Reproductive outcome after early-onset pre-eclampsia

Abstract

BACKGROUNDEarly-onset pre-eclampsia is an important cause of maternal and neonatal morbidity and mortality and is believed to have a significant impact on future maternal physical and psychological health. However, structured follow-up data of women with a history of early-onset pre-eclampsia are lacking. This study aims to present comprehensive data of a large cohort of women with a history of early-onset pre-eclampsia with respect to future reproductive health, family planning and subsequent pregnancy rates.METHODSA tertiary referral cohort of 304 women entered the follow-up study at 612 months after their first delivery. Detailed data on maternal and neonatal outcomes, family planning and subsequent pregnancies were recorded. In addition, data on perspectives, major concerns and decision-making of women who had not achieved a second pregnancy were collected by questionnaire and structured interviews. Data were compared with a population of 268 low-risk primiparous women with an uncomplicated delivery.RESULTSAt a mean of 5.5 years after first delivery, 65.8 of women with a history of early-onset pre-eclampsia had achieved a second pregnancy compared with 77.6 of healthy controls. At follow-up, 19.1 of women with a history of early-onset pre-eclampsia had an active wish to become pregnant, whereas 15.1 of women did not wish to achieve a future pregnancy. In the latter group, decision-making was most commonly influenced by fear of recurrent disease (33) and fear of delivering another premature child (33) among others reasons, e.g. post-partum counseling and concerns of the partner.CONCLUSIONSThe majority of women with a history of early-onset pre-eclampsia achieve or wish to achieve a second pregnancy within a few years of their delivery. Nonetheless, first pregnancy early-onset pre-eclampsia appears to have a significant impact on future reproductive health and decision-making, emphasizing the importance of careful post-partum counseling. © 2010 The Author.