Risk of Preeclampsia Recurrence in Subsequent Pregnancies
Women with a history of preeclampsia have approximately a 15% risk of developing preeclampsia again in a subsequent pregnancy, with an additional 15% risk of developing gestational hypertension. 1
Recurrence Risk Factors
The likelihood of recurrence varies significantly based on several factors:
Severity of previous preeclampsia: Women who had severe preeclampsia in their first pregnancy have significantly higher recurrence rates, approaching 50% in some cases 2, 3
Gestational age at onset: Early-onset preeclampsia (before 34 weeks) carries a much higher recurrence risk than late-onset disease 4
- Women with early-onset preeclampsia in their first pregnancy have a 50% chance of recurrence versus 11% for those with later onset 5
Multiple affected pregnancies: The risk increases dramatically with each affected pregnancy
- 14.7% risk in second pregnancy after one affected pregnancy
- 31.9% risk after two previously affected pregnancies 4
Preexisting medical conditions: Women with chronic hypertension, renal disease, or other medical disorders have higher recurrence rates 6
Specific Recurrence Patterns
Early-onset vs. late-onset recurrence: Early-onset preeclampsia (before 34 weeks) has a recurrence rate of approximately 6.8% compared to 0.11% in women without previous preeclampsia 4
Blood pressure patterns: Changes in mean arterial pressure (MAP) during early second trimester may predict recurrence, with smaller decreases in MAP associated with higher recurrence risk 5
Baseline risk: Women with no history of preeclampsia have only about a 1% risk of developing the condition in subsequent pregnancies 4
Associated Risks in Subsequent Pregnancies
Even without recurrent preeclampsia, women with previous preeclampsia have increased risks of:
Other pregnancy complications: Higher rates of preterm delivery, fetal growth restriction, placental abruption, and fetal death 6, 3
Long-term health implications: Increased lifetime risk of cardiovascular disease, stroke, diabetes mellitus, venous thromboembolic disease, and chronic kidney disease 1
Monitoring and Management
For women with previous preeclampsia:
Preconception counseling: Optimize maternal health before conception to reduce risk factors 6
Early and frequent prenatal care: More frequent monitoring than standard pregnancy care is recommended 3
Blood pressure monitoring: Consider home blood pressure monitoring or more frequent clinical checks 6
Fetal surveillance: Serial ultrasound evaluation of fetal growth and amniotic fluid volume, especially if previous preeclampsia was associated with fetal growth restriction 6
Preventive measures: Low-dose aspirin may be offered on an individualized basis 6
Long-term follow-up: Regular monitoring of blood pressure, fasting lipids, and blood sugar is recommended due to increased cardiovascular risk 1
In summary, while the overall recurrence risk is approximately 15%, individual risk assessment based on the specific characteristics of the previous preeclamptic pregnancy is essential for appropriate counseling and management.