Risk Factors for Early- and Late-Onset Superimposed Preeclampsia

Abstract

Objective Risk factors of early- and late-onset preeclampsia among pregnant individuals with chronic hypertension are not well described in the literature. We hypothesized that early- and late-onset superimposed preeclampsia (SIPE) have different risk factors. Therefore, we aimed to examine the risk factors of early- and late-onset SIPE among individuals with chronic hypertension.

Study Design This was a retrospective case-control study of pregnant individuals with chronic hypertension who delivered at 22 weeks' gestation or greater at an academic institution. Early-onset SIPE was defined as SIPE diagnosed before 34 weeks' gestation. To identify risk factors, we compared individuals' characteristics between individuals who developed early- and late-onset SIPE and those who did not. We then compared characteristics between individuals who developed early-onset SIPE and late-onset SIPE. Characteristics with p-values of less than 0.05 by bivariable variables were analyzed by simple and multivariable logistic regression models to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Missing values were imputed with multiple imputation.

Results Of 839 individuals, 156 (18.6%) had early-onset, 154 (18.4%) had late-onset SIPE and 529 (63.1%) did not have SIPE. The multivariate logistic regression model showed that serum creatinine ≥ 0.7 mg/dL compared to less than 0.7 mg/dL (aOR: 2.89 [95% CI: 1.63–5.13]), increase of creatinine (1.33 [1.16–1.53]), nulliparity compared to multiparity (1.77 [1.21–2.60]), and pregestational diabetes (1.70 [1.11–2.62]) were risk factors for early-onset SIPE. The multivariate logistic regression model showed that nulliparity compared to multiparity (1.53 [1.05–2.22]) and pregestational diabetes (1.74 [1.14–2.64]) was a risk factor for late-onset SIPE. Serum creatinine ≥ 0.7 mg/dL (2.90 [1.36–6.15]) and increase of creatinine (1.33 [1.10–1.60]) were significantly associated with early-onset SIPE compared to late-onset SIPE.

Conclusion Kidney dysfunction seemed to be associated with the pathophysiology of early-onset SIPE. Nulliparity and pregestational diabetes were common risk factors for both early- and late-onset SIPE.

Key Points

• Serum creatinine level was positively associated with early-onset superimposed preeclampsia (SIPE).

• Pregestational diabetes and nulliparity were associated with both early- and late-onset SIPE.

• The identification of risk factors may provide an opportunity to decrease the rates of SIPE.

Keywords

chronic hypertension - creatinine - nulliparous - pregestational diabetes - pregnancy

Publikationsverlauf

Eingereicht: 10. November 2022

Angenommen: 19. Mai 2023

Accepted Manuscript online:
21. Mai 2023

Artikel online veröffentlicht:
19. Juni 2023

• References

• 1 Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghan WM, Kuklina EV. Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol 2012; 206 (02) 134.e1-134.e8
• 2 Sibai BM, Lindheimer M, Hauth J. et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. N Engl J Med 1998; 339 (10) 667-671
• 3 Ferrer RL, Sibai BM, Mulrow CD, Chiquette E, Stevens KR, Cornell J. Management of mild chronic hypertension during pregnancy: a review. Obstet Gynecol 2000; 96 (5 Pt 2): 849-860
• 4 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 203: chronic hypertension in pregnancy. Obstet Gynecol 2019; 133 (01) e26-e50
• 5 Chappell LC, Enye S, Seed P, Briley AL, Poston L, Shennan AH. Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: a prospective study. Hypertension 2008; 51 (04) 1002-1009
• 6 Wertaschnigg D, Selvaratnam RJ, Rolnik DL. et al. Hypertensive disorders in pregnancy—trends over eight years: a population-based cohort study. Pregnancy Hypertens 2022; 28: 60-65
• 7 Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am J Obstet Gynecol 2013; 209 (06) 544.e1-544.e12
• 8 Weitzner O, Yagur Y, Weissbach T, Man El G, Biron-Shental T. Preeclampsia: risk factors and neonatal outcomes associated with early- versus late-onset diseases. J Matern Fetal Neonatal Med 2020; 33 (05) 780-784
• 9 Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ 2019; 366: l2381
• 10 Roberts JM, Rich-Edwards JW, McElrath TF, Garmire L, Myatt L. Global Pregnancy Collaboration. Subtypes of preeclampsia: recognition and determining clinical usefulness. Hypertension 2021; 77 (05) 1430-1441
• 11 Shakhmatova EI, Osipova NA, Natochin YV. Changes in osmolality and blood serum ion concentrations in pregnancy. Hum Physiol 2000; 26 (01) 92-95
• 12 Hoffman BL, Horsager R, Roberts SW, Rogers VL, Santiago-Muñoz PC, Worley KC. Williams Obstetrics 23rd Edition Study Guide. McGraw-Hill Education; 2011
• 13 Enders CK. Applied Missing Data Analysis. Applied Missing Data Analysis. Guilford Press; 2010. :xv, 377-xv, 377
• 14 Rubin DB. Multiple Imputation for Nonresponse in Surveys. vol 81. John Wiley & Sons; 2004
• 15 D'Anna R, Baviera G, Corrado F. et al. Adiponectin and insulin resistance in early- and late-onset pre-eclampsia. BJOG 2006; 113 (11) 1264-1269
• 16 Durst JK, Tuuli MG, Stout MJ, Macones GA, Cahill AG. Degree of obesity at delivery and risk of preeclampsia with severe features. Am J Obstet Gynecol 2016; 214 (05) 651.e1-651.e5
• 17 Webster LM, Gill C, Seed PT. et al. Chronic hypertension in pregnancy: impact of ethnicity and superimposed preeclampsia on placental, endothelial, and renal biomarkers. Am J Physiol Regul Integr Comp Physiol 2018; 315 (01) R36-R47
• 18 Morgan JL, Nelson DB, Roberts SW, Wells CE, McIntire DD, Cunningham FG. Association of baseline proteinuria and adverse outcomes in pregnant women with treated chronic hypertension. Obstet Gynecol 2016; 128 (02) 270-276
• 19 Lecarpentier E, Tsatsaris V, Goffinet F, Cabrol D, Sibai B, Haddad B. Risk factors of superimposed preeclampsia in women with essential chronic hypertension treated before pregnancy. PLoS One 2013; 8 (05) e62140
• 20 Kuper SG, Tita AT, Youngstrom ML. et al. Baseline renal function tests and adverse outcomes in pregnant patients with chronic hypertension. Obstet Gynecol 2016; 128 (01) 93-103
• 21 Kawakita T, Seagraves E, Baraki D, Donaldson T, Barake C, Abuhamad A. Assessment of baseline renal function tests to predict adverse outcomes in women with chronic hypertension. Am J Obstet Gynecol 2023; 228 (01) 95-97.e3
• 22 Holmes VA, Young IS, Patterson CC. et al; Diabetes and Pre-eclampsia Intervention Trial Study Group. Optimal glycemic control, pre-eclampsia, and gestational hypertension in women with type 1 diabetes in the diabetes and pre-eclampsia intervention trial. Diabetes Care 2011; 34 (08) 1683-1688
• 23 Wang M, Chen S, He Y, Zhao M, Yang H, Chen Q. Low-dose aspirin for the prevention of severe preeclampsia in patients with chronic kidney disease: a retrospective study: this is the study for kidney and pregnancy. J Nephrol 2021; 34 (05) 1631-1639
• 24 Hui D, Hladunewich MA. Chronic kidney disease and pregnancy. Obstet Gynecol 2019; 133 (06) 1182-1194
• 25 Tita AT, Szychowski JM, Boggess K. et al; Chronic Hypertension and Pregnancy (CHAP) Trial Consortium. Treatment for mild chronic hypertension during pregnancy. N Engl J Med 2022; 386 (19) 1781-1792
• 26 Perni U, Sison C, Sharma V. et al. Angiogenic factors in superimposed preeclampsia: a longitudinal study of women with chronic hypertension during pregnancy. Hypertension 2012; 59 (03) 740-746
• 27 Hussain A, Karovitch A, Carson MP. Blood pressure goals and treatment in pregnant patients with chronic kidney disease. Adv Chronic Kidney Dis 2015; 22 (02) 165-169
• 28 Wiles K, Chappell L, Clark K. et al. Clinical practice guideline on pregnancy and renal disease. BMC Nephrol 2019; 20 (01) 401
• 29 Wright D, Nicolaides KH. Aspirin delays the development of preeclampsia. Am J Obstet Gynecol 2019; 220 (06) 580.e1-580.e6