What is the probability of developing preeclampsia in a subsequent pregnancy after having it once, also known as recurrent preeclampsia (PE)?

From the Guidelines

The probability of having preeclampsia after having it once is approximately 15%. This risk is significantly higher compared to women who have had normotensive pregnancies, as noted in the 2018 study published in Hypertension 1. According to this study, women with a history of preeclampsia not only have a 15% risk of developing preeclampsia again but also a further 15% risk for gestational hypertension in a future pregnancy.

Key Points to Consider

• Women with preeclampsia should be advised about their increased risks of cardiovascular disease, death, stroke, diabetes mellitus, venous thromboembolic disease, and chronic kidney disease (CKD) compared with women who have had normotensive pregnancies, as highlighted in the study 1.
• The study recommends that women with preeclampsia receive low-dose aspirin in another pregnancy to reduce the risk of recurrence 1.
• Regular follow-up with a general practitioner to monitor blood pressure and periodic measurement of fasting lipids and blood sugar is crucial for women with a history of preeclampsia or gestational hypertension, as suggested by the 2018 guidelines 1.
• Adopting a healthy lifestyle, including maintenance of ideal weight and regular aerobic exercise, is also recommended for these women 1.

Management and Prevention

• Low-dose aspirin (starting between 12-16 weeks of pregnancy and continuing until delivery) is recommended as preventive therapy for women with a history of preeclampsia.
• Maintaining a healthy weight before pregnancy, regular prenatal care with more frequent monitoring, blood pressure checks, and urine protein screenings are additional preventive measures.
• The recurrence risk is higher for women who experienced severe preeclampsia, early-onset preeclampsia (before 34 weeks), or had complications like HELLP syndrome in their previous pregnancy, indicating the need for closer monitoring and more aggressive management in these cases.

From the Research

Preeclampsia Recurrence Risk

• The risk of recurrence of preeclampsia in a subsequent pregnancy is dependent on several factors, including gestational age at the time of disease onset, severity of disease, and presence or absence of preexisting medical disorders 2.
• Women with a history of preeclampsia are at an increased risk of preeclampsia and other adverse pregnancy outcomes in subsequent pregnancies 2, 3.
• The recurrence rate of preeclampsia can be as high as 50% in some studies, especially for women with severe features in their initial pregnancy 2.
• A study found that 55.5% of women with a history of preeclampsia developed preeclampsia again in their subsequent pregnancy, with 55.7% of these cases having severe features 3.

Factors Influencing Recurrence Risk

• The severity of preeclampsia in the initial pregnancy is a significant factor in determining the risk of recurrence 2.
• Women with preexisting medical disorders are also at a higher risk of recurrence 2.
• A study found that complications in the first pregnancy, such as preterm delivery, perinatal mortality, and gestational diabetes, are risk factors for primary preeclampsia in the second pregnancy 4.

Adverse Outcomes in Subsequent Pregnancies

• Women with a history of preeclampsia are at an increased risk of adverse pregnancy outcomes, including preterm delivery, fetal growth restriction, abruptio placentae, and fetal death, in their subsequent pregnancies 2, 5.
• A study found that women with prior preterm preeclampsia had more than doubled risks of stillbirth, placental abruption, and preterm births in their second pregnancy, even in the absence of preeclampsia 5.