension were excluded. Forty-nine percent developed one or more pregnancy complications. Of those with complication(s), 72% developed hypertension, 25.8% PE, 25% GDM, 2% OC and 19% FGR (Figure 1:). The overall recurrence rate of PE was 12.5% (ISSHP-2014) (Figure 2). Higher blood pressure and body mass index at booking were associated with higher risk of PE and GDM. Earlier gestation at diagnosis of hypertension in the previous pregnancy was associated with higher risk of PE and FGR. The ISSHP-2014 compared to the 2001 guidelines classified 56% more women as having PE. Pregnant women with a history of gestational hypertension have a 50% chance of developing a complication primarily related to GDM and recurrence of hypertension. The reported rate of PE was more than doubled (12.5 versus 5.4%) if the updated ISSHP-2014 definition was used.▪▪